The Immorality of the Kratom Extract Industry

This is the second in what will likely be a series analyzing and asking critical questions of the kava and kratom industry. Today, we focus on some trends in kratom extracts that I, and many of my close friends, have grown increasingly concerned with.

To start off, for those that do not have a background on kratom…

What is kratom?

Kratom is a plant in the Rubiaceae family of flowering plants, hailing from southeast Asia - I’m already getting ahead of myself. Let’s start this off with the ‘discovery’ of kratom by western science, and work our way back a bit through indigenous use of the plant; then move toward developing a surface level understanding of the modern science of the plant, and it’s activity within the human body.

Pieter Willem Korthals was a member of the Commission for Natural Sciences of the East India Trade Company(yeah that one…) between 1830-1837. In this time, he ‘discovered,’ classified, and named numerous plants found in the Malay peninsula. Korthals was the first European to ‘discover’ Mitragyna speciosa(kratom) and named it in 1839. Interestingly enough, due to a clerical error made by Korthals, his initial naming of the plant did not stick. He published the creation of a new genus, and the new species in the same publication, but he neglected to include a species description, making it invalid according to the International Code of Botanical Nomenclature. The name changed a lot after that. Korthals himself transferred the species to a different genus, Stephegyne, in 1842. Steudel, Blanco and Miquel all moved the species in to Nauclea, in 1841, 1845 and 1856 respectfully. The species was moved back to its current home, and assigned its currently accepted name, Mitragyna speciosa (Korth,) by Havilland in 1897.1

Kratom (Mitragyna speciosa) is a tropical evergreen tree indigenous to Southeast Asia, reaching heights up to 82 feet with trunk diameters up to 3 feet. Its ovate-acuminate2 leaves, typically 12-17 veined, can grow up to 8 inches long and 5 inches wide, with vein colors ranging from white to red.3 Kratom is in the Rubiaceae family of plants - this is the fourth largest family of plants, containing more than 13,000 species, split among 600-650 genera.4 This family is also one of the older groups of flowering plants, estimated to have diverged around 90.6 million years ago. This family contains numerous species of economic, industrial, and medical importance. Everything from Cinchona species(where quinine is derived from,) to Coffea species(primarily arabica, whose seeds are roasted to produce coffee,) to Uncaria gambir(used to produce a substance used in tanning.) to Rubia tinctorum(previously cultivated for its roots to produce red dye.)5 Many species within this family are used as sources of timber as well, but there are far too many to choose a single representative.

Kratom Through an Indigenous Lens: cultural significance and medicinal use

Kratom has a history nearly as ancient as human habitation of South East Asia, it’s discovery by indigenous peoples is impossible to accurately determine, but we can begin to infer it’s age by the way it is integrated within ceremony and ritual. One such ritual has to do with family, kratom leaf was used as an offering in honor of fallen family members.6 Interestingly enough, there is also a communal element, akin to kava(Piper methysticum,) communities would gather, and more often than not, they’d gather around this plant and share in communion with each other. The innate draw to social lubricants is as ancient as our species itself.

Many of the Mitragyna species have been used within indigenous medicine, and many of the African species have been used as a wood source, but today we focus on M. speciosa, kratom. A professor of epidemiology in Thailand, Sawitri Assanangkornchai, said that kratom has been used medicinally in South East Asia “from time immemorial.” Leaves were often chewed as an energy support, akin to our use of coffee, but medicinal uses of leaves ranged from wound dressings to use as a local anesthetic. Liquid tinctures were used to treat ailments such as: coughs, diarrhea, musculoskeletal pain, and as a supplement to increase male virility and sexual prowess.

It is hard for us to truly know all of the indigenous uses of kratom, and what we do know of it’s ancient roots is based primarily on second-hand writings of vocal stories passed down through countless generations.

Suffice to say, kratom has an ancient, storied history.

How does kratom work? What does it do?

Kratom contains a variety of active compounds, but the predominant active alkaloids powering its explosive popularity are, mitragynine(MG) and 7-hydroxymitragynine(7-OH-MG.) Contrary to the claims of industry, these are opioids from a non-opium source. To hammer this point home, both MG and 7-OH-MG show a high affinity for opioid receptors, interaction with naloxone(Narcan,) and two-way cross tolerance with morphine. There can be no doubt about their classification as opioids, we must stop pretending they are not, and we absolutely must inform consumers of this scientific fact.

Mitragynine is the dominant alkaloid within the plant, accounting for about 66.2% of the content of crude extracts, and 6% of the dry weight of leaf; but over fifty alkaloids have been isolated, and classified. I will not be diving in to them here, but some of the more interesting significant minor alkaloids are: speciogynine, paynantheine, and mitragynine pseudoindoxyl(a metabolic product that acts on opioid receptors.) Minor alkaloids are still not well researched, but what little research we have indicates measurable impacts on effects, and enormous promise as medicinal compounds. As is the case with many medicinal plants, the alkaloids of kratom have a synergistic relationship with each other, and it is difficult to disentangle their effects from one another. This also means, isolating them from each other, and manipulating the alkaloid profile can significantly alter the safety profile of kratom products.

When taken at low doses, MG and 7-OH-MG produce stimulant like effects, this can be seen in kratom’s long history of use by laborers to alleviate work related fatigue. At high doses, opium-like effects can be achieved; this has led to it’s use as a treatment for pain, diarrhea, cough, hypertension, depression, fever reduction, and in alleviating opiate withdrawal symptoms.7 

Opioid Receptors, Endogenous Opioids and Mitragynines.

The endogenous8 opioid system, the system of opioid receptors and neurotransmitters within the human body, is a complex and incredibly important piece of our biology. For a long time, our only understanding of opioids, and opioid receptors within the human body came from the human relationship with Papaver somniferum, the opium poppy. It wasn’t until the 1970’s that we discovered endogenous opioids and began to understand the role they play within the human body. The endogenous opioid system is critical for everything from stress resilience to pain relief, from triggering euphoria to the control of how much we eat.9 Dysfunction within the endogenous opioid system is thought to be involved in depression, seizures, and even Parkinson’s disease.

Another side of the endogenous opioid system is its role in addiction. Alterations within the reward systems of the brain tie directly in to addiction; these systems are heavily impacted by dopamine activity and cortisol response - both of which are modulated by endogenous opioids and the receptors they bind to. Long term use of exogenous10 opiates leads to deficiencies in endorphins, which leads to reward seeking behavior, i.e. opiate seeking behavior.

Mitragynine and 7-hydroxymitragynine both bind to mu-, delta-, and kappa opioid receptors - both compounds show a higher selective affinity for MOR over both DOR and KOR. MG shows a 10-fold selectivity for MOR over DOR, and a 1000-fold selectivity for MOR over KOR. 7-OH-MG, while stronger, has a similar ratio of affinities for MOR and DOR, with affinity for KOR being near equal to DOR. Further, both MG and 7-OH-MG show profound antinociceptive effects(pain relief,) through their action on the central nervous system - as evidenced by effects observed when MG was injected directly in to the brains of mice. In antinociception studies such as mouse tail flick tests, mouse hot-plate tests, rat paw pressure tests, and dog hindleg flick tests - the results are the same, antinociceptive effects were observed.11 What does all this mean? Alkaloids found in kratom elicit observable, laboratory confirmed, pain relief through direct interaction with opioid receptors within the central nervous system. It is further confirmation that these compounds are, irrefutably, opiates - they act within the body in similar ways as classical opiates such as morphine and codeine, and meet every single marker for classification as such.

Modern Use

In modern times, kratom is often used as an alternative to various other substances, both legal and illegal. From replacing the innocent, ala caffeine; to replacing more harmful substances such as alcohol and illicit opiates - many within this community are seeking harm reduction, but more importantly, a sense of belonging.12 This is the key to our community, and to it’s success up until this point. We have rallied around a collective effort to live a life less harmful to our well being.

In my opinion, the most important aspect of kratom, and the various botanicals served within kava bars is this — many people never found comfort in alcohol, nor the bars in which it is served. Without this many people feel a lack of community. It is hard to be ‘sober’ in this world, and maintain a semblance of community, especially, for those that get triggered around alcohol. For them, kava bars and the ethnobotanical community at large, have become a place of solace, a community in which they feel safe and comfortable. A place where they feel home.

As we move forward, the number of people seeking alternatives to alcohol will continue to grow. New people walk in to kava bars everyday, and they are meeting these substances for the first time in their life. If we do this right, we have the collective power to create a seismic shift within our society; a chance to decrease and manage harm at a societal scale. A chance to renew humanities sense of community.

We must take this responsibility seriously. These plants are powerful, and have the potential to cause harm. If we do this wrong, we are no better than tobacco companies in the 1950’s.13

Modern Abuse: abuse liability of 7-hydroxymitragynine

Abuse liability is something I have spent a long time thinking about, and not only in regards to kratom. I have spent many a night pondering the abuse potential of everything from alcohol to cannabis to caffeine. Abuse potential is determined through various means, the primary mode of initially quantifying this is through animal studies. The science on the abuse potential of kratom is an ever evolving subject, currently there is work goings towards a human abuse potential study,14 and I for one am looking forward to seeing the results.

Trigger Warning: Many animal studies border on animal abuse and some of them are described in this section. If this may trigger you, I highly advise you skip this section. There are a lot of ethical concerns that we could discuss; for now, let’s just look at the data.

Something interesting about kratom is this, in a study using the rat self administration and substitution paradigm, it was found that after rats acclimated to 7-OH-MG they were more likely to use an increased amount of morphine upon it’s substitution, however, this effect was not observed with mitragynine.15 The takeaway here is this: mitragynine seems to have an aversive effect on morphine use, ie, it decreases the likelihood of use; while 7-OH-MG increases the likelihood of use. This result indicates that 7-OH-MG has significant potential for abuse. This may infer a similar effect in humans, and the circumstantial observational evidence just keeps piling up. Extracts that are high in 7-OH-MG have been exploding in popularity, and watching the way people flock to them, buying multiple tubes of 200mg+ extract in one day is disturbing, if not outright confirmation of this inference.

Another type of study used in assessing the abuse liability of drugs is, intracranial self stimulation. In this paradigm, electrodes are placed in the brains of mice, usually in the medial forebrain bundle near the hypothalamus. During experiments, different frequencies and amplitudes of stimulation are applied. The responses to various stimulus are interpreted as either an abuse-stimulating effect, or an abuse limiting effect. ICSS can be related to operant conditioning, in which, stimulus is associated with a reward and can be used to train a subject, except in ICSS, the stimulus directly induces reward seeking behavior within the brain.

In an initial ICSS study comparing mitragynine, 7-hydroxymitragynine, and morphine16 it was found that both 7-OH-MG and morphine increased response latency(time between stimulation and response.) Additionally, it was found that 7-OH-MG increased reward thresholds(strength required for behavior induction,) while morphine decreased reward thresholds. Through post-hoc statistical analysis, the authors of this study, concluded that neither mitragynine, nor 7-hydroxymitragynine have significant potential for abuse within the ICSS paradigm.

I note this study in such detail, because it is important to keep in mind, the science of determining the abuse liability of any substance is complicated. We can not take one study that supports a preferred image and discard the rest - no one experimental design can paint the picture alone. I have a lot of respect for the authors of this study, especially Christopher McCurdy, and I do not mean to devalue or negate this work - but it must be noted that this conclusion does not align with many others.

There are many other studies on these alkaloids that point to significant potential for abuse, at least, when it comes to 7-hydroxymitragynine. Of special interest in relation to kava bars, are the studies on conditioned place preference. In CPP studies, mice learn to associate a specific location with the administration of a drug, and to associate another, clearly different location, with the lack of said drug. After a preset period of time, they are allowed to choose which they prefer. Mice that show a strong favorability to the administration site are said to have a place preference. This is exactly what happened when this was done with 7-hydroxymitragynine. Mice showed a strong, dose-dependent place preference compared to the control.17 Looking at the behavior of consumers of kratom extracts within businesses that sell them, there is more than enough evidence to infer a similar effect in humans.

Why we should be concerned: the addiction business

What we are facing is a systemic as well as a cultural issue within this community. The reality is, we are a community whose population is made up of a large percentage of recovering addicts. We know this. Business owners know this; and, some of them exploit it to increase their profits. Exploitation of a vulnerable community is never okay, and to exploit a vulnerable community in order to gain profits is absolutely reprehensible.

The following story is all too common and if you stay in this community long enough, you will witness it yourself. One day, someone early on in their recovery will walk into a kava bar. Invariably, they will be recommended kratom. Tolerance builds quickly, and once it does, some irresponsible party will suggest they try an extract to feel something again, and off they go — off to chase the dragon once again. One thing leads to another, and one fateful, fatal, day, extracts will not not be enough to satiate the desire, the need. They step out, they WILL find drugs, and more often than not, they will end up with fentanyl…and then? They are dead. Gone. Forever.

I, and a lot of people I call friends, have lost many people like this. The responsibility for this falls on, not just the industry leaders, but all of us. The community as a whole.

Every single death.

Every. Single. Relapse. 

We could have prevented them.

We can do better, we should do better, but how?

Education: or the lack thereof

To this day, education within the kratom industry has been abysmal.

There is one business association in particular(the American Kratom Association18) that should lead the way in education and harm reduction - but instead, they seemingly intentionally, mislead both the public, and the state - concealing the fact that it has been well demonstrated that kratom, especially when the alkaloid profile is manipulated away from it’s ‘natural’ balance, is highly addictive and has high potential for abuse. Additionally, instead of presenting the full picture, they continuously point to adulteration as the primary cause of harm. Granted, adulteration is a significant issue, but this behavior is highly irresponsible. While, it is true, dried leaf products have a similar profile of abuse liability to coffee - kratom is addictive, and habit forming. Does this mean that prohibition of kratom is the answer? Absolutely not.19 Caffeine is highly addictive and habit forming too, but do we ban coffee? Or cola’s? Or caffeine pills? Absolutely not.

Well what about extracts? They are highly manipulated and intentionally designed to be highly potent, and therefore, have high potential for abuse. Does this mean we should ban extracts? Preferably, no. Absolutely not. This plant and its concentrated forms are powerful herbal tools, we humans have a right to use them, and it is more than possible to implement them, responsibly, into our lifestyles and wellness plans. There are many such cases of individuals that, for the most part, do not use extracts. The only time they do is at times of intense pain, whether acute pain, or a flare in chronic pain that becomes an impassable obstacle in life. For those of us with a history of substance abuse, those of us that can not seek relief from pharmaceutical options; having this option available is incredibly important, and limiting access would lead to immense harm and, inevitably, loss of life.

But something has to give, and if the threat of a blanket extract ban is what that takes? Maybe that is what this industry needs to finally take the harm it is causing seriously. Most of all?

We need to educate.

We need to inform.

This is of the utmost importance, both for the health of our community, and for the continued legality of kratom. We must take control of this. We must hold the businesses surrounding our community accountable to stringent product standards, and strict ethical guidelines, because if we don’t, I may, for once, have to agree with the FDA.20 

We must immediately adopt a model of informed consent and harm reduction across the entire community and industry surrounding it. We must demand that these businesses make enforceable commitments to do better, to be, better. They must commit to reducing harm, or we must force them to by withholding our money. We do not owe any of them our business, they do not have a monopoly on our habits.

There is a responsible way to do this, and there are many businesses that do it right.

The State of the Extract Market

Kratom extract manufacturers have been on a slippery slope since their inception. Competing with each other to produce stronger, more potent extracts. Manipulating the alkaloid profile to increase the high, increase the addictive potential and, therefore, increase abuse potential beyond a reasonable amount.21

One of, if not the, most recognizable names in the kratom industry is OPMS. While, their powdered leaf products are not the worst on the market, their extracts are pretty darn sketchy. Especially since their products are one of the most common kratom products to be counterfeited. Even so, OPMS shots(a potent, 5ml vial of extract) straight from the manufacturer, often tests positive for everything from the innocuous(residual solvents) to the potentially dangerous(DXM.)

But the latest, most popular extract that the kids are flocking to(sometimes literally) is Tusk. There is a special place in hell reserved for the manufacturers of tusk…this extract product has it’s alkaloid profile pushed to the absolute extremes. It is so potent that many people refer to it as the closest thing on the market to pharmaceutical opiates. I have not gone a single week since it’s release without hearing it compared to Percocet.

THIS IS NOT OKAY.

Worse still, this is not an isolated phenomenon. More and more extract products with their 7-OH-MG boosted to absurd levels are entering the market every month. In fact, we finally have verifiable deaths attributable to kratom exclusively, and they will keep happening.

This has to stop, and if we are not going to step up and stop it, then, sorry not sorry, I will be joining the forces advocating for a blanket ban of kratom extracts.

DO BETTER.

The Rise of the ‘Smoke Shop’ Model

I am going to try and write on what I have observed in an unbiased way, with generalized language, because my intent is not to harm anyone’s business, regardless of their current, seemingly malicious, business practices. The intent is to draw attention to harmful practices that seem to be gaining popularity in this industry; hopefully, those that are causing harm will accept accountability, and make an effort to do better. And if they don’t? We see you.

Anywho! Have you noticed the increase in the ‘smoke shop’ model in kava bars? By this, I mean, kava bars that derive a significant portion of their profit from third-party products. The ones that profit the most from selling packaged extracts, and pushing whatever the newest, strongest extract is. The amount of excessively potent, potentially adulterated extract products that flow across the shelves is disturbing to say the least.

The actions exhibited within this model seem to be defined by an intentional effort of the business to get it’s customers ‘hooked’ to the products they sell; and there is no shortage of predatory extract manufacturers to provide them the tools to do so. Some bar owners even refer to their customers as junkies.

All of this shows a complete lack of accountability within the industry. These businesses do not show any semblance of care for the at-risk community that they serve. Additionally, these businesses continue to sell to people that have been hospitalized for both chronic, and acute illnesses that were likely exasperated by the potent extract products they are sold.

This is not representative of the community that I fell in love with, and this should not be allowed to continue.

What should we do?

You may be sitting there asking: “Well Eevee, since you are pointing out all these issues, what do you think the solution is? What can we do to make a change? I’m just one person!” Well my lovelies, I am beyond elated that you asked!

First things first, you can share this post. We need to have this discussion as a community, use this as the seed.

Communal Accountability: voting with our dollars

The most straightforward option; the easiest option as an individual; the thing you can do today, right now, is vote with your dollar. Stop supporting businesses that operate like pill mills. These businesses fully believe they are obligated to every penny you spend with them, and even reducing that by twenty percent will hurt. Leave negative reviews for businesses that show a pattern of reckless behavior and consistent harm. Make sure they know why this is happening, without that awareness and without a little push, they will never change.

On the other hand, we must prioritize supporting businesses that make education, harm reduction, and communal development their priority. The backbone of this industry must be community, harm reduction, and mutual aid; we must take care of each other if we are to survive.

Regulation: self or otherwise

The best option available to us is self regulation. We can, and should, come together to return this industry, and this community, to balance. We must make this industry THE most ethical, conscious, and health minded industry in this country. There is too much at risk for us to be ambivalent about this.

The other option is less ideal, but this is important enough to warrant intervention by the state if we can not do it ourselves. If so, we must completely bypass the American Kratom Association(they have been corrupted by moneyed interests) and take direct action. Email your representatives and senators. We must demand sensible, science based regulation. Eventually we will begin circulating an open letter outlining some regulations that this industry desperately needs.22

We need a ‘Kratom Consumer Protection Act’ that is not corrupted and watered down by the interests of industry. We need legislation that legitimately protects consumers, NOT the businesses that care only about extracting as much profit as possible from our community.

Unionization

I have spoken on this in passing many times, but, it is far past the time for us to unionize this industry. This has the potential to completely change the industry for the better. Both for the workers within it and the consumers that rely on it. The collective power of the workers within the industry can not be understated, it could not, and can not, exist without them. We must use that power to make it safer for the consumer AND to fight for better working conditions. You heard that part right - you deserve better pay.

To those bars that are still employing the incredibly exploitative practice of ‘shift pay,’ an illegal practice by the way, we see you. Do better.

Your right to organize with your fellow workers is protected under the National Labor Relations Act, and there are federally funded resources to help in this process. Forming a union, while it is work, could not be simpler. Once you have decided to form a union, and have determined that at least 30% of the workforce is on board; file a petition application with the National Labor Relations Board. Once your petition is filed, a representative from the NLRB will help organize and run a secret ballot election; this will either be done in-person, through the mail, or some combination of both. If the majority of the workers at your place of work vote in favor of a union, congratulations! You now have a union that will act as your exclusive collective bargaining representative. There is one other option to form a union, your employer can voluntarily recognize your union after you show that a majority of the workers are in favor of unionization. Sadly, knowing the owners in this industry, I doubt that this is an option for most of you.23

In Conclusion:

The prevalent use and promotion of highly addictive kratom extracts within the kava community poses a dangerous path back to substance abuse and fatal overdoses. We touched on several related themes, such as the high potential for abuse of 7-hydroxymitragynine, the potential these products have of exasperating preexisting health conditions, and the likelihood of them being responsible for more fatalities. We also discussed the industry writ large, the community surrounding it, and how — what should be a symbiotic relationship — has become a toxic and exploitative one.

I have presented some of our options to move forward and make our community healthier. Use your voice, ‘vote’ with your dollars, use our collective power to organize and make this industry better. I am just one person, but today I start the conversation, and call you all to action. Feel free to message me with any questions, and most of all, be a part of the change that we need to see, else, the security of access to kratom will be at risk for us all.