Statewide bans of kratom, an herbal compound which can cause opioid-like addiction, now loom as legislators in Connecticut and Massachusetts recently introduced laws to classify it as a “schedule one” controlled substance. It’s common on convenience store shelves, but the drug has, so far, been unregulated.
“Schedule one” controlled substances, according to the Connecticut Department of Consumer Protection, are “drugs with a high abuse risk [that] have NO safe, accepted medical use,” such as heroin, LSD and ecstasy.
The new law in Connecticut re-scheduling kratom was introduced in 2023, reviewed earlier this summer and enacted in October. Massachusetts referred a similar regulation to their public health agency in February, which was approved earlier this week.
Often marketed as a “mood-enhancing supplement,” kratom is derived from the leaves of the Southeast Asian tree Mitragyna speciosa. The plant’s primary compounds, mitragynine and 7‑hydroxymitragynine (7‑OH), interact with receptors in the brain. Although 7-OH is naturally a small part of kratom, synthetic formulas can be more potent than morphine in much of the product for sale, according to the FDA.
“One of the risks associated with kratom use is that products can differ dramatically in the doses of 7-OH,” said Dr. C Michael White, the department head of pharmacy practice at the University of Connecticut School of Pharmacy. “In other words, one kratom product could be more dangerous than another… Since kratom products are not FDA-regulated, there is no uniformity to the products.”
The FDA has warned people not to use kratom due to risks of seizures, liver toxicity and addiction disorders. They also say that numerous deaths have been associated with kratom use.
“Recently, there has been a concerning proliferation of concentrated 7-OH products that are sold over the counter and online… The pharmacological profile, abuse liability, and emerging patterns of non-medical use establish 7-OH as a dangerous substance,” an FDA report on 7-OH and kratom states. “Current regulatory gaps have enabled widespread availability of these products despite their opioid-like properties and necessitate immediate policy intervention to address this emerging threat to American public health.”
In July, the FDA called for 7-OH to be classified as a “schedule one” controlled substance federally.
“Vape stores are popping up in every neighborhood in America, and many are selling addictive products like concentrated 7-OH. After the last wave of the opioid epidemic, we cannot get caught flat-footed again,” said FDA Commissioner Marty Makary in a statement. “7-OH is an opioid that can be more potent than morphine. We need regulation and public education to prevent another wave of the opioid epidemic.”
The FDA also notes in its report that the use of kratom and related substances is still not lawful when added to conventional foods as dietary supplements, or as ingredients in any FDA-approved drug, “and yet, these substances are still sold in various markets.”
While some people report that kratom can be used as a pain reliever or as a drug to help treat opioid use disorders, White says that there are no clinical trials which have yet conclusively supported those use cases.
“If patients have access to traditional FDA-approved therapies [for pain relief or to help treat opioid use disorders], these are the safest and best place to start,” he said.
As of 2023, kratom has been banned in seven other states, and the U.S. Drug Enforcement Administration (DEA) has listed it as a “drug of concern.” According to the DEA, kratom is also called “thang, kakuam, thom, ketum and biak.”
A 2023 survey from the Substance Abuse and Mental Health Services Administration estimated that about 1.6 million Americans aged 12 and older used kratom in the year before the study.
White has led research on kratom and related substances for years at UConn, and helped found the Kratom Consumer Advisory Council (KCAC), an organization to promote scientific understanding and engage with policymakers on issues related to kratom.
“By sharing and discussing the evidence, we can ensure that everyone has the same platform of knowledge,” White shared as part of his chairman’s address for KCAC. “Together, we will look for ways to maximize kratom’s potential benefits and minimize the chances of harm for consumers.”