War on Drugs Ensnares Coffee Relative

Wisconsin becomes the fourth state to ban kratom, which is closer to caffeine than opium.

Kerry Biggs needed help managing her chronic pain.

Years of taking prescription medications to alleviate the pain caused by her fibromyalgia, rheumatoid arthritis and other ailments had left the mother of two "feeling foggy."

Desperate to find an alternative, Biggs tried kratom. Derived from the leaves of the kratom tree, a close relative of the coffee plant, it has been used for centuries in Southeast Asia for its medicinal properties.

In small doses, kratom acts as a minor stimulant similar to caffeine. In larger doses its works as a painkiller and can act as an antidepressant for some people. 

"It gave me a new lease on life," said Biggs, who was able to wean herself off prescription painkillers by using kratom. "It dampened down my pain without all the side effects that come with taking prescription drugs."

That new lease on life came to an abrupt end last year, because Biggs lives in Wisconsin. In 2014, Wisconsin became the fourth state to ban kratom.

Kratom was never mentioned by state legislators either before or after the vote that made it illegal. 

Instead, two of the chemicals in it were included on a list of synthetic opioids lawmakers classified as Schedule 1 drugs, despite the fact kratom is neither synthetic nor an opioid.

No one in Madison has been able to explain how or why the chemicals ended up on the list, but their inclusion means kratom is now in the same category as heroin and cocaine.

At a meeting of the Wisconsin Controlled Substances Board last week, board member Alan Bloom said he was surprised to see the kratom on the list of schedule substances.

"They stick out like a sore thumb," said Bloom, a professor of pharmacology and toxicology at the Medical College of Wisconsin.

Bloom was blunt in his assessment of the scheduling of kratom. "There's no scientific basis for it," he told his colleagues.

But state lawmakers aren't required to rely on science in their decisions. In 2012, legislators in Indiana made kratom illegal by declaring it to be a synthetic drug.

Tennessee and Vermont followed Indiana's example, treating a tree's leaves like something created in a lab.

"Most people in this country have never heard of kratom, and there's a lot of bad information out there about it," said Susan Ash, executive director of the American Kratom Association.

Ash has used kratom since 2011 to manage the symptoms of advanced Lyme disease. She founded AKA last year to advocate for people who use kratom and combat misinformation and efforts to ban it.

"There are some companies out there who aren't interested in helping people and they are promoting kratom as a 'legal high.' That's led to some hysterical stories in the media," Ash said.

"Usually it's a story by a local TV news crew. They usually claim it's a dangerous new synthetic drug, even though it's not synthetic and it's been used for hundreds of years in Asia. They never talk to people who use for health reasons."

Kratom, she says, "would be a terrible recreational drug. You either drink a liquid extract of kratom or swallow it as a powder, and it tastes awful. It tastes like green tea mixed with dirt."

Anyone looking for a high, legal or otherwise, is going to be disappointed by kratom, according to Dr. Jack Henningfield, the former chief of the Clinical Pharmacology Research Branch at the National Institute on Drug Abuse.

"Kratom has what is known as a ceiling effect – that is, the pain relief it provides in larger doses has a definite limit. No matter how much you take, it is never going to reproduce the effect of a morphine-like opiate," Henningfield said.

"The best comparison is caffeine. People drink coffee or cola to get the stimulant effect of caffeine. But even drinking a lot of coffee is never going to achieve the stimulant effect of amphetamines because caffeine also has a ceiling effect."

Henningfield is vice president of Health Policy and Abuse Liability at Pinney Associate, a scientific consulting firm. (Pinney was hired to study kratom by United Naturals, which makes a low-dose liquid extract of kratom that it sells as a short-term energy booster.)

"My team and I reviewed the medical literature to determine the potential for abuse of kratom," Henningfield said. "Again, the best comparison is caffeine. Some people may come to depend on it for its effects, but it doesn't pose a real danger of addiction or other severe adverse effects."

CSB member Dr. Timothy Westlake sees the possible public benefits in making kratom legal again.

"We're trying to decrease the amount of opiates that are prescribed for pain. [Kratom] is not a panacea, but the addictive potential seems a heck of a lot less than that of opiates," Westlake, a physician, said at last week's meeting.

Descheduling kratom in Wisconsin would be a long process. But last week the board voted unanimously to take the first step, directing its staff to research how the two chemicals in kratom found their ways onto last year's list of substances to be scheduled.

The only reason the CSB took that first, tentative step is because Kerry Biggs and a group of other Wisconsinites represented by AKA pressed the board to do so at its August meeting. 

Biggs, who attended the more recent CSB December, was pleased by the board's action. She intends to make the long drive from her Milwaukee home to Madison every time kratom is on the board's agenda.

"I'll keep coming back, as many times as necessary," Biggs said. "This is very important to me. It's very important to a lot of people."