The life-and-death fight over pain reliever kratom

The U.S. Drug Enforcement Administration told 24 Hour News 8 it will “soon determine whether to place kratom under Schedule I of the Controlled Substances Act. Schedule I drugs, like heroin and LSD, have no medically accepted use and high potential for abuse.

“I honestly don’t know what I’ll do if it’s made illegal,” Amber Hitsman told Target 8 from the living room of her Spring Lake home.

Hitsman, 30, has been taking kratom for a year and a half to relieve severe back pain caused by a degenerative disc disease.

“For me, it worked right away, the first time I took it. It was amazing. I didn’t feel the pain. It doesn’t make you feel like you do when you’re on traditional opiates,” she said.

Hitsman, who beat an addiction to the opioid Norco twice in her 20s, discovered kratom while searching for a natural pain reliever.

“My back was bad. I was in a bad place, and I could feel the third relapse coming on. I just googled natural pain alternatives,” she said. “At that time, I was only using cannabis and it just wasn’t cutting it.”

The American Kratom Association says kratom has helped millions of Americans manage their overall health and well-being. Part of the coffee family, it can produce a mild euphoric or stimulant effect. It’s used to ease anxiety, depression and pain, and it comes in multiple forms, including capsules, tea and powder.

‘IF THEY BAN IT, THEY’RE GOING TO SEE MORE DEATHS’

Kratom is relatively inexpensive and easily bought online, in smokes shops and some gas stations.

“If they ban it, they’re going to see more deaths,” Hitsman said. “More deaths from opiates, more deaths from illegal substances, people not being able to work who work now thanks to Kratom.”

But according to public health leaders, the supplement that advocates call lifesaving can also be deadly.

In November 2017, the Food and Drug Administration issued a public health advisory related to the FDA’s “mounting concerns regarding risks associated with the use of Kratom.”

“Evidence shows that kratom has similar effects to narcotics like opioids, and carries similar risks of abuse, addiction and in some cases, death,” the advisory read in part. “Thus, it’s not surprising that often kratom is taken recreationally by users for its euphoric effects. At a time when we have hit a critical point in the opioid epidemic, the increasing use of kratom as an alternative or adjunct to opioid use is extremely concerning.”

This week, an FDA spokesperson told Target 8 the agency has identified 47 deaths nationwide that “may be kratom-related.”

In Kent County, longtime medical examiner Dr. Stephen Cohle has reported five overdose deaths tied to kratom since December 2017.

ADA MOM: ‘KRATOM KILLED MY SON’

Peggy LaPenna’s son, Joey, was among the five dead in Kent County.

“Joe was sweet,” LaPenna said. “That would be my one word. He was sweet. He was kind. He had many friends who loved him and adored him. In fact, after he passed, 20-plus of them went and got a tattoo in honor of him.”

She found the 21-year-old Grand Rapids Christian High School graduate dead of an overdose in the family’s Ada home the morning of Jan. 25.

Now, she wants her son’s death to serve as a warning, hoping it will save lives.

“Kratom killed my son,” she told Target 8.

“I’d never heard of it,” she continued. “I haven’t talked to anyone who’s heard of it. When the medical examiner called me to tell me what the cause of death was, I was like, ‘What? Spell it for me.'”

The medical examiner determined her son’s death was an accidental overdose on a “recreational drug.” The cause listed on the death certificate was “Acute Mitragynine (Kratom) Toxicity,” with no other significant conditions noted.

LaPenna had tried everything to help her son get off drugs. The car-obsessed young man who loved to skateboard and snowboard struggled with an addiction to Xanax, a benzodiazepine used to treat anxiety and panic disorders.

“He’s a good kid who got caught up in drugs, and, I think, experimented and then it grabbed hold of him and it just wouldn’t let go,” LaPenna said.

She said he often took supplements and researched everything meticulously. She wonders if he saw the myriad websites that declare it impossible to overdose on kratom.

“It needs to get out to the public,” she said. “It can kill you and don’t believe all those websites that say it can’t.”

ADVOCATES: ‘KRATOM DOES NOT KILL PEOPLE’

Kratom advocates question the medical examiner’s determination on the cause of Joey LaPenna’s death, as well as those of the 47 nationwide that have been tied to Kratom.

“There is not one death that the FDA has been able to show that was caused by Kratom,” Pete Candland of the American Kratom Association wrote in an email to Target 8. “In fact, the FDA has abandoned using the word ’caused’ altogether. Now they just say kratom ‘related’ or ‘associated’ deaths in order not to have to show causality.”

Cohle, the medical examiner, said three of the five deaths in Kent County involved significant amounts of other drugs in addition to kratom, including fentanyl and oxycodone.

“But we have at least one, I think two, pure mytraginine (kratom) overdose deaths,” he told Target 8.

He acknowledged that in one of those two cases, the death of LaPenna, the autopsy also found nonprescription Xanax.

“He has a slightly elevated level,” Cohle said as he reviewed the autopsy report.

But Cohle said there wasn’t enough Xanax — 80 ng/mL — to be a significant factor in LaPenna’s death.

“There could have been some very, very small contribution,” he said.

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In the second death attributed to kratom alone, that of a 26-year-old Grand Rapids man, the autopsy noted the individual had a “fatty liver.”

Once again, Cohle said that if the fatty liver contributed to the death, it was only in a very minor way.

“The immediate cause of death is clearly kratom,” Cohle said.

MEDICAL EXAMINER: IF YOU MISUSE KRATOM, YOU CAN DIE

“Look, (kratom) has opioid-like properties,” Cohle said. “If you overuse it or misuse it, you can die like you can with any opioid. End of case. We do an autopsy to make sure there’s nothing else. … We have a death in someone who’s otherwise healthy who has no other drugs. That, to me, is the most compelling evidence. How do you explain their death then?”

Cohle relies on a nationally-recognized reference laboratory for kratom testing, submitting blood samples to Pennsylvania-based National Medical Services. NMS provides a toxicity range for kratom, reporting that blood concentrations listed in fatalities ranged from 20-600 ng/mL.

Joey LaPenna’s kratom level measured 290 ng/mL. In the other death blamed solely on the botanical supplement, the blood concentration measured 830 ng/mL.

“Although most reports of mitragynine (kratom) related fatalities include other drugs, there have been instances where the other drug levels were determined to be minimal,” Dr. Barry Logan, a senior vice president at NMS, wrote in an email to Target 8. “We have had cases of (kratom) deaths with no other apparent illness or trauma, and no other drugs detected where mitragynine was the only significant finding.”

The American Kratom Association points to its own scientific research to refute the FDA’s case against kratom.

“Dr. Jack Henningfield, one of the world’s leading scientists in addiction, concluded in his 8-Factor analysis that kratom is about as addictive as caffeine or St. John’s Wort,” it wrote.

“The (AKA) believes the government does have a significant role in the kratom marketplace,” Pete Candland wrote to Target 8. “They believe there should be industry standards for safety and cleanliness, and that the ‘bad actor’ manufacturers of adulterated kratom products should be held accountable- just as any manufacturer of any botanical or supplement is today.”

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