Pod Insights Short Wave Why Kratom Is At The Heart Of A Big Public Health Debate About this episode Kratom and 7-OH products are available in many smoke shops. But earlier this year, the FDA recommended certain 7-OH products be scheduled alongside opioids. This isn’t the first time kratom has come under scrutiny. Nearly a decade ago, the DEA wanted to make certain active ingredients in kratom controlled substances. Meaning products would go from being widely available to highly restricted. After a massive wave of protest, the DEA decided not to move forward. Producer Rachel Carlson https://www.npr.org/people/1112796909/rachel-carlson joins host Emily Kwong https://www.npr.org/people/767284140/emily-kwong to talk about what could happen this time around, and what scientists know – and don’t know – about kratom and 7-OH.
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1:02 Emily Kwong? least, at plus.npr.org. Sign up to unlock a bunch of perks like bonus episodes and more from across NPR's podcasts. Plus, you get to feel good about supporting public media while you listen. So end the year on a high note and invest in a public service that matters to you. Visit plus.npr.org today. Thank you. You're listening to Short Wave from NPR. Hey, Short Wavers. Emily Kwong here with Rachel Carlson, one of our show's producers. Hey, Rachel.
1:32 Speaker 02 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.
1:47 Emily Kwong? Well, where does kratom come from exactly?
1:49 Speaker 02 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.
2:18 Emily Kwong? Okay, so the term kratom could actually mean a bunch of different things?
2:21 Speaker 02 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.
2:35 Emily Kwong? Okay, complicated.
2:36 Speaker 02 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 7OH, which stands for seven hydroxymetraginine. Some people also pronounce it mitraginine, but mostly people just say 7OH.
2:52 Emily Kwong? 7OH, okay. Where do people buy 7OH?
2:56 Speaker 02 You can pretty much buy it anywhere. So it's sold in smoke shops, gas stations, convenience stores. It's possible you've actually seen it advertised on those neon signs that say weed, but instead it'll say kratom or 7OH in those bright letters.
3:11 Speaker 03 7OH is not just like an opioid. It is an opioid.
3:17 Speaker 02 That was FDA Commissioner Marty McCary during a press conference in July. And that's when the FDA said they were recommending certain 7OH products be scheduled alongside opioids.
3:28 Speaker 03 Our focus is not on kratom. Our focus is on 7OH, which, according to the Journal of Medical Chemistry, is 13 times more potent than morphine.
3:39 Speaker 02 But not every researcher I talked to was ready to sound those alarm bells. They told me kratom and 7OH are at the heart of a big public health debate right now.
3:51 Speaker 02 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 7OH to wean themselves off opioids like heroin, or as a way to manage chronic pain without prescription drugs.
4:09 Emily Kwong? Oh, OK. I can see why people are so drawn to it, because of course opioids are known for being really addictive.
4:16 Speaker 02 Yeah, I mean, according to the CDC, 76% of drug overdose deaths in 2023 involved opioids.
4:23 Emily Kwong? I can imagine having an alternative, a way out of using opioids, would be really appealing.
4:29 Speaker 02 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 7OH products have addictive properties themselves, and that they should be better regulated.
4:44 Emily Kwong? So today on the show, what we do and do not know about kratom.
4:49 Speaker 02 Why people are drawn to it, what it does to the body, and what happens when the drug market gets ahead of the science.
4:56 Emily Kwong? You're listening to Short Wave, the science podcast from NPR.
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6:38 Emily Kwong? 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?
6:47 Speaker 02 Yeah, naturally, I wanted to know that, too. So when I started reporting on this, I went to go look for some.
6:54 Emily Kwong? What'd you find?
6:54 Speaker 02 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.
7:13 Emily Kwong? A lot of places. But it originally comes from a plant, right?
7:16 Speaker 02 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.
7:24 Emily Kwong? Wait, if it comes from a tree in the coffee family, does that mean it's a stimulant?
7:27 Speaker 02 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.
7:45 Speaker 05 And often, actually, they do compare that feeling good to what a cup of coffee does.
7:49 Speaker 02 Hmm. Some people even use it to manage depression, anxiety, PTSD and ADHD. But in larger doses...
7:57 Speaker 05 They also compare it a little bit to what opioids feel like.
8:01 Speaker 02 Which is what FDA Commissioner Marty Makary was referring to earlier. It can relieve pain, make people feel kind of calm or even euphoric.
8:09 Emily Kwong? 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.
8:18 Speaker 02 Right. The kratom plant contains different compounds called alkaloids. Metrogenine and 7-hydroxymetrogenine, 7OH, are two of the major psychoactive ingredients.
8:29 Speaker 02 Metrogenine binds to opioid receptors, but also things like serotonin receptors in the brain. And in the kratom plant and in natural kratom leaf products, 7OH shows up in tiny quantities. Mm hmm. But what about products that have higher concentrations of 7OH? What does that do to the brain? 7OH does seem to bind more exclusively to opioid receptors in the brain, just like heroin, morphine, or fentanyl. Your classic opioids, yeah.
8:55 Speaker 06 So I would see 7-hydroxymetrogen more as an opioid than kratom.
9:02 Speaker 02 That's Oliver Grundmann. He's a professor at University of Florida College of Pharmacy. OK, 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 7OH 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, OK. So 7OH, 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.
9:39 Speaker 07 Can you get addicted to kratom? Yes. Can you get addicted to 7-hydroxymetrogen? Yes. Is the propensity towards addiction greater for kratom than other opioids? I don't know.
9:55 Speaker 02 Is there any data about this? There's not a lot, but there's some. One study surveyed around 2,000 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. OK. David Epstein told me those symptoms typically include withdrawal, increased tolerance, and cravings.
10:14 Speaker 05 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.
10:23 Speaker 02 Gotcha. But what about 7OH products? Are there reports of addiction concerns? I have seen anecdotal reports on addiction. There are Reddit channels devoted to people quitting kratom and 7OH 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 7OH could be more addictive, especially because there are some products that are manufactured specifically to have a stronger impact on the body.
10:52 Speaker 06 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-hydroxymetrogenine from getting into the bloodstream and then through the bloodstream into the brain.
11:18 Emily Kwong? Whoa, okay. I mean, given that, how are 7OH formulations affecting people?
11:23 Speaker 02 There have been deaths related to kratom and 7OH, 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 7OH 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.
11:52 Emily Kwong? Oof.
11:52 Speaker 02 And then there's the fact that the products may not be labeled well to begin with.
11:57 Emily Kwong? Yeah, right. So people don't always know then how much of these different ingredients they are taking.
12:03 Speaker 02 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.
12:12 Speaker 08 The real problem, too, is that even some of these products that are extracts that have high levels of 7OH 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, you know, very high content of alcohol.
12:30 Emily Kwong? Oof, that doesn't sound good. Okay, Rachel, at the beginning of our conversation, we talked about how the FDA wants to schedule 7OH products, which would be a big deal. It would regulate them. Do you think this could actually happen?
12:43 Speaker 02 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, metrogenine and 7-hydroxymetrogenine.
12:58 Speaker 02 Controlled substances, meaning kratom would go from being widely available to highly restricted.
13:05 Emily Kwong? Hmm.
13:06 Speaker 02 And there was a huge wave of protest following that announcement. People were sending letters, writing comments.
13:11 Emily Kwong? Saying like, don't touch our kratom. Don't regulate it.
13:14 Speaker 02 Right. And after getting all those comments, the DEA decided not to move forward.
13:19 Emily Kwong? Wow.
13:20 Speaker 02 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.
13:36 Emily Kwong? Hmm.
13:37 Speaker 02 There are also some countries where kratom products are illegal, including Australia, Sweden, France.
13:45 Speaker 02 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 70H is scheduled will be up to the DEA. So I'm interested to see where they draw this line and what happens next.
14:05 Emily Kwong? Rachel Carlson, thank you for diving into this. Um, I've learned a lot.
14:10 Speaker 02 Yeah, you're welcome, Emily.
14:11 Emily Kwong? This episode was produced by Rachel Carlson and Hannah Chin. It was edited by Rebecca Ramirez. Tyler Jones checked the facts. Jimmy Keely was the audio engineer. Beth Donovan is our vice president of podcasting. I'm Emily Kwong. Thank you for listening to Short Wave from NPR.
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