Advocates for kratom tout the popular herbal substance grown mainly in Southeast Asia as great for treating chronic pain, anxiety and heroin addiction, among many other uses, and decry Denver Environmental Health's decision to ban it for human consumption last November. But University of Colorado professor and pharmacologist Robert Valuck thinks such a prohibition makes sense even if kratom has medical value.
"I'm not saying kratom doesn't work," Valuck stresses. "I'm saying we don't know if it works or what the proof is."
Valuck has an extremely distinguished academic background. He's a professor of pharmacy, epidemiology and family medicine at the University of Colorado Anschutz Medical Campus and the director of the Colorado Consortium for Prescription Drug Abuse Prevention. In the latter role, he's been spending much of his time working on ways to reduce the opioid epidemic.
He's also a confirmed kratom doubter, as he made clear in a recent 9News report whose incendiary online headline reads, "Herbal Supplement Sold at Gas Stations and Smoke Shops Kills Arvada Man."
Among his kratom concerns, Valuck says, is that "it has pharmacologic activity — and because of that, I think it should be considered as a drug and not just a plant. To me, a plant would be more like daisies I'm planting in my yard. I'm not going to be chewing, smoking, cooking or ingesting my daisies. But if I'm doing that, I presume I'm doing it for some therapeutic purpose, and when that's the case, we can't consider it just a plant anymore."
As Valuck acknowledges, "Kratom has been used for a long time for various medicinal purposes. But what I do for a living is work as a pharmacologist, so I look at it through a pharmacological lens — and when I do that, I see people making claims about this substance having therapeutic utility. And it may be good as a mild stimulant or to treat pain, anxiety, opioid withdrawal — a host of things. But if kratom isn't an opioid itself, it's at the very least opioid-like. An opioid is something that attaches to opioid receptors in the body. And kratom does that at higher doses" — levels some users say have led to addiction.
At the same time, Valuck notes, "I don't dispute there could be therapeutic uses from the active compound in kratom. But if there is, I just believe it should be studied and proven and regulated as any other drug would be, whether it's aspirin for headaches or Lipitor for cholesterol, or anything else. And when I look for evidence for the efficacy and safety of kratom, I can't find any."
In the absence of approval by a federal agency such as the U.S. Food and Drug Administration, which has released numerous warnings about the herb over the past year or so, Valuck says, "it becomes the Wild West, where anyone can make any claim about anything. And we've seen the problems that can create in this country over the past two centuries. There used to be sales of patent medicines that were completely unregulated and contained ingredients including opium, cocaine, heroin and morphine in various quantities. A lot of people became addicted and died before the passage of regulations and laws beginning with the Pure Food and Drug Act of 1906 and continuing over the next sixty or seventy years."
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To earn federal approval, manufacturers must provide evidence to prove that drugs actually do what is claimed for them. That's not happening with kratom, and advocates such as Clean Kratom Wellness Center's Faith Day, profiled by Westword in February, believes the reason comes down to dollars and cents. In her words, "It's a medicinal plant the government can't patent, and they don't want it being sold, because companies can't make any money off it."
In Valuck's view, this theory is suspect. "It's certainly easier to just sell kratom than it is to get it regulated," he says. "It could cost millions to prove that it works — and if I'm a kratom seller, I would rather not do that. I'd rather just hang out a shingle and put it on sale... . But it's being sold by people who don't have any medical training."
Right now, sale of kratom is prohibited in six states (Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin), as well as a handful of countries. "It's banned in Thailand, Myanmar, Vietnam. Virtually everywhere it grows has banned it for consumption," Valuck points out.
This approach makes sense to Valuck. As he sees it, "When we don't regulate these substances and let people use them as a free-for-all, where people take advantage by selling stuff where they can't tell you what's in it or prove that it's safe or effective, people may be at risk."