Kratom use rises in NJ as effects, regulations are weighed

Among the colorful bottles of vape juice and packages of fruit-flavored filters that line the racks of New Jersey smoke shops is often a telltale deep forest green product that can be found in tablets, tea bags, honey sticks, gummies, soft gels, powders, liquid extracts and other forms.

This is kratom, an herbal leaf from a tree native to Southeast Asia used by as many as 15 million Americans as a stimulant or sedative depending on the dosage, thanks to chemical compounds that act much like opioids.

When used responsibly, some users say kratom is an invaluable way to boost energy, relieve pain and anxiety or even help ease debilitating withdrawal symptoms from oxycodone and other addictive pain relievers. Others — including some local addiction experts — say kratom is highly addictive itself and ripe for misuse, and they are seeing more users coming to their rehab clinics.

"It's been prevalent over the past five years in the people we see," said Rachel Wallace, senior director of substance use services at Retreat and Recovery at Ramapo Valley, in Mahwah. "It's become so widely available that you can get it at gas stations and it's marketed in a way that makes it look absolutely safe. And it's not."

New Jersey is the latest state to consider regulating kratom — including making it illegal to sell to anyone under 21.

But the U.S. Food and Drug Administration has stopped just short of instituting a ban, warning that kratom "is not lawfully marketed as a dietary supplement and cannot be lawfully added to conventional foods." The agency has sought to restrict imports of the substance and recently seized a large shipment from an Oklahoma manufacturer.

The FDA is "flat-out wrong on this," said Mac Haddow, a senior fellow on public policy for the American Kratom Association. "Instead of banning it, it should be regulated to protect consumers."

About a third of kratom users take it as an herbal supplement to get an energy buzz, another third use it to try to mitigate depression and anxiety, and the remainder take it to relieve pain or help get off opioids, Haddow said.

The kratom users who seek help at Hackensack Meridian's Carrier Clinic often use it in conjunction with drugs to "come off street opioids or fentanyl, looking for it to alleviate their withdrawal symptoms," said Dr. Anatoliy Vasilov, an addiction psychiatrist at the Somerset County clinic. "But a lot of times kratom just makes it worse.”

Wallace, of the Mahwah facility, said kratom should not be self-administered to help come down off an opioid addiction. Withdrawal needs to be managed by experts who can help provide medication in the right doses if it is needed. She said withdrawal from kratom alone can be just as difficult as other opioids, with symptoms such as nausea, fatigue, high blood pressure, aches and pains, slower breathing and mood swings.

"The science is undeniable: Receptors in the brain are hijacked by this substance," Wallace said. "Kratom becomes the priority over everything — family, community. It impacts all areas of life."

Testing for kratom is not often not seen in routine toxicological reports. And because it's not a controlled substance, nationwide data on its use and impact is limited. An often-cited federal study in 2019 attributed 91 of 27,338 overdose deaths from July 2016 to December 2017 to kratom. But only seven deaths had kratom as the only substance to register on toxicological tests.

Haddow, of the American Kratom Association, said millions of Americans use the herb without problems. Those who develop an addiction to kratom alone cannot be compared to opioid or street drug addicts. "The truth is that if you have a physical dependence on kratom, it is vastly different," he said. "Withdrawal is very different. You're talking at the most 10 days and the symptoms go from a runny nose to a headache."

The kratom association's primary focus is to fight regulators who are trying to make kratom illegal while also setting up laws at the state and federal levels to ensure that the product is sold safely. Its lobbying efforts helped pushed the DEA to reconsider classifying kratom as a Schedule I drug, a category that includes the likes of heroin, LSD, ecstasy and others. It is now fighting efforts by the FDA to ban kratom products.

Meanwhile it has gotten 11 state legislatures to pass laws that would regulate kratom sales. A similar bill — S3549, or the “New Jersey Kratom Protection Act” — was introduced this year in the Senate and Assembly but has not had much movement.

The bill, which has bipartisan sponsors, would make it illegal for retailers to sell kratom products to anyone under 21. It would also require all kratom products to be labeled with information on the amount of two chemical compounds — mitragynine and 7-hydroxymitragynine — that can act as a sedative or stimulant depending on the amount.

The bill would prohibit retailers from selling any kratom that has been adulterated with a "dangerous" substance.

Among those on the federal level who appear in support the association's platform is Sen. Cory Booker who along with other lawmakers had questioned the DEA's original move on kratom and helped sponsor legislation similar to the state bills.

"If the FDA took all of its efforts in trying to ban kratom and used it to establish regulations on the industry, it would be a much better situation for consumers," Haddow said.

While addiction specialists didn't want to veer publicly into policy debates over kratom, they maintained that easy access to the product and lack of any control over what's in it will lead to more people seeking help at rehab centers.

"The patient really doesn't realize the danger it poses," said Vasilov, the Somerset County doctor. "You have a product that has opioid effects and virtually nothing that regulates it."

This article contains material from USA Today.