Is it a potentially dangerous opioid that needs to be tightly regulated, as the U.S. Food and Drug Administration has argued in recent months?
Or is it a misunderstood natural product that provides people in pain an alternative to opioids, a point of view asserted by a number of scientists who’ve studied kratom?
Disagreement centers largely upon the herb’s ability to activate opioid receptors in the brain, experts say.
The FDA claims kratom is an opioid based on computer analysis showing that its most prevalent compounds activate receptors in the brain that also respond to heroin, morphine, oxycodone and other opioids.
This data “shows us that kratom compounds are predicted to affect the body just like opioids,” FDA Commissioner Dr. Scott Gottlieb said in a February statement declaring the herb an opioid.
But just because kratom activates opioid receptors does not mean that the herb is as powerful or addictive as heroin or oxycodone, researchers argue.
“There are lots of plant-based substances that work on opioid receptors,” said Marc Swogger, an associate professor of psychiatry with the University of Rochester Medical Center, in New York, who has studied kratom.
Kratom grows naturally in the Southeast Asian countries of Thailand, Malaysia, Indonesia and Papua New Guinea. It has been sold as a dietary supplement, typically to help manage pain and boost energy. Some people also tout its ability to help opioid addicts wean themselves off drugs.
But concerns over kratom’s harmful effects have led the FDA to focus regulatory efforts on the product.
In the weeks after Gottlieb’s declaration, the FDA linked kratom-containing dietary supplements to 28 cases of salmonella poisoning and stepped up pressure on supplement companies to take all kratom products off the market.
But some scientists believe the FDA is going off half-cocked, and that more research is necessary to figure out kratom’s risks and benefits.
There’s no doubt that kratom’s major compounds bind with opioid receptors, said Swogger and Scott Hemby, chair of basic pharmaceutical sciences at High Point University in North Carolina. That much was known even before the FDA’s computer analysis.