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Arkansas's ban of the natural painkiller Kratom has left sufferers and former opiate addicts in the lurch 

State Department of Health added it to the list of Schedule 1 narcotics last year.

click to enlarge KRATOM: Advocates say the Southeast Asian plant can break the cycle of addiction.
  • KRATOM: Advocates say the Southeast Asian plant can break the cycle of addiction.

Talking to a reporter about the decision by the state to criminalize Kratom, an herb she started taking over a year ago to help her manage her chronic pain, and the thought of going back to prescription painkillers, Arkansas resident Lisa (not her real name) broke down in tears.

More than a decade of debilitating fibromyalgia and other conditions left Lisa on the rollercoaster of opiate addiction. She felt like a zombie wandering in a fog of medication and was teetering on the verge of unemployment when she discovered Kratom. The herb's a godsend that has given her her life back, and she said she will continue taking Kratom even if it means breaking the law.

Made from the leaves of the plant Mitragyna speciosa, which grows wild in Southeast Asia, Kratom usually comes in powdered or liquid form and has been used in Asian traditional medicine for thousands of years. Last September, the state Department of Health added Kratom to the list of Schedule 1 narcotics, making it a crime to possess or sell. The ban went into effect Feb. 1. Several other states, including Alabama, Tennessee, Wisconsin, Vermont and Indiana, have banned Kratom as well, and other states are considering restrictions. In February, after the Arkansas ban went into effect, police in Fayetteville raided three local businesses there and seized almost 100 pounds of powdered and liquid Kratom, but made no arrests.

"When I heard they'd banned it and the way they banned it, I literally broke down in tears," Lisa said. "I don't want to go back to pain medication, and I won't go back to pain medication. But now that it's illegal, it's hard to get. Nobody will send it here because they don't want to get in trouble, which I totally understand. The way they went about doing it was so underhanded."

The way Kratom works in the human brain hasn't been well studied, but it's thought to plug into opioid receptors to dull pain. Unlike the drowsy euphoria that can come from prescription painkillers like oxycontin or hydrocodone, however, Kratom has a stimulant effect. Though Kratom is listed as a "drug of concern" by the DEA, advocates say Kratom has great promise in the fight against addiction, particularly addiction to hard-to-kick prescription pain pills and heroin.

The American Society of Addiction Medicine estimates that over 1.9 million Americans are addicted to prescription pain medications, with another 586,000 addicted to heroin. Currently, drug overdose is the leading cause of accidental death in the U.S. Kratom, supporters say, offers chronic pain sufferers relief without the foggy feeling and danger of addiction and overdose, and gives heroin and prescription pill addicts a way to kick their habit without painful withdrawal. An animal study published in 2013 by researchers at the University of Mississippi found that Kratom somehow blocked withdrawal symptoms in opiate-addicted mice. In the same study, cocaine-addicted mice stopped seeking out and "self administering" cocaine after being given Kratom.

Lisa takes two teaspoons of Kratom twice daily, washing down the powder with water. The effect of Kratom, she said, is nothing like the effect of prescription pain meds. "When I take opiates for my pain, it doesn't even really help with the pain," Lisa said. "It just makes me not care about the pain. But when it comes back, it comes back 10 times worse. Therefore you have to take more and more opiates to make it go away. With Kratom, it literally makes the pain go away. When you take Kratom, you don't get the high feeling. You're just normal."

Susan Ash is the founder and director of the Virginia-based American Kratom Association, which launched in February 2015. The way Ash found Kratom is typical of many who rely on the herb. After suffering from sometimes excruciating pain from undiagnosed Lyme Disease for six years, she became so dependent on prescribed opiate painkillers that she wound up in drug rehab in 2011. She had taken Kratom before, but made her way back to it as an alternative to pain pills after getting out of treatment.

"When I got out of rehab, I was faced with a pretty tough decision: I'm a chronic pain patient, and my doctors felt that going on Suboxone was my only option to deal with the pain," she said. "I did that for about eight months. It is an opiate. It's easy to abuse. It does make you feel like you've taken an opiate. I didn't like it. I didn't feel like I was truly sober after going through a recovery program. That's when I remembered Kratom. That's when I started taking it again." Since then, she said, she has been able to function again, with none of the drugged feeling she got from opiates.

The Times contacted several addiction clinics for their take on Kratom and the potential for abuse, including the Springdale Treatment Center, a substance abuse clinic. A doctor who works at the clinic is listed by the Health Department as having submitted concerns about Kratom that were later cited in paperwork used to add Kratom to the list of controlled substances. Those calls were not returned at press time.

Meg Mirivel, public information officer with the Arkansas Department of Health, said the way a substance usually ends up on the list is the Health Department's Pharmacy Services Department will make a recommendation to the Board of Health. After consulting with other agencies, including the governor's office, the Board of Health will then vote. Any rules changes must be approved by the Arkansas Legislative Council. Mirivel said that mitragynine and 7-hydroxymitragynine, the active compounds in Kratom, were added as Schedule 1 controlled substances at the Oct. 22, 2015 State Board of Health meeting, after a 30-day public comment period. Health Department deputy general counsel Elizabeth Harris said notice that the substances would be added to the list of narcotics was made by way of a posting in the Arkansas Democrat-Gazette between July 30 and Aug. 1, 2015. Mirivel said no public comments were received by the Health Department concerning the change.

Ash said much of the concern over Kratom stems from the way it was initially marketed as a "legal high," sold in tobacco stores and head shops. That put the substance on law enforcement and legislative radar as a potential danger to the public health. Though Kratom does work in the brain in a similar way to opiates, she said, the effect in the body is not comparable and the potential for abuse is low.

"Yes, it does activate opiate receptors. That's the reason why it's so effective on pain," she said. "It does boost your mood slightly, and that's why a lot of people use it for an antidepressant. But there's no comparison to the type of euphoria that you experience when you take an actual opiate — the foggy feeling, the feeling of escape. You have to deal with real life when you take Kratom. You can't escape your problems like you can when you're on a regular opiate. It doesn't have as strong a bond to the opiate receptors in your brain. It's something more like coffee."

Ash said she has stopped using Kratom abruptly for a full week to learn what withdrawal from it is like. Quitting an addiction to prescription opiates cold turkey can lead to painful withdrawal, including cramps and even seizures, but Ash said she suffered no ill effects other than her chronic pain returning after she stopped using Kratom. Though overdose on prescription pain medications is epidemic in the U.S., Ash claims it's not possible to overdose on Kratom, because taking too much leads immediately to nausea.

"If you take too much Kratom, you literally throw up," she said. "It has its own safety mechanism. You can't keep taking it and feel something stronger and stronger. The more you take, the sicker you're going to feel. The only fatalities that have been linked to this plant are fatalities linked to other substances."

That's a statement that seems to be borne out by recent deaths in the state that made headlines as having been related to Kratom. In 2015, testing by the Arkansas State Crime Lab found Kratom in the systems of three people who died from apparent drug overdose in the Fayetteville area. Chief Medical Examiner Dr. Charles Kokes said that of those three cases, all the subjects "had other substances on board that could have contributed to death." In two of the cases, Kokes said, the cause of death was "combined or mixed drug intoxication." The third was ruled undetermined because, in addition to Kratom, there was another drug that was possibly present, but not at a high enough level for laboratory testing to confirm.

"I would say that if you took the Kratom out of the picture in all three cases, at least two of them you could make a reasonable argument that the death was caused by the other substances in those individuals' systems," he said. "But because Kratom was found with these other substances, and we don't know what the interaction is, we certainly consider the possibility that it could have contributed to death. In the third one, if you took the Kratom out of the picture and you have this other drug that may or may not have been there, and there may have been some natural disease processes that were in place at the time, then you're still left at undetermined."

As for Lisa, she said that she can't go back to prescription pain pills. She has a stockpile of Kratom purchased before the ban went into effect, but said when she runs out, she will find a way to purchase more. The idea that it might be banned nationwide has caused near panic in the online communities she visits, where people talk about using Kratom for chronic pain, anxiety or to help stave off addiction.

"I've seen stories in [online] groups that break my heart," she said, "because people are talking about having to go back to the streets — going back to heroin, going back to the things that they came off of ... . Honestly, I will find a way. I will continue to use Kratom. I don't know how, but I will. I can't go back to pain medication that has almost cost me good jobs. There's something natural that helps me, and they took it away overnight. I don't know what I'm supposed to do without it."

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