Michigan may regulate sale of kratom, an herbal mix linked to overdoses

• Kratom is marketed as an alternative medicine or natural remedy for pain and stress, including PTSD 
• The FDA does not consider Kratom a recognized supplement and has warned against its use 
• A Michigan law would regulate its manufacture and use

Whether it’s harmful or helpful, addictive or medicinal, Michigan soon may regulate the herbal supplement kratom, making it illegal for minors and requiring licenses and product testing for anyone wishing to sell it.

A Michigan bill, sponsored by State Rep. Lori Stone, D-Warren, several other Democrats and a Republican, swings the spotlight on a controversial herbal extract that can be chewed, taken in capsule form or brewed into hot water as a tea.

The U.S. Food and Drug Administration warns that kratom “affects the same opioid brain receptors as morphine.” Others promote it as a natural pick-me-up that manages pain, depression and anxiety, and can help curb opioid addiction and PTSD.

Related:

• Michigan debates future of kratom, an herbal remedy linked to 9 state deaths
• Opinion | Kratom has given me a better life. Michigan needs regulation

Stone’s bill would create the Kratom Consumer Protection and Regulatory Act, what the rep called a “common-sense” regulatory approach similar to Michigan’s marijuna regulation. It would require specific labeling on kratom packaging and limit the herb to adult use, “because we don't want our youth enticed by one more thing,” Stone said.

Despite concerns about its safety, Stone said, kratom “is not problematic for everyone. Some of the issues around it are knowing what you're taking.” 

The bill, which would be effective on Jan. 1 if passed, would:

• Require a license to sell, distribute or manufacture kratom 
• Require testing of raw materials used in kratom products
• Require label warnings for kratom products, including statements saying kratom is an unapproved dietary ingredient, ingesting it may be dangerous, the product should be kept out of reach of children, and people breastfeeding or pregnant should not use kratom.

The proposed law would cover online sales, too.

The bill’s passage is not guaranteed. The mostly Democrat-sponsored bill has to make it through a Republican-controlled legislature. A dozen Democrats cosponsored the bill; Rep. Sue Allor from Wolverine is its sole Republican.

Senator Aric Nesbitt, R-Lawton, who chairs the Senate Regulatory Reform Committee, said he would “like to see” the bill moved, but noted that it’s opposed by the state’s Department of Licensing and Regulatory Affairs (LARA).

Sen. Curt VanderWall, who chairs the Senate’s health policy committee and sits on the regulatory reform committee, did not respond to requests for comment. 

Six states have banned kratom, while others have regulated it. But most states have not yet taken any action, neither regulating nor restricting its use, said Derek Sova, a legislative specialist with the state’s Cannabis Regulatory Agency, speaking on behalf of LARA.

Without consensus or better research, “it is simply premature to commit to the possibly significant resources necessary to pursue new regulation that has not found broad support either amongst health professionals, or across the states,” he told the Senate Regulatory Reform committee last week.

LARA would be willing to “revisit the conversation” after more research into kratom’s risk and effectiveness, Sova told the committee.

Stone, the state representative, said she became interested in the issue after a constituent brought her the packaging from a kratom product and inquired about its safety. She hadn’t heard of kratom at the time.

“I was taken aback. There wasn’t a whole lot of information,” she said, adding that the label didn’t specify how much you should take and how often, how much is too much and potential drug interactions.

Some published studies report the extract helps users break free from opioid addiction, but research, especially in Western countries, is early. The National Institute on Drug Abuse reports that kratom provides opioid- and stimulant-like effects.

After the first encounter involving the kratom packaging, Stone spoke to Michigan substance abuse experts.

“The problem they had was that people who had a propensity to addiction were soon becoming addicted to kratom,” she said.

The debate

Kratom comes from the Mitragyna speciosa tree found in Southeast Asia, particularly in Thailand, Malaysia, Indonesia and Papua New Guinea, according to the FDA. The plant can bring the user energy or calm, depending on the maturity of the leaves when harvested.

According to the Virginia-based American Kratom Association, the herb made its way to the U.S. after the Vietnam War.

Michiganders can purchase kratom in tobacco and head shops, grocery stores or online. 

But addiction specialists, health experts and the FDA warn that kratom can have psychoactive (mind-altering) effects on the brain, and carries the risk of “addiction, abuse, and dependence.” The FDA warns against its use.

According to a 2019 report in the peer-reviewed journal Clinical Toxicology, poison control centers reported 1,807 “exposures” to kratom between 2011 and 2017, with most of them occurring in the final two years of the study period. 

In 2015, three of 1,991 overdose deaths in Michigan were linked to kratom. By 2018, that number jumped to 51 of 2,599 deaths. 

Last year, 103 drug deaths included the use of kratom, according to preliminary data Bridge received from the Michigan Department of Health and Human Services.

While the FDA has objected to the herb and has issued warning letters to companies that allegedly promoted the project as a treatment or cure for opioid addiction, the National Institute of Drug Abuse acknowledges kratom’s possible benefits. 

NIDA “supports research towards better understanding the health and safety effects of kratom use,” according to its website. 

The World Health Organization’s Expert Committee on Drug Dependence voted against adding kratom and its psychoactive ingredients, mitragynine and 7-hydroxymitragynine, to the United Nations’ list of internationally controlled substances.

While kratom “can produce serious toxicity” in high doses, “the number of cases is probably low as a proportion of the total number of people who use kratom,” according to the committee’s findings.

Supporters argue that deaths associated with kratom involve cases in which multiple drugs are found in people’s systems, or instances in which kratom was adulterated with other substances such as fentanyl.

“That's why the Kratom Consumer Protection Act has to be implemented. There are no regulations now,” said Marc Haddow, a senior fellow on public policy at the Kratom Association.

The association has been pushing states to set up state-level regulations allowing its use while enacting limits and independent testing procedures. 

Stone said she consulted with the association to develop her bill.

She also consulted Mark Kilgore, a program coordinator for Project VOX, a drug recovery advocacy group in Macomb County.

Kilgore told Bridge he worries about kratom because of its possible addictive nature and the resulting hospitalizations from its use. But he’s also heard from people who talk of its benefits to help relieve pain.

“How can I tell somebody ‘it doesn't help you with your pain?” he said. 

If passed, the law would “make sure that, if people are going to use (kratom), that it is legit, that there's no additives, impurities, and that it is regulated.”

A person who violates the labeling requirements or sells kratom illegally would face an administrative fine of up to $500 for a first offense and up to $1,000 for a second or subsequent offense. They also could lose their license.

Among bill supporters are the Michigan Primary Care Association and the Michigan Health & Hospital Association, which represents the states largest health care providers. Spokesperson John Karasinsk said MHA would prefer the drug be banned. 

But the Stone bill, he said, “will help limit adolescent addiction and prevent adulterated products from being on the market.”