Kratom activates some of the same receptors as opioid medicines. It acts as a stimulant in small doses and has sedative effects in larger doses. What is appealing to many users is that, unlike opioids, kratom does not appear to be associated with slowed breathing (a.k.a. respiratory depression), which is the cause of many opioid deaths, and is thought to be less addictive.
It can cause nausea, itching, and sweating, and some users have reported psychotic symptoms and dependency. Others have had seizures, usually with other drugs. The Centers for Disease Control and Prevention reported a surge in calls to poison control centers from 2010 to 2015, and there were 15 known kratom-associated deaths between 2014 and 2016.
In addition, doctors feared that people would use kratom to wean themselves off opioid drugs or alcohol without seeking professional help. The National Institutes of Health maintains that the substance has not been proven safe and effective for this purpose. And there is widespread fear of adulteration in such an unregulated product.
The DEA can temporarily designated substances as Schedule I (essentially banning them) for up to two years, if it believes they pose a threat to public health. The department had been able to retain or lift the ban after researching them.
The DEA announced its intent to temporarily place mitragynine and 7-HMG into Schedule I on August 31, 2016. The Controlled Substances Act (CSA) empowers the U.S. Attorney General to place a previously unscheduled substance temporarily into Schedule I if the DEA (in collaboration with the Department of Health and Human Services) determines it is necessary “to avoid an imminent hazard to public safety.”1 Prior to this announcement, kratom was regulated as an herbal product under FDA and DEA policies and, as such, was considered to be a legal substance in most of the U.S..
Placing a drug in Schedule I means that, in the opinion of the DEA, the drug has "no currently accepted medical use and a high potential for abuse. "7 The emergency schedule is usually for a period of 2 years (with a 1-year extension available) while the DEA gathers additional information, after which a more permanent classification can be carried out using the formal administrative procedure. The emergency schedule is only for Schedule I drugs.
When considering the timing of a drug, the DEA considers what is known as the Eight Factor Test, which includes data on the drug's potential for abuse, pharmacology, and risks. In the case of temporary planning, the Agency is required to consider three of the eight factors: the history of the substance and the current pattern of abuse; the extent, duration and significance of the abuse; and, if any, the risks to public health.1 In making its decision, the DEA takes into account the actual abuse of the drug, the diversion from legitimate channels, and the clandestine importation, manufacture, etc.
In making this determination on kratom, the DEA stated that "available information indicates that these opioid substances, plant kratom constituents, have a high potential for abuse, a lack of currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision."
In reaching this conclusion, the DEA found that kratom is "an increasingly popular drug of abuse and readily available on the recreation drug market in the United States. "1 The DEA also reported a large increase in kratom seizures intended for the recreation market in the first half of 2016. The DEA was concerned that kratom could be easily accessed from smoke shops and the Internet. It is misused for self-treatment of chronic pain and opioid withdrawal, and users have reported effects similar to those of prescription opioids. The DEA also noted that users report dose-dependent psychoactive effects including euphoria, simultaneous stimulation and relaxation, analgesia, vivid dreams, and sedation. In addition, addiction or dependence and withdrawal have been documented with long-term, regular use of kratom.
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