When Sgt. Matthew Dana of Tupper Lake, New York was found dead in his apartment last summer, the internet was outraged. At only 27 years old, Dana’s death would have been tragic regardless, but the debate that surrounded his passing was focused on what the coroner announced as the cause of death: an herbal supplement known as Kratom.
After a month-long investigation, Franklin County Coroner Shawn Stuart and medical examiner Dr. C. Francis Varga concluded that Dana had died of a pulmonary edema or blood in the lungs caused by an overdose on mitragynine, the active chemical in Kratom. Yet, a large online community that swears by this Southeast Asian herb for everything from physical pain to opioid addiction has claimed that an overdose is impossible.
Kratom is commonly taken in powder form—a method which was confirmed by Dana’s coroner. It’s taken by the spoonful and washed down with water. This method has led some in the Kratom community to suggest that overdoses on the supplement are similar to deaths reported from the viral Cinnamon challenge. They argue that taking too much of the powder at one time can cause respiratory problems and this might have been the cause of what examiners called an overdose.
The coroner’s report showed that Dana took five times the normal amount of Kratom, finding 3,500 nanograms per milliliter in his blood.
But the answer could also be hidden in the coroner’s research. Since county coroners are elected and don’t necessarily have to have medical credentials, they rely on heavy research and the help of medical examiners to make their determinations. In Stuart’s case, he cited the Journal of Analytical Toxicology and Journal of Forensic Sciences as his primary sources. They both describe cases in which Kratom overdoses were observed.
In the case of the Journal of Forensic Sciences, an article from 2012 describes a man who had 600 nanograms of Kratom in his blood at the time of death but also took other medications such as benzodiazepines. While the coroner reported no other substances were found at the apartment, the Journal of Analytical Toxicology found that in at least nine overdose cases, Kratom was laced with a powerful opiate known as O-desmethyltramadol.
In November 2017, reports of overdoses caused the FDA to send out an advisory on the risks of Kratom use, but the agency’s extremely loose regulations on dietary supplements means that the substance may not always be what it says it is.
Under the FDA’s current guidelines supplements are loosely regulated with the only stipulation being that they refrain from making claims that the supplement is a cure or treatment for disease. Otherwise, in terms of ingredients, they may be made up of any number of herbs, vitamins, minerals or amino acids.
Despite these loose regulations and limited research, the DEA announced its intent to temporarily classify Kratom as a Schedule I substance in August of 2016. Citing 15 Kratom-related deaths from 2014 to 2016, the DEA condemned this herbal supplement to the highest restrictive category alongside heroin.
“Importantly,” the DEA’s rescheduling announcement stated, “evidence shows that kratom has similar effects to narcotics like opioids, and carries similar risks of abuse, addiction and, in some cases, death.”
After their decision sparked outrage, the Agency was forced to de-schedule Kratom in order to allow for the public to weigh in.
Meanwhile, it appears that many coroners have been quick to identify Kratom as the main cause of death in cases in which a mixture of substances has been found.
In December of 2017, when the HuffPost investigated Kratom overdoses in Georgia, they found that the state’s coroners were, “counting every fatal drug overdose in which mitragynine is present as a so-called kratom-related death,” and that all but four cases also included another substance.
But the DEA wasn’t entirely wrong about Kratom’s effects. It does work on many of the same parts of the brain which are activated by opioids, just in a much more positive way.
According to a 2008 study published in Addiction, Kratom could potentially be used to treat opioid addiction because, mitragynine interacts with the same receptors in the brain as opioids, also known as the mu- and kappa receptors.
When asked about his study of a man who had self-medicated on Kratom, Edward Boyer, a professor of emergency medicine and director of medical toxicology at the University of Massachusetts, told the Scientific American that it was only after the man had begun to use other substances that he required serious medical attention.
In fact, the first human study on the therapeutic effects of Kratom found that it had potential to treat addiction with “no adverse effects.”
The truth is, the loose regulations within the U.S. on supplements and minimal research make it difficult to say whether an overdose on Kratom is possible, but it’s worth considering that fatalities may be related to other substances or whatever mixture makes up the supplement. Especially when a massive community of users are flatly convinced of its benefits—so much so that they convinced the DEA to change its mind.