To help or to harm: The controversy over kratom
February 1, 2019
STEAMBOAT SPRINGS — One year, eight months, 17 seconds.
That is how long Steamboat Springs resident Alex Malacoff has been clean — at least on Thursday morning when he opened an app on his phone that he has been using to track his recovery.
Malacoff started using opioids when was 18. First he took pills, then he switched to shooting up heroin. At the time, he lived in Pennsylvania, where the state’s department of health declares the prescription opioid and heroin overdose epidemic "the worst public health crisis" in the state.
Malacoff used opioids off and on until he was 25.
"It was more on than off," he said.
Every time he tried to get clean, the withdrawals that racked his body brought him back to using.
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"It feels like the flu times 10," he said of his withdrawal symptoms.
About five years ago, he tried kratom, a botanic dietary supplement that some users say offers euphoria and pain relief similar to opioids without the debilitating side effects or overdose risk. It helped Malacoff to manage his withdrawal symptoms.
"It was the first time I quit doing heroin," he said.
It took a few more attempts to stay clean, but one year, eight months and 17 seconds later, Malacoff said that he owes his sobriety to kratom.
Kratom is a legal supplement in the U.S., usually sold at head shops alongside rolling papers and psychedelic tapestries. The powder form that people purchase comes from leaves of the kratom tree, native to Southeast Asia.
The American Kratom Association estimates that 3 to 5 million people have used the supplement. Proponents, including Colorado Governor Jared Polis, say that it is largely harmless and that it can help people like Malacoff overcome an addiction. Yet it remains controversial.
The U.S. Food and Drug administration has not approved any uses for kratom. The commissioner of the FDA is one of many critics who accuses the supplement of being addictive itself and unhealthy, even deadly, to users.
In 2018, the FDA issued a health warning for kratom, announcing that it has "opioid properties" and associated its use with the deaths of 44 people between April 2011 and December 2017.
In a statement, FDA Commissioner Dr. Scott Gottlieb said his agency used scientific research and computational modeling to conclude that kratom has "potential for abuse, addiction and serious health consequences, including death."
In 2014, the FDA temporarily labeled kratom as a suspicious substance and temporarily banned its import into the U.S. The agency eventually lifted that ban, but cities like Denver have passed restrictions on the sale and use of kratom.
Advocates, including many politicians, see kratom as a way to address a growing, national opioid crisis. Governor Polis signed a bipartisan letter last year, when he was still a Democratic congressman, asking Gottlieb and the FDA to lift the health warning on the supplement.
In that letter, Polis and other politicians said the "beneficial potential, safety, and efficacy of kratom has been discussed, studied, clinically researched, and found to be as safe as coffee,” citing studies funded by the National Institute of Health.
Proponents of the supplement argue that the 44 people who died with kratom in their system had mixed other drugs with the supplement, which contributed to their deaths. Of those deaths, only one case had no "historical or toxicologic evidence of opioid use, except for kratom," according to an FDA report.
Dave Herman, chairman of the American Kratom Association, attributes none of those 44 deaths to kratom. "The FDA is saying people died, and they found kratom in their system," he said in an interview with Rolling Stone."It's like if I drank a Coke and got hit by a truck."
Malacoff, who doesn't see any reason that kratom should be illegal, uses the supplement every day. He mixes the fine, earthy-green powder into a glass of water. The taste, he says, is awful — like drinking dirt. Honey helps it go down.
He usually takes one to three doses throughout the day, after which he feels an energy boost similar to a cup of coffee without the inevitable crash.
"It makes me more talkative," he said, which comes in handy at his job at a marijuana dispensary in town.
For Malacoff, kratom gave him his life back. When he was trying to come off opioids, the withdrawals exhausted his body.
"You feel like trash," he said. "Everything just hurts."
The pain relief from kratom made sobriety possible.
"It worked well enough for me to be able to go to work," he said.
Malacoff admitted that he experienced some side effects when he started taking kratom, mostly nausea. He added that the supplement does involve a slight physical dependency.
"It's really mild," he said, comparing it to a dependence on caffeine.
If he stops using kratom for a few days, he notices that his body does not regulate temperature normally.
"It's not perfect by any means," he said. "But it's a heck of a lot better than doing dope."