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You're listening to Shortwave from NPR.
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Emily Kwong here with Rachel Carlson, one of our show's producers.
Hey, Rachel.
Hey, Emily.
So I am here today to talk to you about something becoming more popular.
It's called kratom or kratom.
People pronounce it both ways, but a lot of the sources I talked to said kratom.
So I think that's what we'll stick with for this episode.
Well, where does kratom come from exactly?
Kratom's derived from tree leaves.
It's been used for centuries in Southeast Asia, mostly Indonesia, Malaysia and Thailand, for energy and to treat pain.
But in the US it's sort of an umbrella term that includes a bunch of different products like teas pills extracts, synthetic goods, that all vary in strength depending on how they're made.
It's kind of like when someone says cannabis products, that could mean whole leaf or extracts from the leaves or synthetic products.
Okay, so the term kratom could actually mean a bunch of different things?
Yeah, I've heard it referred to as a drug, as a supplement, as an ingredient.
So I asked the FDA, the Food and Drug Administration and they told me in an email statement it depends on the specific product.
Okay, complicated.
And on top of that there's one compound in the kratom plant in particular that's been in the headlines recently.
People call it 7-OH, which stands for 7-hydroxymetragynine.
Some people also pronounce it mitragynine, but mostly people just say 7-OH.
7-OH.
Okay.
Where do people buy 7-OH?
You can pretty much buy it anywhere.
So it's sold in smoke shops, gas stations, convenience stores.
Wow.
It's possible.
You've actually seen it advertised on those neon signs that say weed, but instead it'll say Kratom or 70H in those bright letters.
70H is not just like an opioid.
It is an opioid.
That was FDA Commissioner Marty McCary during a press conference in July.
And that's when the FDA said they were recommending certain 70H products be scheduled alongside opioids.
Our focus is not on kratom.
Our focus is on 7-OH which, according to the Journal of Medical Chemistry, is 13 times more potent than morphine.
But not every researcher I talked to was ready to sound those alarm bells.
They told me kratom and 7-OH are at the heart of a big public health debate right now.
Mm-hmm.
Past estimates for how many people use Kratom every year run anywhere from 2 million to more than 10 million.
But there's not that much recent data.
And those numbers include people who use Kratom or 7-OH to wean themselves off opioids like heroin or as a way to manage chronic pain without prescription drugs.
Oh, okay.
I can see why people are so drawn to it.
Because, of course, opioids are known for being really addictive.
Yeah, I mean, according to the CDC, 76% of drug overdose deaths in 2023 involved opioids.
I can imagine having an alternative, a way out of using opioids would be really appealing.
For some people, it is.
And some researchers say further restricting access to these products could affect those who've benefited.
Others say Kratom and 708 products have addictive properties themselves and that they should be better regulated.
So today on the show, what we do and do not know about kratom.
Why people are drawn to it, what it does to the body and what happens when the drug market gets ahead of the science.
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Okay Rachel, so you've been looking into a whole suite of products sold under the names Kratom and 7OH.
What exactly do these products look like?
Yeah, naturally, I wanted to know that too.
So when I started reporting on this, I went to go look for some.
What did you find?
I found so many different permutations of it on shelves.
Pills, tablets, gummies, seltzers, kind of like your average alcoholic seltzer beverage thing.
Some companies even make chocolates.
And it's available in smoke shops, liquor stores, gas stations.
A lot of places.
But it originally comes from a plant, right?
Yeah, it comes from a tree in the coffee family.
And traditionally, people brew the leaves like a tea or they'll pick them off and chew them.
Wait, if it comes from a tree in the coffee family, does that mean it's a stimulant?
So it's a little weird because in smaller amounts, kratom can be a mood booster.
I talked to David Epstein.
He's a senior investigator at the National Institute on Drug Abuse, or NIDA.
He wasn't speaking on behalf of NIDA when we talked, but he said it can make people feel energized, more focused.
And often, actually, they do compare that feeling good to what a cup of coffee does.
Some people even use it to manage depression, anxiety, PTSD, and ADHD.
But in larger doses... They also compare it a little bit to what opioids feel like.
Which is what FDA Commissioner Marty McCary was referring to earlier.
It can relieve pain, make people feel kind of calm or even euphoric.
Okay, interesting.
And like you said earlier, the term kratom can refer to a lot of different things, right?
When people are talking about it.
Right.
The kratom plant contains different compounds called alkaloids.
Metragynine and 7-hydroxymetragynine, 7-OH, are two of the major psychoactive ingredients.
Metragynine binds to opioid receptors, but also things like serotonin receptors in the brain.
And in the kratom plant and in natural kratom leaf products...
7-OH shows up in tiny quantities.
But what about products that have higher concentrations of 7-OH?
What does that do to the brain?
7-OH does seem to bind more exclusively to opioid receptors in the brain, just like heroin, morphine or fentanyl.
Your classic opioids.
Yeah.
So I would see 7-hydroxymetraginine more as an opioid than Kratom.
That's Oliver Grunman.
He's a professor at University of Florida College of Pharmacy.
Okay, so he's saying that it's a compound of kratom.
That's really worrying people because it's so potent.
Yeah, the concern is that there are a lot of new 7-OH products popping up, like extracts and pills that are much stronger than the kratom products researchers have been studying for the last decade or so.
Got it.
Okay.
So 7-OH, it binds to opioid receptors.
Does it make those products more addictive?
I asked Ed Boyer that.
He's a medical toxicologist at The Ohio State University, and that means his job is dealing with things like poisonings and overdoses in humans.
Can you get addicted to kratom?
Yes.
Can you get addicted to 7-hydroxymitragynine?
Yes.
Is the propensity towards addiction greater for kratom than other opioids?
I don't know.
Is there any data about this?
There's not a lot, but there's some.
One study surveyed around 2000 people who used kratom in the natural leaf form or concentrates or extracts, and a little over a quarter met criteria for kratom use disorder.
David Epstein told me those symptoms typically include withdrawal, increased tolerance and cravings.
Which look like mild opioid withdrawal, when they try to stop using it and they need to keep using it in order not to have those symptoms.
Gotcha.
But what about 7-OH products?
Are there reports of addiction concerns?
I have seen anecdotal reports on addiction.
There are Reddit channels devoted to people quitting Kratom and 7-OH products.
Of course, there are also ones where people say they've benefited.
But when it comes to the research, there's even less data on that.
Some animal studies and early data suggest 7-OH could be more addictive, especially because there are some products that are manufactured specifically to have a stronger impact on the body.
When you think about something that is, for example, a nasal spray or something that is a tablet that dissolves under the tongue, then you actually circumvent many of the processes that would potentially prevent 7-hydroxymetraginin from getting into the bloodstream and then, through the bloodstream, into the brain.
Whoa, okay.
I mean, given that, how are 7-OH formulations affecting people?
There have been deaths related to kratom and 7-OH, but the numbers of how many deaths are tricky.
A lot of them involve other substances like drugs or medications.
And then, of course, there's the fact that Kratom and 7-OH aren't regulated by the FDA in the same way that prescription medications are.
And that's created some health scares.
Over the years, the FDA has recalled Kratom products for salmonella contamination and for unsafe levels of heavy metals like lead and nickel.
And then there's the fact that the products may not be labeled well to begin with.
Yeah, right.
So people don't always know then how much of these different ingredients they are taking.
Yeah, you might not.
Here's what Albert Garcia-Romeo told me.
He's an associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine.
The real problem too, is that even some of these products that are extracts that have high levels of 7-OH are not labeled as such.
They often just say kratom.
So it would be like picking up a bottle of beer that should have 5 alcohol in it and actually getting a bottle of Everclear that has very high content of alcohol.
Okay.
That doesn't sound good.
Okay Rachel, at the beginning of our conversation, we talked about how the FDA wants to schedule 7-OH products, which would be a big deal.
It would regulate them.
Do you think this could actually happen?
It's really tricky.
A similar question came up almost a decade ago, August 2016.
The Drug Enforcement Administration, or DEA, wanted to make those two active ingredients in kratom.
We talked about mitragynine and 7-hydroxymitragynine Controlled substances.
Meaning kratom would go from being widely available to highly restricted.
And there was a huge wave of protest following that announcement.
People were sending letters, writing comments.
Saying, like, don't touch our kratom.
Don't regulate it.
Right.
And after getting all those comments, the DEA decided not to move forward.
Wow.
So it's possible 70H could follow a similar path.
But for now, it's up to states.
There are some, like Ohio, Florida, Rhode Island, Vermont, Indiana.
They have either bans, limitations, or age restrictions on either Kratom or 70H.
There are also some countries where Kratom products are illegal, including Australia Sweden, France.
And after reporting all this, I feel like we're in ethical and legal limbo.
Where are the lines when you're weighing the risks of a drug against its potential rewards?
Ultimately, whether or not 7-OH is scheduled will be up to the DEA.
So I'm interested to see where they draw this line and what happens next.
Rachel Carlson, thank you for diving into this.
I've learned a lot.
Yeah, you're welcome, Emily.
Thank you.
This episode was produced by Rachel Carlson and Hannah Chin.
It was edited by Rebecca Ramirez.
Tyler Jones checked the facts.
Jimmy Keeley was the audio engineer.
Beth Donovan is our vice president of podcasting.
I'm Emily Kwong.
Thank you for listening to Shortwave from NPR.
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