By Mitra Norowzi
By the time Friday rolls around, Candice Varnadore is tired and sore. She steps into Oasis Coffee & Tea House at Carr Mill in Carrboro for a pick-me-up. The coffee shop offers a wide assortment of coffee beverages, teas and smoothies. But those are not what she came for.
Although her steps are slow and calculated, weary after a hard week’s work of cleaning houses, she strides purposefully towards the counter. She greets the shop’s owner, Robert Roskind, with a grin, revealing a few missing teeth. Wasting no time, she tells him she’d like four bags, please. Roskind quickly fills her order, telling her her total will be $86, and that he’s thrown in a fifth bag for free. She thanks him profusely.
The 20-ounce bags she bought contain a little-known substance called kratom. Scientifically known as mitragyna speciosa, kratom comes from the leaves of an evergreen tree that is part of the coffee family. It is native to Southeast Asia and has been used as a natural remedy in Thailand, Indonesia and Malaysia for thousands of years to treat pain and various mood disorders, as well as to increase energy.
It is believed that immigrants from these countries brought the practice of using kratom with them to the U.S. Here, people most often ingest crushed kratom leaves mixed into beverages. The plant is not smoked, nor is it taken intravenously. Older generations tend to use the plant to relieve pain, while the younger generation tends to most often use it for mood enhancement as an alternative to prescription antidepressants, marijuana or alcohol.
Varnadore is one of those users seeking pain relief, which started when she was about 60, she says.
“I would wake up and my hips and my knees would be killing me and I couldn’t get any relief from any doctor,” Varnadore says. “I ate so much Aleve, my stomach was upset. It wasn’t helping me.”
The pain was adversely affecting the 63-year-old’s ability to do the laborious work necessary to make her living cleaning houses until a friend asked her if she’d ever tried kratom. When Varnadore said she hadn’t, her friend brought her to Oasis and bought her a cup, which is typically served there mixed in chocolate almond milk or orange juice.
“It tastes awful,” Varnadore says. “But I’ll be darned if it didn’t take the pain away.”
But Varnadore and the other five million Americans who use kratom may have to seek relief elsewhere.
In November, Scott Gottlieb, commissioner at the Food and Drug Administration, announced that that the agency is concerned about kratom’s opioid-like properties in the face of the nation’s opioid epidemic.
This statement came after a 2016 statement by the Drug Enforcement Administration said it intends to schedule kratom as a Schedule 1 drug, alongside illegal substances such as heroin, cocaine and meth. The DEA halted the criminalization process after an outcry from kratom advocates, agreeing to postpone the ban until further research by the FDA could be conducted.
On Feb. 6, Gottlieb released another statement further detailing the FDA’s worries about kratom, announcing that the agency was now confident in labeling the substances in kratom as opioids. This statement was based on computational modeling the agency conducted, and in consideration of reports of 36 deaths associated with kratom use.
But defenders of kratom are not satisfied with Gottlieb and the FDA’s evidence, and are especially displeased that their research is based off a computational model rather than practical trials.
Roskind criticized the FDA and DEA statements regarding kratom, pointing out that Gottlieb, who was appointed to the FDA by President Donald Trump, is a pharmacy industry insider. Indeed, Gottlieb has worked with drug companies in the past, making millions, an issue raised during his nomination.
Among the 36 deaths associated with kratom, just one individual had only kratom in his system—the rest either had other drugs in their systems in addition to kratom at the times of their deaths, or prior health conditions, according to FDA reports.
Kratom’s pharmacology isn’t well understood and few studies have been conducted on it. More comprehensive analyses, like those from researchers at Columbia University and the University of Oklahoma have found that kratom does contain alkaloids that bind to opioid receptors in the brain similar to the way morphine does.
However, the study conducted by Columbia University and Memorial Sloan Kettering Cancer Center found that kratom only partially stimulates opioid receptors, more closely resembling the effects of drugs used to treat opioid addiction than that of opioids most responsible for overdose, such as heroin and fentanyl.
The problem is, none of these studies have been conducted on humans, so the tangible human effects of kratom are supported only by anecdotal evidence. This anecdotal evidence is abundant, especially at Oasis.
Different purposes for different people
Of the five people lingering in the shop at the time of Varnadore’s visit, four are drinking kratom, Roskind points out. One is a graduate student using kratom to increase his productivity while he studies. He wears headphones and has textbooks strewn about on his table as he bends over his laptop. Another two are a middle-aged couple visiting from Sunset Beach, decked out in Pittsburgh Penguins jerseys, in town for a hockey game. They noticed a sign outside Oasis about kratom, and decided to try it for the first time, hoping it might be something they can recommend to their daughter to help her depression. The last is a young woman in business attire who says she takes kratom for her anxiety.
Tina Rizzo, 55, one half the of the Penguins-loving duo, thoughtfully evaluates her first drink of kratom.
“I’ve noticed it a little bit since we sat down,” she says. “It’s definitely relaxing — it’s nice.”
Her companion, Jeff Hillwig, 55, doesn’t feel as much of an effect, but speculates that his significant daily coffee intake might have increased his tolerance to stimulant-like substances.
“I couldn’t see this affecting anything to do with driving or cognitive skills,” he says. “I could see it being a beverage of choice in the evening over alcohol.”
An herbal alternative
Roskind has been selling kratom for two years now at Oasis, alongside his standard offering of teas, coffee and smoothies, and says it is his top-selling product. He has customers of all walks of life taking it for pain, depression and even to aid addiction.
“I got people kicking heroin, alcohol, opiates,” Roskind says. “And they’re using it and all are having success.”
For opioid addiction, the FDA urges the public to seek help from a medical provider.
Roskind, who is known as a proponent of whole-body healing in the Carrboro community, is confident that kratom is overall a helpful substance, though he is not oblivious to its potential for abuse. For most people, he says, kratom may be habit-forming, much like coffee or sugar, but it is addictive for only a small fraction of users.
The potential for kratom dependence, and risk of an uncomfortable withdrawal, is higher for those users who take it in the form of extracts, rather than in plant form.
“Some of the ones that have addictive personalities like they’re using heroin or alcohol real bad, I would say they kind of abuse it,” Roskind says.
While the average person takes around 6 grams a day, these people might go through as much as 25-30 grams. “But they’re trading a rather benign habit for a life-destroying addiction,” Roskind says.
Roskind says there’s probably little to nothing that can be done at this point to stop a ban on kratom in the near future, but predicts that the FDA and DEA will wait a few months at least to implement a ban to allow users like Varnadore to find alternatives to kratom treatment.
“If they cut it off, they’re taking stuff away from people who are just trying to make a living and do their best,” she said. “When you get older, you need a little help.”
Edited by Mimi Tomei