Last year more people died from drug overdose than from traffic accidents. The majority of these deaths involve opioids, whether that’s prescription medication or street drugs. In Austin, some addicts are replacing opioids with an herbal supplement, which has the potential to save lives. But across the country, opponents of the herb are mounting a drive to get it banned.
Kratom technically isn’t a drug; it’s a dietary supplement. Meaning that, as far as the FDA is concerned, it’s legal. It comes from Thailand, where they make it by grinding down the broad leaves of the tropical Mitragnya speciosa plant into a fine powder.
Over the last few years it’s become more popular on this side of the Pacific. In lower doses, this cousin of the coffee plant works as a mild stimulant. It also acts on our opioid receptors, so if you take enough it induces an opioid-like euphoria. While it’s not an actual opioid and doesn’t get you as high as pills or street drugs, several states have moved to outlaw the substance anyway – though not Texas.
Sam Ghanbar, self-professed “local superhero,” is active on the Austin music scene. He picks up his supply of kratom once a month.
“Kratom kind of helps motivate, gives me a little extra boost, like some people do a cup of coffee,” he said. “Part of it is definitely stimulating, but it’s mostly just euphoria. And I used to definitely abuse pharmaceuticals – hydrocodone, Norco, Percocet, Lortab, Lorcet – this has definitely been a great replacement for it.”
He said there are a lot of reasons he switched from pills to kratom: It’s cheaper, the comedown is milder, and it’s hard to OD on. If you take too much, you just end up throwing it up.
Some use kratom to kick a heroin addiction, Ghanbar said.
“Since I was turned onto it three years ago, I can name about 30 people,” he said. “I think it’s the difference of not dying, maybe, and dying.”
“It absolutely helps people,” said Mark Kinzly from the Austin Harm Reduction Coalition. The group meets addicts on the streets where they live, bringing services directly to them.
“Bottoming out, right now, in the opioid epidemic, looks like death. It’s really hard to do good work and get people services when they’re dead," Kinzly said.
As a former IV user, for Kinzly this is an intensely personal matter. He’s been working in harm-reduction treatment since the 1980s.
“Recovery is any positive change, based on where you’re at in that particular moment,” Kinzly said. “And so just being realistic about what addiction looks like.”
This could mean distributing clean needles, getting addicts to see a doctor, or moving them to a safer drug. Like Ghanbar, Kinzly has seen kratom used as a substitute for street drugs. It can also help people get completely off of drugs by taking the edge off of withdrawal.
“Because when you’re sick, you’re going to end up going out and using. And so people that are motivated to not be using, kratom is a really good tool to help them stave off that period of withdrawal.”
Methadone and similar pharmaceuticals have traditionally played this role, but they can be hard to kick too. After a relapse three years ago, Kinzly himself had to use kratom as a stepping stone off those drugs.
“There is a massive amount of people in the state of Texas that could really benefit from this. We’re number two in the United States for health care costs associated with opioid abuse.”
Texas spends nearly $2 billion a year on opioid-related health care costs. Kratom is cheap and available without a prescription. And in the end, it’s really all about having more tools in the kit.
“The reality of it is, is that our success rates are so small, this needs to be on the table for the people that this may work for, right? It’s a pretty humane way of treating people.”
“I do agree there is a harm-reduction benefit to using kratom,” said Dr. Carlos Tirado, out of Austin.
Tirado is an addiction psychiatrist who's been in academic and private practice for the last decade.
Some of his patients have used kratom with success. Because it is a dietary supplement, it’s too loosely regulated for him to recommend, but if a patient asks him about it, he’ll tell them how to use it safely. It is relatively safe, he said, and the number of people overdosing primarily on kratom is low. But this hasn’t stopped six states from banning it, citing its dangers and addictive potential.
Dr. Tirado doesn’t love kratom’s unregulated status, but he said a ban will just drive people to a dangerous black market. Even so, more states are lining up to be next. The state of New York prides itself as a leader in addiction treatment, but they’ve got a bill pending – introduced by State Sen. David Carlucci, who said he’s frustrated with the number of overdose deaths – that would ban kratom. The Senator said that until the FDA approves the substance, he doesn’t feel it’s safe enough to consume.
Back at his place, Ghanbar ran through his ritual. He poured the kratom out of the baggie, measured it out, splashed a little seltzer in his mouth, and dumped in a teaspoon.
He swallowed a couple more teaspoons and moved on with his day.
In 2014, there were 2,600 drug overdose deaths in Texas. Not all of those involved opioids, and experts say that many Texas overdose deaths are going unreported. The FDA’s official position is that kratom has “no legitimate medical use.” As of now, Texas has no legislation proposed to ban it.