Around 3 am, the morning after Mother's Day in 2015, Nick Barth was coming home from his restaurant job when he was robbed at gunpoint and shot in the leg. The bullet missed the bone, didn't hit any major vessels, but it tore through about eight inches of his leg, doing extensive nerve damage. The damaged nerves caused more pain than the wound, because he was walking on muscles he could no longer fully control. He went to physical therapy and cycled through the prescription opioids, muscle relaxers, and a nerve-pain suppressant. "For the first three or four months I pretty much lived on my parents' couch," he says, "I would wake up in pain, take some painkillers, and fall asleep about an hour later. Wake up groggy and in pain, take some more, and fall asleep."
Then a videogaming friend recommended kratom, a plant that users say can help with chronic pain, anxiety, and PTSD. Others have used it to wean themselves from opioids, saying that, for them, it has a similar effect, but without the same addictive qualities.
It's also drawn more attention lately, particularly since late last year, after the Drug Enforcement Administration announced a plan to temporarily place kratom on the list of Schedule 1 drugs, including heroin, LSD, marijuana, and MDMA—those defined as unsafe, having no accepted medical use in the United States, and with a high potential of abuse. Previously, kratom had largely been off the regulatory radar, sold as a dietary supplement and often shipped in packages labeled "not for human consumption." As a Schedule 1 drug, kratom would be outlawed. And because the DEA was invoking its emergency scheduling powers, the public had no right to comment.
Yet tens of thousands of people responded, asking the DEA to reconsider via a whitehouse.gov petition. A bipartisan group of 51 members of the US House of Representatives signed a letter opposing the decision, saying it would hurt federal research into opioid addiction and treatment. (The DEA refused to share the data on which it'd based the emergency plan.) The DEA backed down, withdrawing its plan for emergency scheduling. Instead, it would open up public comments—which soon, again, numbered in the tens of thousands of people testifying how kratom had helped them—and would defer a judgment pending research by the Food and Drug Administration.
At the federal level, kratom remains legal, though it's unclear for how long. But it's already been outlawed in six states, and bans have been proposed in New York and Florida. Rep. Kristin Jacobs, who filed the Florida legislation, calls kratom "a scourge on society," pushed by "addicts with glassy eyes and shaky hands," and suggests there's a powerful lobby determined to keep it legal. " They have a story," she told Florida Politics. "Just like Hitler believed if you tell a lie over and over again, it becomes the truth." (Susan Ash, founder of the American Kratom Association, a nonprofit group that advocates for consumers, called the remarks "outrageous," and pointed out that she, like many of the association's members, uses kratom as an alternative to opioids. She herself is a former opioid addict.)
Nick Barth doesn't see himself as the glassy-eyed addict Jacobs portrays. He didn't like drifting in and out of consciousness on his parents' couch. He'd heard the stories about opioid addiction and considered himself an addictive personality; he'd had trouble with alcoholism in the past. So he moved away from the opiates, instead combining kratom with muscle relaxers and the nerve-pain suppressant.
Eventually the pain became manageable. He could use kratom by itself, a teaspoon about an hour after waking up, and an evening dose if he was really going to be active. "By trade I was a chef. I've been working kitchens for six or seven years, and with my leg injury, I don't know if I can be on my feet running around all day without something to help me," he says. "And I don't really want to go back to rampant alcoholism."
You don't have to go far to find stories like Barth's: The American Kratom Society has a collection, as does the kratom subreddit. People testify about quitting nicotine, treating hypertension, coping with chronic pain, and mitigating bipolar disorder.
So what is kratom doing, and why does it seem to be working for so many people across so many ailments? The research is in its infancy, says Andrew Kruegel, a pharmacologist who's working to better understand the plant. "Kratom has been sporadically studied since the 1970s, at least," he says, and we now understand that a pair of alkaloids—mitragynine and 7-hydroxymitragynine—activate Mu opioid receptors in the brain and spinal cord. Those are the same receptors activated by more well-known opioids such as morphine and heroin. That's what has the DEA so alarmed, Kruegel says: Kratom looks like something we've seen before.
It also acts in similar ways, providing the pain relief that made opioids useful in the first place. But a potent side-effect of opioids has always been respiratory depression: At high doses you get so sedated that you stop breathing. Additionally, there's the problem of addiction: Users can become psychologically addicted to the feeling of being high, and with overuse, the body becomes physically dependent on the drug. Without it, painful withdrawal symptoms wrack the body.
While kratom shares the same pain-relieving properties of opioids, it doesn't seem to have the same effect on breathing. That's a good thing, obviously; anecdotal reports suggest that high doses of kratom produce nausea without potentially deadly side effects. (I found that when you take too much, you throw up," says Nick Barth. He'd tried higher doses to see if he felt any of the often-reported mood-elevation and relaxation effects.) Addiction, however, is a trickier question. There's no scientific consensus about kratom's potential addictiveness—it's something that simply requires more study.
Kruegel says banning kratom would make that study much more difficult. "It would slow things down tremendously," he says. Few Schedule 1 drugs are widely studied because of the controls necessary to do so; you end up with what Kruegel calls "die-hard labs" working on their own, with few new entrants to the field, as has already happened in marijuana and psilocybin research. "It just adds a level of oversight and a level of bureaucracy that most scientists aren't willing to deal with," he says.
In the meantime, scientists are working to disentangle the multiple, interacting components of kratom. It's slow going, but as Kruegel says, "I don't think the kratom plant itself is ever going to become an FDA-approved medication," because it's so difficult to standardize what's in a plant. (Again, there are obvious similarities to marijuana research.) Substantive human testing is likely years away, with potential FDA approval a long time after that.
All of which hinges on what the FDA and DEA decide to do next. Susan Ash of the American Kratom Association says she and her organization are dedicated to educating legislators and opposing bans. Another advocate, Drew Turner, suggests that the real problem is a lack of nuanced regulation. "We have a very strange system of laws that don't really apply anymore to things like plants," he says. "The same issue with marijuana is happening with kratom. We just need to find some better ways to regulate things like this so we're not forced into a corner. We don't force the government to decide that a ban is the only available option."
When the DEA announced its emergency ban on kratom, "My first thought was to buy as much as I could afford," says Nick Barth. He'd been in and out of work, but for a couple weeks he was flush enough that he bought a kilo, figuring it would last him about two months. His leg has been feeling better, and he's weaned his doses down. He doesn't know if he'll have to manage this pain for the rest of his life; maybe in five years it'll be gone. For now, though, he's looking to kratom for help. "I feel that once I get back to work," he says, "if it hasn't been outright banned by then, I'll go back to it."