At her home in Spring Hill, Stepheny Cashion sits at her kitchen table with a bag of greenish-brown powder and a white, plastic box.
She pours out some empty, clear pills and pops them into the capsule maker. Then she scrapes the powdered kratom with a business card into the capsules.
“And you just kinda jiggle everything down in there,” Cashion says as she packs the pills full of the herbal supplement.
Cashion says kratom helps stave off flares from chronic pain conditions like Trigeminal neuralgia – a nerve pain disorder – and fibromyalgia. Some research also supports the herb as a mood elevation drug.
"It made such a huge difference, not only on my just basic level of pain, but also on my anxiety and depression,” Cashion said.
Kratom comes from a tropical tree native to Southeast Asia – and is part of the caffeine family. There, farmers drink it like coffee – brewed from fresh leaves for an energy boost – with no reported ill effects.
In the United States, kratom – marketed as a dietary or herbal supplement – is consumed in a powdered form in capsules or tea. It has grown in popularity as users swear by its effect on chronic pain, fatigue, and more.
But regulators have expressed concerns about the safety of the drug since it was introduced to the U.S. in the 1990s. Recent media reports have flooded social media with headlines about kratom-associated deaths.
The research
The University of Florida College of Pharmacy will soon be adding to that body of research with two recent multimillion dollar grants from the National Institute on Drug Abuse.
A five-year, $3.4 million grant comes on the heels of another two-year, $3.5 million NIDA grant awarded to the college in December. The first NIDA-funded study examines kratom’s alkaloids individually. This grant evaluates these alkaloids together to study kratom’s effect as a whole.
The research has severals goals which include finding out why kratom sometimes has adverse effects in the U.S. and none in Southeast Asia; to further explore its use as an opioid alterative or antidepressant; to build a list of drug interactions so users know what they can’t mix it with; and to determine safe dosages.
McCrudy says while kratom advocates are correct – there are a lot of studies that support kratom use for pain and addiction – we're still at least five years away from human clinical trials that could lead to better regulations and FDA support.
The policy
In 2017, the Food and Drug Administration issued a public health advisory for kratom. The Drug Enforcement Administration identifies it as a "drug of concern."
And while it's legal to sell and use in most cities and states, there's technically an FDA ban on its importation. But that doesn't slow it down.
"The FDA doesn't have enough people to police the importation of material into the United States,” McCurdy said.
Six states, and several cities and counties across the nation, have banned kratom. In Florida, state legislators have introduced several bills over the years to do the same thing, but none passed. But in Sarasota County, where CBD oil is currently being cracked down on, kratom has been banned since 2014.
"And it is not a substance that ought to be banned,” said Mac Haddow, Senior Fellow on Public Policy with the American Kratom Association. His group has helped four states pass the Kratom Consumer Protection Act, which creates a framework for regulation and safety that doesn’t exist on the federal level.
Why regulators are concerned
McCurdy says kratom in the U.S. is sometimes contaminated by heavy metals. Researchers say it doesn’t come from the soil it’s grown in, and suspect it’s being processed in World War I-era metal grinders instead of in stainless steel food-grade grinders.
Sometimes it comes into the country under the guise of seaweed or kelp, and poor storage conditions have led to salmonella outbreaks.
You can also buy kratom from countless websites, smoke shops and convenience stores, so there's no way of knowing what exactly is in it. Some sellers say they're abiding by Good Manufacturing Practice Regulations, but they can fake it and use the label without getting caught.
And from 2011 to 2017, the National Poison Center reporting database documented almost 2,000 calls concerning kratom.
The Centers for Disease Control and Prevention recently reported that kratom caused 91 deaths in 27 states between 2016 and 2017, but that's out of about 27,000 overdose deaths linked to opioids (while kratom is not an opioid, it’s included in this data).
“If the FDA were accurate in their assessment, that kratom itself is dangerous, we would have thousands of people dropping dead in the street because there are more than 15 million kratom users in the United States today,” Haddow said.
Most of the kratom-associated deaths happened to people taking a cocktail of medications – another reason UF wants to investigate how it interacts with other drugs.
"When you look at the entire year's worth of coverage of the Kratom-associated deaths, it’s still far less than what we're losing in a single day to the opioid crisis,” McCurdy said.
Recreational use
Kratom bars are also popping up all over the world as an alternative to alcohol. The dried, crushed leaves are served as a tea that is flavored to cut back on its bitter taste.
Christopher Traver and his wife own the Spookeasy in Tampa’s historic Ybor City. The gothic lounge, decorated with macabre art and high-backed, Neo-Victorian furniture, sells kratom and kava teas in skull glasses.
“I’ve spent my entire adult existence in one fashion or another, putting on parties and events, getting people out in the nightlife. But as I as I grow, I see the toll that is taking on me and all my friends,” Traver said.
“I want to help them find a way to enjoy themselves, kind of a provide a social lubricant that is not toxic, that is not a poison, a verified poison, that is going to kill you one day. So we go to the ratom, where it's, in my opinion, a much healthier alternative.”
Kratom sales aren’t restricted to legal adults in Florida, but Traver refuses to serve anyone under 18. He also works with a vendor he trusts who tests materials in the lab to make sure it’s not contaminated.
“It doesn't rob you of your good judgment, like alcohol does and like other drugs do. It’s more relaxing. If you have the aches and pains, it’s going to take care of that. You need a little energy, it can take care of that.”
Travers, like most kratom advocates, supports some level of regulation to make sure products are safe. And, he says, it’s hard for people to take kratom seriously when there are bad products being sold by questionable vendors.
The dark side of kratom
Matthew O’Brien used to help run a kratom advocacy and support group on Facebook, which paid in free kratom. He says the herb gives a mild, Vicodin buzz, and was a cheaper stand-in for his preferred painkillers.
When he lost his job as a moderator, he lost his kratom supply. He says the withdrawal was worse than the opioids he was addicted to, and he's not sure about its use in opioid treatment.
“I was in withdrawals for I felt like forever,” O’Brien said. “I can bounce back from pills quicker than I could from kratom. So I was out of commission for like two days. I didn't even leave the bed. I didn't eat anything.”
O’Brien, who is also bipolar, is very concerned about how easy it is for people to get kratom and treat themselves like he did.
“If the treatment for your mental health is being bought over the counter of the gas station, I feel like that should be a very big red flag," O’Brien said.
O’Brien now attends Alchoholics Anonymous meetings (there are more meeting options than Narcotics Anonymous), and is a sober living home manager in Clearwater where kratom is problematic.
"We do drug tests once a week and we have a special stick to dip in to test for kratom and we have searched cars and found kratom and pills in people's cars,” O’Brien said. "So it is a big problem. And for an addict, there really is no way to legitimize using it."
Looking forward
Chris McCurdy, the UF researcher, has studied kratom for 15 years. He says the target kratom has on its back currently is more of a “wrong place, wrong time” situation.
Kratom was originally sold alongside spice, a synthetic marijuana, and bath salts – both of which were blamed for overdoses, delirium and kidney failure.
“And so bath salts and spice were made Schedule I (drugs) and outlawed,” McCurdy said. “And then right there next to them was kratom. And so once those products were off of the market and off of the shelf, people started experimenting with (kratom) because it was the next thing in line, so to speak.”
McCurdy says the good thing is that everyone – including the federal government – is receptive to research right now. And as it inches closer to human clinical trials, he expects the policy will change to reflect the findings.
“Luckily, everybody's got an open ear to the science right now. And (the FDA is) really waiting to make some final decisions until we get more science done,” McCurdy said.
Haddow supports the research.
“So we think that the bottom line to this is when it's all gets sorted out, that the FDA will come to their senses and appropriately regulate in a way that will block the bad actors from getting into the system, that it can be become a product that is mainstream, and that will be acceptable for use and marketing,” Haddow said.
In the meantime, the American Kratom Association is connecting with legislatures in the other 46 states and Washington D.C. to pass statewide Kratom Consumer Protection Acts to hold everyone in the market accountable.
Until that happens in Florida, kratom users like Stepheny Cashion say they’ll keep doing their own research - which includes asking for lab reports from kratom companies.
