Kratom (Mitragyna speciosa) is a tropical tree that is native to Southeast Asia (primarily Malaysia and Thailand). The leaves are typically brewed as tea or chewed and used as traditional medicine. The active chemicals in kratom bind to the same receptors as an opioid, producing opioid-like effects such as a heightened sense of pleasure or euphoria for some people. Proponents of kratom believe it is a safe alternative for pain management and treatment of other ailments including addition to opioids. There is no evidence base to support these claims of kratom use as a harm reduction strategy.
In February 2018, the Snohomish Health District became aware of kratom’s link to a nationwide salmonella outbreak, which eventually included one case in Snohomish County, and prompted a closer look.
Kratom is a controlled substance in 16 countries, including two of its countries of origin (Malaysia and Thailand). The legality of kratom across the United States is changing and, at the federal level, has not been adequately addressed. Both the U.S. Food and Drug Administration (FDA) and U.S. Drug Enforcement Agency (DEA) have raised concerns about kratom, issuing warnings, intents to ban, and walking those back. In 2016 the DEA listed kratom as a drug of concern and is currently determining whether or not to list kratom as a Schedule 1 drug. In response to the mixed signals at the federal level, many states and local municipalities have begun passing their own legislation. Four different actions have been used to regulate and/or limit access to kratom:
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Minimum age of purchase (18 or 21 years of age)
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Ban active compounds of kratom, mitragynine and 7-hydroxymitragynine, as Schedule 1 drugs
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Ban on kratom for human consumption
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Research
As of October 2018, nine states and three cities have banned kratom and two states have minimum age restrictions. Most uniquely, the City of Denver has banned kratom for human consumption and requires a warning label on products containing kratom.
In Snohomish County, kratom is available through smoke and vape shops and online retailers. Fifty-six percent (n=14) of smoke and vape stores surveyed (n= 25) sold kratom, and have largely done so at the request of their customers. Kratom is sold in loose powder or capsules. Directions for use and/or dosage are generally not included on labels.
The Snohomish County Medical Examiner has identified four deaths since January 2018 where kratom, along with other substances, were present in the blood system.
Based on this information and several discussions, the Board of Health’s Program Policy Committee recommended a resolution (Exhibit A) calling on the Washington State legislature to take meaningful action to address kratom that could include a ban, age restrictions, research and data collection, and an educational campaign.