Poisonings from kratom, sold as an herbal supplement, are rising. But no one knows how much

An unregulated herbal product that advocates say can relieve pain and help with opioid withdrawal has been linked to at least four deaths in the Philadelphia region, but with many authorities failing to track kratom poisonings, there's no way to know if there are more deaths related to the substance.

Kratom, derived from the leaves of a Southeast Asian tree that is part of the coffee family, has gained popularity in recent years. It is sold online, in gas stations and in smoke shops, and is typically brewed as a tea, chewed, smoked or ingested in capsules.

An estimated 3 million to 5 million people use , according to the American Kratom Association, a Colorado-based nonprofit founded in 2014 to promote the herbal product. It has become a billion-dollar business, according to the Botanical Education Alliance, another kratom advocacy group.

The U.S. Drug Enforcement Administration announced in 2016 it would reclassify kratom as a Schedule 1 drug, similar to heroin or marijuana, a step other nations have taken. But the industry groups lobbied to keep it on store shelves.

The U.S. Food and Drug Administration says the active ingredient in kratom, mitragynine, is an addictive substance that acts on the brain's opioid receptors—and is indeed an opioid. Though touted as a stimulant (at low doses), sedative (at high doses), painkiller, and addiction therapy, kratom has no medical value, the FDA declared in February, and has been linked to at least 44 deaths nationally, though the agency admits tracking is haphazard. The kratom industry, meanwhile, disputes the FDA's science and data collection, insisting no one has died from kratom use.

Still, there are troubling indicators that poisonings are on the rise.

The American Association of Poison Control Centers has seen a sixfold increase in calls—from 97 in all of 2016, to 635 so far in 2018—to its national hotline for kratom use. Since 2016, it has recorded 10 deaths associated with kratom, three for the product alone, others in combination with other substances. Such mixtures, scientists say, can be especially dangerous because many users don't think kratom could compound the impact of other opioids, making overdose more likely.

NMS Labs, a nationally known forensic laboratory in Willow Grove, started testing for mitragynine about five years ago and is seeing more of it in postmortem toxicology cases, said vice president Barry Logan, a senior scientist. From January to June, there were 303 deaths in which mitragynine was found, often in combination with other opioids, he said.

In Pennsylvania, OverdoseFreePA, a website that tracks overdose fatalities, reported there were 27 deaths in 2017 in which mitragynine was present. Thirty-seven of Pennsylvania's 67 county coroners contribute to the database.

Since 2016, Bucks and Montgomery counties each have recorded a that coroners attributed to mitragynine. Chester County found two deaths where mitragynine was listed as the sole cause of death.

Those three counties, along with Philadelphia, have also found at least 19 other deaths where mitragynine was present in postmortem toxicology reports, alongside drugs like heroin, fentanyl, and cocaine. Delaware County has not found mitragynine in any toxicology reports.

New Jersey does not track mitragynine-involved deaths, according to the Department of Health.

The most recent local death attributed to kratom occurred in Chester County on June 27.

Caleb Sturgis, 25, was driving to work on the Pennsylvania Turnpike in Chester County when his car veered into the right lane, stuck a curb and flipped over. The coroner there ruled this month the West Chester man died from "acute mitragynine intoxication." There were no other drugs—save an amount of caffeine equivalent to what's in a cup of coffee—in his system.

"I remember (Caleb) very adamantly telling us (kratom) would be perfectly safe and not a problem," said his father, Scott, an editor with the Philadelphia Inquirer and Daily News. Caleb had struggled with opioid use in the past after the narcotics were prescribed for wisdom tooth removal but stopped using them a few years ago, his father said.

Caleb began using kratom in the form of tea in fall 2016 after reading online that it was a safer stimulant than coffee, which gave him the jitters, said his mother, Lori Chernisky Sturgis. There were no dosing instructions on any of the kratom products he purchased online, she said.

But his parents noticed that Caleb kept using more of the product, and was becoming cranky, irritable, nervous, and tired, Scott Sturgis said.

"I wish I had known more about it, because I would have nagged him and nagged him relentlessly," his mother said. "I can't bring him back. It's breaking my heart."

Montgomery County coroners listed Veronica Detwiler's cause of death in May as multiple drug intoxication. She had cocaine, heroin, fentanyl—and mitragynine—in her system.

Detwiler, 37, who also struggled with mental health issues, had been using opioids since she was a teenager, said her mother, Faith Detwiler, of Royersford. She had been in and out of rehab and tried 12-step meetings. She was even off all drugs for about two years, her mother said.

"I did not know she was using and I didn't know if she knew the risks," Detwiler said.

Brandon Jones was shocked when his brother, Ryan, 38, collapsed and died in May. He was equally surprised to find out that "mitragynine toxicity" was listed as a cause of death along with "hypertensive cardiovascular disease."

"I took it myself," Jones, of Downingtown, said about kratom. He described his brother as "a home body" who didn't use drugs, alcohol or tobacco. He was "a little" overweight and had high blood pressure, but no other heart-disease history and worked out every day.

Jones doesn't know why his brother was using kratom, which he purchased on the internet. He points out that "you have to go through rabbit holes to figure out what dose to take." Yet he supports keeping kratom legal.

"I think this is the first alert here," said Chester County Coroner Christina VandePol of deaths such as that of Ryan Jones.

Most physicians are not aware of the product and wouldn't know to ask patients whether they are using it. Many users think of it as an herbal supplement, not a drug, and may not mention it to their physician, she said.

"I do think people should be concerned and should be looking for it," she said.

Bucks County has had a total of 13 cases where mitragynine has been found. It was the primary cause of death in two of those cases, said Joseph Campbell, county coroner.

"I think a lot of research needs to be done with this particular item," he said.

FDA Commissioner Scott Gottlieb has been adamant in his criticism of kratom, with his agency issuing public health advisories and cautioning that kratom could expand the opioid epidemic.

The American Kratom Association, meanwhile, says government science and data are "incomplete, inaccurate, extrapolated and distorted."

"Every time we look at how studies were done, we've found some glaring errors," said David Herman, AKA chairman. He says his reviews show people died of heart attacks or cancer, not kratom.

"American citizens should have the right to consume what they want if it is not harmful," he said.

In 2016, 142,000 people signed a petition to the U.S. Senate Judiciary Committee asking that kratom not be listed by the DEA as a scheduled drug. Sixty-two members of the House and Senate wrote to the DEA in support of keeping kratom legal.

But Daniel Fabricant, president of the National Products Association, an 82-year-old trade association, says he agrees with the government on this one.

"That is not a dietary supplement, it is a drug, always has been, always will be," Fabricant said. The kratom industry is "making this a political issue and not a science issue."

C. Michael White, professor of pharmacy practice at the University of Connecticut, said kratom has been so little studied, its properties and risks are not fully understood.

Animal studies suggest its opioid effect could help treat pain. Respiratory depression has not been reported with kratom as with other opioids, he said, but it has been found to disrupt a liver enzyme that helps metabolize opioids, he said. For that reason, if drug users went off prescription narcotics or heroin in favor of kratom, but then went back to their previous drugs, kratom might be "increasing the deadliness of the other opioids that you were taking."

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User comments

Aug 21, 2018
Seriously, you need to get your facts correct and stop with the propaganda! Kratom is not a drug. You cannot overdose on it and every single "kratom death" has been debunked as most had way higher amounts of lethal drugs in their system or a long history of mental illness.
The truth is that the drug people want it banned so they can push their "opioid addiction drugs" on people and create addicts out of addicts! I have been taking kratom for 3 years and as a result no longer take ANY other medications for pain, not even tylenol. It works, it will help cure people of opioid addiction and can save lives. Morons like you are just trying to kill it so pharmaceutical companies can have higher profits pure and simple.

Aug 29, 2018
I am having a really hard time trusting elected officials on the so called "kratom deaths" 21 yrs sober CPP and use to be on 13 "FDA approved drugs" I can assure you these ppl died from FDA approved drugs, poly drug use. I'm not a med pro and read tox reports it's so obvious it's a big scam. Do better research, check deceased social media pages you will see some of them batted addiction even say 1 talking about using research chemicals and a cop talking about steroids. Looking at his body it was a little to obvious he didn't bulk up naturally. I keep asking myself WTH is going on and you quoted Daniel Fabrican't? You just lost all credibility quoting that rapist. Do a quick search and find the charges an employee made about her night out. Came too in a place went to the ER and tested pos for the date rape drug. I wish ppl did actual reporting and just like Pres. Trump keeps saying it's #FakeNews

Aug 29, 2018
First, kratom isn't "smoked" it does nothing if smoked. There has never been a recorded death solely with With the consumption. State refuses to release the toxicology report after many times requested by, it is obviously they are hiding behind their "state law", it is simple, the tox report would should something different. This fake Kratom propaganda is getting old. Oh, and the "44" kratom deaths FDA reports, consumers had pharmaceutical if not also illicit drugs in their system. It's clear, FDA does not want anything to do with this natural plant, since it hurts big pharma who finds FDA and DEA. You failed to also mention the 10s of thousands die each year with FDA approved medication. So here we are, fighting as Americans for our right to consume a natural plant and we have our controlling government trying to take it away. The feds lost the fight against cannabis and they will loose the fight against Kratom. Btw, there is #science behind kratom.

Aug 29, 2018
All we can ask of any person that wants to put information, news, thoughts on certain subjects. Is that you do your research. Follow where the science leads you. If it don't smell right, deeper. This world, unfortunately, is run by greed. It would be nice to think those government agencies have our best interests at heart, but the truth is, they don't always. Plants in and of themselves are God given and can do wonderful this. For the most part all these "dangerous plants" are only dangerous when man starts messing with it and synthesizing them down, making them stronger. Just do your homework. This is pretty much reefer madness all over again and now our government agencies are being made to back peddle. Do the research.

Aug 29, 2018
I am not suprised by the miss information here. Many responsible adults take kratom for a variety of reasons. The deaths is #fakenews and the FDA should be ashamed of themselves for failing to release information even after many people requesting the information. Why would the FDA fail to back up their arguments? Because they want people on "approved" medications to make bank on people's misery.

No thanks! I quit all pharmaceutical items 3 years ago. Strictly herbal or natural food items even for cleaning. I refuse to buy these mass production items that have questionable ingredients that no one knows how it will affect the human or environment. I will stick with plants. The great thing about knowledge is it's easy to spread and people can grow their own plants regardless of government misinformation.

Aug 29, 2018
As a CCP, I have no other options!! Kratom has been proven to be safe by some of the nations leading scientists etc! Before finding Kratom, I had tried EVERYTHING to alleviate my pain and suffering! I was in Pain Management for over 10 yrs, was prescribed Kadian (morphine) at 26yrs old! From there, I went from Oxycontin to Fentanyl! I trusted the system, I lived that life day in day out. I was still unable to live a productive life! I dropped out of college, my life has been a blur! I'm now 44.. and will graduate next year with a degree in Human Services. That would never have been possible had I continued living on Pharmaceuticals! I lost so many years of my life trusting my doctors and the pharma drugs that controlled my life! Kratom is simply a natural leaf, it is so simple yet the powers that be want to take it away because they aren't profiting! Follow the science, not the opinions of those who have not done their research! Follow the Science!!

Aug 29, 2018
You NEED to quit lieing about kratom, big pharmaceutical companies are paying you to spread lies about KRATOM and YOU don't know what you are talking about. Why don't you check it out, instead of saying it is harmful?? You apparently are misinformed about the benefits of KRATOM and don't want to help your fellow man in getting a LIFE without the poision the big pharmaceutical companies are pushing. My prayers are for you to see the harm you are spreading.

Aug 31, 2018
Totally not believable. Im surprised a Science publication would fall for the "anti" propaganda so willingly. I would be shocked if there was one real death from kratom. If you are an alcoholic or opioid abuser trying to stay clean, this is a gift from God. It kills any desire to abuse or feed an addiction, and allows one to function normally with virtually no desire for a substance. It is benign in every sense of the word. The feeling it provides is not a 'buzz' or high. It is just a mild sense of well-being. In a world where alcohol is legal, it is the height of hypocrisy to demonize a safe plant and people who choose to live a holistic lifestyle. I cannot opine what it is right now, but Im sure when the truth is known about this war on kratom, and all the fake, manipulated data provided by the 'anti' forces, it will have something to do with money. It always does. So again . . . Many people suffer so few can prosper.

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