Kratom, health supplement targeted by FDA, linked to 9 deaths in Cook County

At a corner store in Bucktown, a 10-gram silver-foil pouch of an herbal supplement called Bali Red kratom goes for about $10.

A middle-aged customer said he uses kratom — a Southeast Asian plant that mimics the effect of opioids — to wean himself off heroin. It’s a far cheaper alternative to prescription drugs, he said.

Others take the herbal remedy to alleviate pain or simply for its euphoric effects.

On a visit to the CBDKratom store at Dickens and Damen, an employee warned a reporter that alcohol can multiply the effects of kratom. He also warned not to take kratom on an empty stomach because it could lead to nausea. He suggested drinking it in a spoon-sized dose stirred into orange juice. The effects could last for four hours, he said.

The kratom purchased by the Chicago Sun-Times didn’t come with any written instructions or warnings about side-effects, as would be required with a drug approved by the federal Food and Drug Administration. Kratom, whose main active ingredient is a substance called mitragynine, is unregulated.

But it’s still potentially dangerous, according to the FDA and the federal Drug Enforcement Administration, which have found themselves locked in a fight with kratom’s manufacturers and supporters.

UPDATE: Click to hear reporter Frank Main discuss kratom on WBEZ’s “Morning Shift”

According to the FDA, 44 deaths across the country have been tied to kratom between 2011 and 2017, and there has been a rise in calls to poison centers about it.

The supplement has been linked to nine deaths in Cook County since 2016, Cook County medical examiner’s office records show.

For years, the FDA has been seizing shipments of the herbal supplement and destroying them, including 90,000 bottles found in 2016 at a factory near Rockford.

But pressure from some members of Congress so far has staved off the DEA’s efforts to label kratom a Schedule I drug with no medicinal purpose — the same category as illicit drugs such as heroin and LSD. The DEA postponed a decision on that in 2016 but is still considering it.

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“Regulation before prohibition is the answer,” says Susan Ash, a founder of the American Kratom Association in Virginia, who says she uses the herb three times a day to treat pain and lethargy from chronic Lyme disease.

Ash says the product should be restricted to adults, the supplement’s packaging should carry warning labels and vendors should test their products for purity.

“Most of us believe there should be some standards,” Ash says. “But they want to prohibit the substance completely. They need to recognize the millions of us who are using this responsibly and getting off opiates.”

Kratom — which is pronounced CRAY-tum — is a plant that grows in Thailand, Malaysia, Indonesia and Papua New Guinea. Mitragynine, one of its active chemicals, is an alkaloid that acts on the body’s opioid receptors, according to the National Institutes of Health.

According to Cook County medical examiner’s records, there have been nine cases since 2016 in which mitragynine was listed as a cause of death — in each instance along with at least one drug, often opioids such as heroin or fentanyl. All of those who died were white men between 23 and 61 years old.

They included a 40-year-old man found dead in June 2016 inside his tractor-trailer outside a Wendy’s restaurant in Oak Forest. In the cab of the truck, police found what appeared to be heroin in an Altoids container and a yellow bottle labeled “kratom.” The medical examiner’s office ruled the cause of death was heroin and mitragynine toxicity.

Its report quoted a relative who said the man had been “using kratom in an attempt to stop using heroin,” relieve back pain and deal with the stress of a divorce, the sister-in-law told the Sun-Times.

“He was doing anything to feel better, and it killed him,” the woman said, asking that she and the man who overdosed not be identified.

Representatives of the American Kratom Association have lobbied Congress to “delay action by the DEA regarding kratom” and “educating lawmakers on the beneficial use of kratom,” according to the group’s 2016 federal not-for-profit tax filing.

The group has quickly grown. It reported assets of $200 in 2014, $51,000 in 2015 and $1.04 million in 2016.

“We went from zero to 60,” says Ash, who no longer is affiliated with the group but remains an advocate for kratom use.

She says she started using kratom about four years ago after going through two rehabilitation programs for prescription opioid dependence.

In 2016, the association spent $247,000 on the Washington law firm Hogan Lovells and another $156,000 on a Washington-area lobbying firm, according to its last available tax filing.

In September 2016, U.S. Sen. Orrin Hatch, R-Utah, and then-Sen. Mark Kirk, R-Illinois, were among nine senators who signed a letter asking the DEA to delay classifying kratom as a Schedule I drug.

“We understand the DEA’s desire to uphold public health and safety, and we share the goal of seeing unsafe products remove from the market. However, hearing multiple perspectives allows for more fulsome decision-making,” the letter said.

Hatch, who is retiring at the end of the year and whose son has lobbied for health supplement companies, is known in Washington as one of the biggest allies of the largely unregulated industry.

“We are thankful to Senator Hatch that he was a champion for us,” Ash says.

Dozens of U.S. representatives signed a similar letter.

In 2016, the DEA reversed its “notice of intent” to give kratom a Schedule I designation and opened a public comment period that ended in December 2016.

“That was unprecedented,” Ash says. “They’re still in a holding pattern reviewing the science.”

Over the past year and as recently as Feb. 6, FDA Commissioner Scott Gottlieb has issued warnings about serious side-effects from kratom, including seizures and respiratory depression.

Kratom supporters have countered with testimonials about how it’s helped people who suffer from everything from back pain to post-traumatic stress disorder and insisted that it’s safe to take.

States including Indiana and Wisconsin have banned the sale of kratom. Illinois lawmakers haven’t gone that far. In 2014, Illinois restricted minors from purchasing the herbal supplement.

But the sponsor of the legislation, then-state Rep. Dennis Reboletti, R-Addison, was unable to persuade his colleagues in the General Assembly to approve a ban.

“At the time of the bill, we could not show there was any death associated with it,” says Reboletti, a former Will County prosecutor and current Addison Township supervisor. “I would challenge the General Assembly and the governor to look at this again.”

Ash says reports of deaths linked to kratom “give us all pause,” but she note that most of the cases involve “people abusing this with other substances.”

The nine kratom-linked fatalities in Cook County constitute a fraction of the deaths attributed to opioids. Last year alone, more than 1,000 people died of overdoses related to opioids, according to the medical examiner’s office.

People who work in the field of heroin recovery say more research is needed on kratom. They also say better drugs are available to treat the symptoms of opioid withdrawal.

“Kratom is not nearly as effective as a treatment for opioid dependence as methadone and buprenorphine,” says Dan Bigg, head of the Chicago Recovery Alliance, which does outreach work with drug users.

“It’s just another option,” Bigg says. “People want to cling to hope. But there’s just too little research about it.

David Palatnik, owner of CBDKratom, the store in Bucktown, says thousands of his customers have used his kratom products for pain relief and opioid withdrawal with positive results.

Palatnik, an Israeli immigrant who lives in St. Louis, also has stores in Andersonville and Boystown in Chicago, as well as in St. Louis and Dallas. He sells kratom and CBD, a hemp extract. Although those products are often seen in “head shops” where paraphernalia for smoking is sold, Palatnik says he liked the idea of opening a business that feels more like a health store.

“Kratom does not get you high,” Palatnik says. “If someone buys it to get high, they will be very disappointed.”

His company’s website says some varieties, like Red Bali, produce a “euphoric” feeling.

Palatnik says he takes Green Dampar kratom in the morning for its caffeine-like zing.

“We open at 8 a.m. because people buy it in the morning to make tea instead of going to Starbucks,” he says.

Palatnik accuses the FDA of using “scare tactics.”

“We sell to thousands of people, and nothing bad happens,” he says. “It’s all politics.”