Kratom

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Key Facts

externally-reviewed

      • Kratom, also referred to as thang, kakuam, thom, ketom, biak, kratho, or ketum, is a group of tree-like plants in the Mitragyna genus of the Rubiacea family.
      • Kratom is consumed for its stimulant effects and as an opioid substitute. Individuals can consume the plant by chewing, smoking, brewing it into a tea, or by ingesting it in tablet, capsule, or concentrated extract form.
      • Little is known about the production and food safety of kratom, as it is a banned substance in many parts of the US and is illegal in many of the countries where the plant is grown.

Introduction

kratom_tree
Young Mitragyna speciosa tree. Photo by: Wikimedia Commons

Kratom, also referred to as thang, kakuam, thom, ketom, biak, kratho, or ketum is a group of tree-like plants in the Mitragyna genus of the Rubiacea family. The species, Mitragyna speciose, has two active chemical compounds: miragyna and 7-hydroxymitragynine.  The physiological effects of these compounds are similar to sedatives (e.g., opioids) when consumed in high doses and to stimulants (e.g., cocaine) when consumed in low doses.  Kratom plants are indigenous to Southeast Asia, specifically Thailand, Indonesia, Myanmar, and Papua New Guinea, where they have historically been used in socio-religious ceremonies, in traditional medicines, during social gatherings, and as a stimulant to improve work productivity. Thailand first regulated kratom under the Kratom Act of 1943 and, currently, planting, possession, import, and export of the plant are all considered illegal.

It is also banned in Australia, Bhutan, Malaysia, and Myanmar . However, kratom plant extracts have recently emerged in other regions, including the United States. The Federal Drug Administration (FDA) has declared kratom to be an opioid substance, but the scheduling of the drug remains to be determined . Because the drug has not been labeled as a scheduled drug by the FDA, state and local governments can create their own laws on the banning of kratom. Currently, it is illegal to buy, possess, or use kratom in Alabama, Arkansas, Indiana, Tennessee, Vermont, and Wisconsin. There are some cities and counties throughout the US that have banned kratom including Denver, CO, Jerseyville, IN, and Sarasota County, FL .

Foodborne Outbreaks and Recalls

As of April 5, 2018, there is a confirmed multistate outbreak of SalmonellaI 4,[5] ,12:b:-,Salmonella Javiana, Salmonella Okatie, and Salmonella Thompson epidemiologically linked to kratom, with 132 persons ill and 38 hospitalized. There have been no reported deaths. Ill persons reported consuming kratom in various forms, including pill, power, and tea. North Dakota and Utah public health officials tested leftover powder obtained from ill persons, and the powder was positive with the SalmonellaI 4,[5] ,12:b:- outbreak strain. The two ill persons who provided leftover powder reported purchasing kratom from online kratom dealers. Investigators have not yet identified a common source of kratom products, and the CDC has recommended not consuming any form of kratom .

On March 10, 2018, an Oregon company, PDX Aromatics, recalled three brands of kratom powder: Kraken Kratom, Phytoextractum, and Soul Speciosa. There are at least 10,000 units of kratom powder subject to the recall after the company identified a supplier in its supply chain as a source of Salmonella. The company was alerted by the California Department of Health (CDPH) after certain lots tested positive for Salmonella and were associated with a confirmed case of Salmonella .

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Kratom in powder form. Photo by: Wikimedia Commons

On March 30, 2018, the FDA issued Triangle Pharmanaturals of Las Vegas, NV a “Notification of Opportunity to Initiate a Voluntary Recall.” The FDA allowed the company 24 hours to respond to the notice; however, Triangle chose not to voluntarily recall their kratom products within the allotted time frame. This inaction led the FDA to issue its first ever agency mandated recall since gaining that power under the Food Safety and Modernization Act of 2011. The recall was prompted when products from the company tested positive for Salmonella. The FDA is still urging customers to not consume any kratom products as they may be contaminated with Salmonella .

 

Production

Kratom plants are best grown in hot, extremely humid environments. Therefore, many of these plants are currently grown in the jungles of Thailand, Indonesia, and Malaysia where they can grow up to 115 feet in a cluster arrangement.

In southeast Asia, harvest season for the plants is considered to be late summer for early autumn or maximum yield and potency . For smaller production, plants and seeds can be purchased through internet vendors and grown at home. These plants can be difficult to grow in open air due to their need for a tropical climate, fertile, rich soil, and excessive water . If the seeds germinate, the leaves will not be ready for harvest for up to a year. Once the harvest occurs, either by the leaves falling off or by picking the leaves off the plant, the leaves can be crushed and refined for personal consumption. On a larger scale, growers harvest and send crushed leaves to distributors, who then use an industrial grinder to refine the leaves into a powder. The powder is then sifted to remove stems and vein material and is sold in its existing form or is used to make other products, such as capsules and tablets .

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Kratom in capsule form. Photo by: Wikimedia Commons

Food Safety

To contribute to the Kratom Food Safety section, please follow this link: http://fsi.colostate.edu/suggest-a-topic/

Consumption

Both fresh and dried kratom leaves are consumed in Southeast Asia, either by brewing tea or by chewing or smoking leaves. In the US, individuals purchase kratom powders, capsules, raw leaves, tablets, and concentrated extracts from Internet sellers or local shops . In that last 5-10 years, kratom has become easier to purchase and is no longer an underground substance. Individuals can purchase the product at local tobacco/smoke shops in states and cities where it is legal. The product is also sold online through legal, domestic vendors, but distributors buy the seeds, plants, and leaves on the dark web . The origin and contents of these products are not easily identifiable or verified. Information on suppliers and distributors within these countries is limited, given many of the plants are grown in hiding among other crops, in ditches, or near fishing ponds . In some countries, individuals have personal connections with suppliers and will purchase kratom from salesmen or will patron local coffee shops where products are sold ready for consumption. Contamination of the product can occur during growing, production, and distribution.

References

 






Externally Reviewed by: Colin Schwensohn, MPH 
Affiliation: U.S. Centers for Disease Control and Prevention
Outbreak Response and Prevention Branch 
Division of Foodborne, Waterborne & Environmental Diseases
National Center for Emerging & Zoonotic Infectious Diseases

Reviewed on: 5 April 2018

Authors

Allison Seidel

Allison Seidel

DrPH Epidemiology Student at Colorado School of Public Health

Atisha Morrison

Atisha Morrison

MPH Environmental Health Student at Colorado School of Public Health

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