Monday, January 13, 2025
UNTHSC's Dr. Matthew Rossheim, College of Public Health, Associate Professor, Health Administration & Health Policy
An herbal substance called “kratom” that can produce opioid- and stimulant-like effects has exploded in vape shop sales over the last few years. While people report using kratom to manage drug withdrawal symptoms and cravings – especially from opioid use – as well as for pain, fatigue and mental health conditions, there is growing concern over its health risks and potential for abuse, reports a public health researcher at The University of North Texas Health Science Center at Fort Worth.
Dr. Matthew Rossheim, associate professor of health administration and health policy at the HSC College of Public Health, was recently published in the American Journal of Public Health for his study “Kratom Products Are Widely Available Throughout the United States,” written with colleagues from George Washington University, the University of Mississippi and Indiana University Bloomington.
According to nationally-representative data from 2022, an estimated 1.9 million Americans reported using kratom in the previous year, Rossheim said. Kratom use, he noted, can have widely varied effects among users, including both stimulant and sedative effects. Kratom is often marketed as having pain-relieving and mood-enhancing properties, and for being a safer substitute for opioids and managing related withdrawal symptoms and cravings, yet kratom has not been approved for any use by the U.S. Food and Drug Administration.
“Kratom is not lawfully marketed as a drug, dietary supplement or food additive because data supporting its safety are lacking,” Rossheim said. “The FDA warns consumers not to use kratom products because of the risk of serious adverse effects, including toxicity, seizures and development of a substance use disorder – and the DEA has listed kratom as a drug and chemical of concern.”
About kratom
Kratom is a tropical tree native to Southeast Asia. Consumption of its leaves produces both stimulant effects in low doses and sedative effects in high doses, and can lead to psychotic symptoms, as well as psychological and physiological dependence. Kratom is mostly used in tablet, capsule or extract form. The leaves may also be dried or powdered and ingested as a tea, or the leaf can be chewed. Concerningly, some kratom products have been found to be contaminated with salmonella. Moreover, researchers have linked kratom use to liver toxicity, seizures and other severe health conditions. The product can be addictive and cause withdrawal symptoms.
“Though kratom has been used for centuries in Southeast Asia, it is relatively new to the mainstream U.S. market, where its popularity – and the sale of high-potency forms – have increased in recent years,” Rossheim said. “Vape shops selling these products often do so without much knowledge of what they really are.”
In the study, Rossheim conducted telephone surveys of 520 tobacco specialty stores across all states, Washington, D.C., and Puerto Rico to determine whether the shops sold kratom, and his findings were examined in the context of state laws.
Across the 46 states and territories where kratom is legal, more than 80% of tobacco and vape specialty stores reported selling it. In states where it is illegal – Alabama, Arkansas, Indiana, Vermont, Wisconsin and Rhode Island – most stores reported not selling the substance. In Rhode Island, however, approximately 40% of the surveyed shops reported selling the illegal substance. Most states have no regulations on kratom marketing, labeling, testing or minimum purchase age.
Gaining legislative attention
Growing national attention is now being paid to kratom, Rossheim said, as evidenced by the Federal Kratom Consumer Protection Act, which was introduced in the House and Senate in October 2023. This bill is purportedly designed to “protect access to kratom” by requiring the FDA to form a committee to examine the health effects and safety of products with kratom. However, the only other major provision in this bill, he noted, is that it would prohibit the FDA from applying regulations to kratom that are more stringent than those for food or dietary supplements or ingredients.
“Given kratom’s unique properties, potential for abuse and health risks not common to typical dietary supplements, it would likely be beneficial to have more tailored regulations addressing specific risks such as dependency and drug interactions. Our findings underscore the scale of this issue nationally and, therefore, the critical need for effective consumer safety regulations,” he said.
What’s needed
“A standardized federal approach is crucial given the widespread availability of kratom across the United States and the existing patchwork of state laws. These regulations should mandate rigorous product testing, establish safety standards and set marketing restrictions. They should also define upper limits for alkaloid content, set a minimum purchase age and require clear labeling of product contents, ingredient lists, safety warnings and directions for safe use, without implying therapeutic benefits or suggesting medical usage,” the researchers concluded.
“Policymakers, regulatory bodies and public health professionals should collaborate to ensure that the marketing, accessibility and attributes of kratom products are regulated in a manner that optimally protects public health and safety,” they noted.
“Our study findings underscore the urgent need for additional studies examining the clinical effects of kratom use, and the impacts of regulatory changes on its marketing, use and associated health effects. These studies will play a crucial role in informing and refining policies to effectively manage the risks—along with any potential harm reduction benefits—associated with kratom.”
Rossheim’s research fits within the HSC College of Public Health’s strategic plan – IMPACT 2030: Commitment to Community – which is based on creating healthier communities through efforts like collaboration with national partners to develop and advocate for solutions addressing the unique health challenges that our communities face.
From HSC Newsroom - Community by Sally Crocker