Kratom, linked to 6 county deaths, was banned. But its health risks remain a mystery

Recently, the Los Angeles County Department of Public Health reported that the deaths of six LA County residents last spring and summer were linked to the use of kratom, a widely available but unregulated supplement sold as a treatment for a variety of health issues.

The deaths prompted public health officials announcement November 7th they All products will be red tagged and pulled from store shelves that contain either kratom or the synthetic alkaloid 7-Hydroxymitragynine, also known as 7-OH, which is derived from kratom. Both are currently unregulated and not approved for use as a drug product, dietary supplement or approved food additive in the United States or the state of California, US Food and Drug Administration.

Ironically, business owners who sell kratom feel neglected by the health department, without realizing how the supplement is helping many LA residents go too far. They say the deaths are not caused by kratom products, but by interactions with other substances.

Perhaps more important are the benefits that kratom users and some experts claim the drug provides. Many say the problem is with 7-OH—a highly concentrated, synthetic version of natural kratom that is subject to adulteration and fraudulent marketing—and that banning the sale of all kratom products could create a dangerous underground market for both kratom and 7-OH.

In fact, many kratom sellers and users would welcome better regulation, so that they can continue to use the cheap, widely available substance to treat physical pain and mental health issues with greater confidence in the efficacy and safety of the products they sell and buy.

Between April and July, a total of six LA County adults between the ages of 19 and 39 died with kratom and 7-OH in their bodies, along with other substances including alcohol, prescription sedatives and muscle relaxants, and cocaine.

In the medical examiner’s reports, the cause of death of the five victims was listed as the result of “mixed drug effects”; A sixth was listed for a cocaine overdose.

The Times spoke with three different toxicologists to review these coroner’s reports and gain a better understanding of what role kratom, or 7-OH, may have played in the deaths.

What experts told The Times is that while toxicologists are aware of the potential impact that kratom alone can have on the body, the picture becomes clearer when other drugs are introduced.

Kratom is an herbal extract made from the leaves Mitragyna speciosaA native tree of Southeast Asia. It is sold in smoke shops and online in a variety of forms including powder, pills and liquid extract.

At low doses, kratom causes a stimulant effect that users report an increase in energy. At higher doses, it produces a calming effect, said Donna Popson, a forensic toxicologist with NMS Laboratories.

Researchers say the majority of kratom users Eat the plant to relieve pain. In some cases, people report using it effectively to treat opioid addiction. Others use it to alleviate mental health challenges such as anxiety and depression.

In the past few years, a synthetic version of kratom that has been refined into its psychoactive compound 7-Hydroxymitragynine, or 7-OH, has grown in popularity. The widespread availability of over-the-counter drugs has become a concern for public health officials and advocates.

But toxicologists say there isn’t enough research to provide a comprehensive understanding of what concentration of kratom or 7-OH can be highly toxic when alone in the body.

It’s possible they also cause dangerous reactions when combined with other drugs that can amplify their effects, experts said, but a lack of research means doctors just don’t know what they are. That’s where the most relevant risks are, said Craig Smolin, medical director of the San Francisco Division of the California Poison Control System.

In cases where kratom and 7-OH are found in the body of a recent sudden death, toxicologists usually find evidence of poly-substance use – when two or more drugs are taken together, intentionally or unintentionally.

“I don’t claim to have investigated all reports of kratom deaths, but I haven’t seen many reports of single drug use of kratom causing death,” Smolin said.

And while there is an effective method to test for the amount of kratom in the body, there is no such accurate test for 7-OH. Current tests can only tell if it is present or not. In all six LA County deaths, it was

But, Papsun notes, when kratom is metabolized in the body, the breakdown component includes 7-OH, which means it will likely show up in medical tests when kratom does.

Toxicology labs face significant challenges when developing rapid tests for substances like 7-OH for use in postmortem medical examinations, Popson said. “Adding something to the testing field is not easy from a forensic standpoint because you have to develop it, validate the test, have a commercial product and it has to be scientifically rigorous because those results can end up in court,” Popson said.

Another challenge for testing 7-OH, in particular, is that the compound is “incredibly unstable,” she said. It can be detected in the body at the time of death but when the sample is collected and tested, the compound may have already started to break down, leading to false results.

Robert Powers, a forensic toxicologist at the University of New Haven, agreed that it was difficult to say whether kratom and 7-OH played a direct role in the LA County deaths. “Most of the problems that arise with these drugs are in combination with other respiratory depression drugs: opiates, benzodiazepines, alcohol,” he said, although he added that mortality is “not an easy picture” to understand.

That’s why, he said, the LA County Health Department’s move to pull those products off the shelves makes sense. “I think it’s fair to recognize that in these cases, kratom really played a supportive role. And I understand the interest in trying to limit the potential effects of this drug in these mixed cases, so I understand why people are interested in controlling this drug.”

Smolin, director of the San Francisco Poison Center, agreed, noting how many counties still don’t know about kratom and 7-OH.

This lack of information hurts consumers, who often rely on guidance from local, state, and federal agencies about the dangers of kratom and 7-OH products.

In fact, De Macaluso, 74, said he had to look for other sources of guidance, and experiment with different daily dosage amounts to reduce symptoms of fatigue and breathing problems due to chronic lung disease.

When she learned of the county’s decision, “it scared me to death that they were going to pull kratom products.” “I told my husband, I don’t know what I would do if I didn’t have this and then I would get out of bed, paint or do whatever little I could,” she said.

Macaluso was an actor and comedian who lived in her 60s in Park City, Utah, but recently moved to LA when her health declined due to pneumonia that developed into debilitating infections in her lungs.

Macaluso lived an active life, but damage to her lungs made it so that she could barely walk up and down the stairs of her Utah home without feeling winded. She also felt that the altitude in Park City was detrimental to her health – one reason she chose to move to Los Angeles, which is mostly at a lower altitude.

She saw several specialists, but none offered options that would help alleviate her symptoms. Then, she stumbled upon a documentary highlighting the benefits of kratom for chronic pain and mental health. She decided to try it.

“I didn’t use it very often, but when I did I found it helped a lot of my issues,” Macaluso said.

She described the effect as a boost of energy, which in turn gave her the motivation and strength to get out of bed. “It was more of a sense of relief from being in someone’s position,” Macaluso said. “I loved it and I still use it.”

As her disease has progressed, Macaluso continues to rely on kratom when she knows she’s going to have a long day or attend an activity and be social.

She said: “It made me feel like my old self – smart-mouthed, funny and fastidious. I was a stand-up comic, I did all these things and I became that tired old lady who got wind of going up a few floors and pissed me off.”

Macaluso isn’t advocating for 7-OH but he doesn’t want kratom banned; He wants it organized and available to the public.

She said: “I think the government should provide us with education.” “There are people out there who abuse it but I don’t think those of us who use it responsibly and take advantage of it should be punished.”

Business owners like Abdullah Mamoon, who started Authentic Kratom 12 years ago, agree with Macaluso’s view.

Authentic Kratom started as an e-commerce business in Canoga Park, and has since grown to three brick-and-mortar locations in Canoga Park, Woodland Hills, and Hollywood.

Mammon believes that 7-OH is a real threat, and that L.A. County should focus its efforts there. However, he said, a blanket ban on all kratom products is counterproductive. First of all, based on what his clients have told him over the past decade, he believes that “kratom doesn’t cure you, but it gives people the relief they’re looking for and the ability to manage their pain.” Second, red-tagging kratom products will directly affect his authentic kratom and the livelihood of his seven full-time employees.

And he welcomes the regulation of kratom products.

“We want them to be properly labeled for consumers because people need to know what they’re putting in their bodies,” he said.