In his State of the Union address, President Trump expressed support for a Right to Try law that would allow terminally-ill patients to test medicines not yet fully vetted by the FDA. This perspective recognizes the trade off between benefits and risks.
The administration is singing a different tune, however, regarding kratom, a medicinal herb grown in East Asia that might help Americans who suffer from chronic pain and do not wish to, or cannot, rely on opioids.
The FDA recently announced that it is considering a ban on kratom and is working to prevent shipments to the United States. This announcement comes on the heels of the DEA’s attempted ban in 2016, which caused a public and Congressional backlash, forcing the DEA to back down.
Kratom, which appears to target opioid receptors in the brain, is used by many chronic pain sufferers. The FDA correctly notes that existing evidence is not conclusive on kratom’s efficacy, but numerous studies and a wealth of anecdotal evidence suggest kratom relieves pain with modest risks.
Kratom is also used to reduce opioid addiction. The FDA also doubts about its effectiveness in this area, but again several studies support its value in easing withdrawal.
Doubts about effectiveness aside, the prima facie reasoning behind the FDA’s crackdown can be found in a press release from November 14, 2017, in which Commissioner Scott Gottlieb attributes 36 deaths to kratom. A recent study, however, found no evidence that kratom alone causes death.
And even if kratom can be dangerous, banning it violates the administration’s defense of Right to Try laws: potentially dangerous medicines are nevertheless valuable if their expected benefits exceed their risks.
Outlawing kratom, moreover, will mainly spawn a black market. This harms kratom consumers (by raising prices and diminishing quality control) and society generally (by generating violence and corruption, as occurs now for other banned substances).
The FDA may believe that kratom’s risks are so great that no rational person would ever accept them. But in a free society, individuals—not a government bureaucracy—decide what risks to take with their health.
The Trump White House is on the right track by supporting Right to Try. The administration should stick to this philosophy in its treatment of kratom.