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Addiction and the kratom business

The second part of our series on the addictive botanical kratom reveals its toll on users even as a felon peddles high-powered kratom shots and a scientist for hire claims addiction to the substance is a myth.

(CN) — Alexandr Gorelik felt enormous pressure on the afternoon of Jan. 30, 2018, so he stopped at the Roots kava bar in Miami and drank several bottles of a concentrated herbal extract to calm his nerves.

His wife Nathalie’s cervical cancer had returned, and her doctors couldn’t do much for the 33-year-old mother of two boys who needed more care than Alexandr alone could give. Nadev was only 10 and Nathan, who is on the autism spectrum, was 12.

When they got home, Alexandr, 35, got a shot of vitamins and took his regular Xanax, plus more of the extract of kratom, a tree found in tropical regions of south Asia with leaves that are touted as a miracle cure for everything from sports pain to heroin withdrawal. A few hours later he was dead from an overdose. Nathalie died a few months later, and Nadev and Nathan were now orphans.

“It was a nightmare, everything that happened,” Nathalie’s sister, Cristina Tipacti, said in a phone interview. “He was for sure addicted. The day he passed away he drank like six little bottles. My mother only speaks Spanish. She told the cops she threw away so many bottles because she didn’t know what it was. She thought it was like energy drinks.”

Tipacti said Alex, a former opiate addict, had used kratom for just a few months before he overdosed. He acted like “a funny drunk” while on the drug, she says, but he had also suffered a seizure.

“My mom found him shaking on the floor and like white foam coming out of his mouth. She called an ambulance; they took him to the hospital,” Tipacti said. “This was maybe a week before he passed away.”

The family believes the powerful kratom shots may have reacted with Alex’s prescription Xanax, though no one at the hospital even knew about the unregulated supplement he’d been taking in ever-increasing doses.

“The place he was buying it from wasn’t regulated and it’s out of business now,” Alex’s sister, Gina Gorelik, said. “I think it’s dangerous. I think he was like just increasing the dose and no one told him not to.”

Gorelik decided to file a lawsuit as she learned more about the kratom industry. “Honestly I think the more cases people file and win, the more likely this is to be shut down,” she said.

The main problem was finding the manufacturer. “So we sued the kava bar because we were unable to determine the manufacturer,” the Gorelick family’s attorney Daren Stabinski said. “The bar had gone out of business.”

The case was settled in early 2020 with a payment to the family, according to Stabinski.

That’s how it goes in the kratom world. Thousands of small importers and pill manufacturers jockey for market share, working out of unmarked warehouses and even home garages and kitchens, wholesaling their wares to head shops and bars that can be as ephemeral as a lost pet flier tacked to a light pole.

Kratom comes in many packages and brands from many vendors. (Screenshot via Courthouse News)

When compared to opioids or Covid-19, kratom’s death toll is tiny. But the substance’s popularity appears to be growing. Fans of kratom, including the comedian and podcaster Joe Rogan, have recommended it to a subculture of Americans increasingly skeptical of conventional medical science. The burgeoning market for kratom points to a dysfunctional regulatory system that allows potentially dangerous substances to exist in a gray area where safety testing, manufacturing consistency and dosage levels are optional at best — a profitable place for unethical businesses and criminals.

Once it clears customs, kratom is perfectly legal in most of the U.S.. Its proponents say it’s as safe as coffee and impossible to overdose on, and openly mock the FDA and U.S. Centers for Disease Control and Prevention’s studies claiming it has contributed to the deaths of more than 150 Americans.

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“ZERO deaths have been proven to have been caused by kratom,” reads an online flier from the American Kratom Association, an industry- and donor-funded nonprofit founded in 2015 to advocate for the substance.

Searching court databases and other sources, Courthouse News found multiple kratom deaths apparently not yet counted by federal health investigators, as well as lawsuits involving kratom sellers and shippers who move dried kratom leaf to the United States by the container load despite an “import alert” issued by the FDA in 2014 that allows federal law enforcement to seize the product on sight. The kratom association’s lobbyist, Mac Haddow, says figures from the Indonesian government show 4,500 metric tons of kratom — nearly 10 million pounds — are exported to America every month from that country alone.

In gas stations and head shops, consumers might pay $25 for a one-ounce (28 gram) packet. Online prices vary downward as the packets become larger, ranging from $65 to about twice that per kilogram. In wholesale bulk, kratom can sell for $10 per kilo, which means a vertically integrated kratom distributor could theoretically, if all goes to plan, turn a $100,000 bulk kratom buy into almost $9 million worth of 1-ounce packets.

But in the kratom business, all does not always go to plan.

One week before my nephew suffocated in his Connecticut bed from a kratom overdose, a lawsuit was filed 3,000 miles away in Clackamas County, Oregon. In the complaint, a New Mexico-based company called Botanical Holdings Group claimed Worldwide Manufacturing of Wilsonville, Oregon, refused to pay the $100,000 invoice for a 10,000 kilogram shipment of kratom sent to an unnamed third party the previous September.

The number for Worldwide Manufacturing, which is listed as a structural metals firm, has been disconnected. Worldwide’s frontman, Josh Becker, replied to an email from Courthouse News this past August: “I didn’t stiff anybody they s bad Kratom to my client and I lost my client for $300,000 a month in bulk capsules so nice try these motherfuckers didn’t even pay for the shipment in Indonesia I have proof of all the stuff are absolutely you cannot air the story, I will sue if you lol”. [sic]

He declined to respond to follow-up questions.

According to public records and news stories, Becker’s criminal record includes convictions for theft, forgery and fraud dating back to 1999. In 2012, federal agents raided his house and seized more than $200,000 as part of a nationwide designer drug sweep called Operation Log Jam, which also ensnared a Bulgarian national named Alexandre V. Dimov on charges including drug conspiracy, money laundering and introducing misbranded drugs into interstate commerce.

“Agents raided a Vancouver warehouse operated by Becker's business, A&J Distribution, seizing two tons of dried plant material, Assistant U.S. Attorney Leah K. Bolstad said during a hearing in Portland U.S. District Court,” the Oregonian newspaper reported, noting the 6-foot, 5-inch, 260-pound defendant was still wearing the basketball shorts he had on when the feds arrested him.

Becker and his wife pleaded guilty to charges relating to the distribution of analogue chemicals used to make synthetic marijuana — “spice” — and an amphetamine being marketed in head shops as “Hayze” incense. In 2013, a federal judge sentenced Becker to four years in prison, plus three years probation, for his part in the conspiracy.

As of mid-October, Becker’s Facebook page was titled “Ultra Alks” and offered kratom shots for sale. His slogan: “To reinvent how people view natural remedies and sources of nutrition.”

A screenshot of Josh Becker's Facebook page in which he advertises kratom shots for sale. (Facebook via Courthouse News)

The American Kratom Association says it wants the FDA to clean out the industry’s bad actors who fail to adhere to the association’s “good manufacturing practices” — testing for impurities and careful mixing to ensure consistent product — or those who make illegal “structure and function” health claims (i.e. “kratom builds stamina for longer workouts”).

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The nonprofit is pushing a model legislation called The Kratom Consumer Protection Act in every state, but it takes no public position on these concentrated extracts. At least one prominent manufacturer, MIT45, was, until just before press time, listed on the association’s website as a major funder. Kratom shots, including from MIT45, have been implicated in at least two of the eight kratom overdose deaths Courthouse News examined.

MIT45 did not respond to emails and messages seeking comment.

The kratom association warns there have been cases of kratom spiked with fentanyl, but the more common problem is dirty kratom. In 2017, Walt Prozialeck, the Midwestern University pharmacologist, tested packets of gas station kratom for toxic heavy metals, finding nickel and chromium in almost every bag. “When I looked at the 10 companies I checked, only 2 were from a vendor that agreed to good manufacturing practices,” he says. “Those were the clean ones.”

In 2018, dozens of people in several states contracted salmonella from contaminated kratom. That prompted an FDA investigation and a recall of kratom products from a company called Triangle Pharmanaturals, a “natural medicines” company whose kratom products are now behind a subscriber paywall.

Notwithstanding thousands of online advertisements, testimonials and labels promising kratom is a strong and safe medicine and supplement, the association insists it is no such thing, and that government efforts to categorize it as such are a lie.

“FDA says it’s an unapproved drug or unapproved dietary supplement,” Haddow, the AKA lobbyist, said. “We contend that it’s a food. Here’s the critical factor: what is its intended use? If I say this is not approved for any therapeutic use ... and I sell it as a food, the FDA should have no say in what I’m doing. They shouldn’t be able to stop me. But FDA wants to reclassify all kratom because some [sellers] use structure and function claims.”

The organization acknowledges FDA has the legal authority to regulate kratom products that make illegal therapeutic claims or when marketed as a dietary supplement without registering the ingredients with the FDA. It also has the authority to crack down on adulterated kratom products.

But for the AKA, kratom is food — and that limits what the FDA can do.

In a lawsuit filed in federal court to extend the deadline for filing comments to the World Health Organization ahead of its pre-review of kratom, the AKA asserted this food “has been used for hundreds of years to safely alleviate pain, combat fatigue and help with the effects of anxiety and depression,” adding that it tastes “bitter and horrible, prompting many kratom users to consume it via capsule.”

The AKA also compares kratom to food when it comes to addictive properties. “Kratom is no more habit-forming than coffee or chocolate.” the Kratom Association’s website claims. “According to leading addiction expert Dr. Jack Henningfield, kratom’s potential for abuse and dependence is on a par with “nutmeg, hops, St. John’s wort, chamomile, guarana and kola nut.”

Henningfield is an adjunct professor of behavioral biology at the Johns Hopkins School of Medicine, but his main job is with Pinney Associates, a scientific gun-for-hire which, according to its website, “helps clients to reduce their regulatory risk and enhance the commercial value of their life sciences products.” He is one of the AKA’s top experts, appearing in press conferences and podcasts where he lends the Hopkins aura to every industry pronouncement. He also has consulted for the tobacco industry.

“There are no meaningful data on the prevalence of ‘addiction’ in the population of kratom users,” Henningfield wrote in an email, citing his own research and two other studies (one of which he had a hand in), concluding that most users do not report addiction and many who do describe it like caffeine addiction.

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None of the three studies focused on addiction. All three were conducted via the AKA’s website. 

“​​An anonymous online survey of kratom users (2,867 current users and 157 former users) was conducted in September 2017 through the American Kratom Association and associated social media sites” is how Pinney Associates researcher Marian A. Coe conducted the 2019 study titled “Kratom as a substitute for opioids: Results from an online survey.”

A second study, titled “Kratom (Mitragyna speciosa): User demographics, use patterns, and implications for the opioid epidemic,” by Albert Garcia-Romeu (Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine), was produced from the same 2017 online survey.

It did not ask users if they were addicted to kratom.

The third and largest study, conceived in 2016 by Oliver Grundmann, a clinical professor of pharmacology at the University of Florida, was drawn from an earlier AKA-directed poll. “I got 10,000 responses in 2 weeks,” Grundmann, currently the secretary of the American College of Clinical Pharmacology, said in a phone interview. “I wasn't expecting so many responses at that time.”

Grundmann was a novice in survey design, so he reached out to the CDC for guidance, and to Henningfield who, he says, is “a really, really big name in the field of addiction research.” In fact, Henningfield used to be the chief of the Clinical Pharmacology Research Branch of the National Institutes of Health's National Institute on Drug Abuse.

The survey provided fresh evidence to the AKA that kratom users were mostly stable, working people in long-term relationships, earning middle-class wages. Most respondents — nearly 80% — said they used kratom responsibly, in low doses, with no problems.

“Obviously you have to take it with a grain of salt that it was a biased sample,” Grundmann acknowledged. “It’s likely biased to have a positive opinion of kratom...nonetheless I felt that we got a pretty good understanding of the demographics of users at the time.”

Only 0.65% of the respondents — 51 people — reported side effects severe enough to require medical treatment. Yet Grundmann hedges when asked if his study proved that kratom is safe.

“So once again I always would advise anyone who wishes to take it to consult with a health professional,” Grundmann said. “But remember the sample was biased.” He also noted kratom users may have felt pressure from would-be government regulators and were thus reluctant to share bad news about the stuff with a researcher.

Still, Grundmann said “kratom taken responsibly and if it’s good product, taken in relatively low amounts, after consultation with a health professional” is probably fine.

His survey asked respondents if they experienced “negative effects” from not taking kratom, and 42% said they did. But Henningfield says that doesn’t equate to addiction.

“Some people use more and use longer than they like and feel they are addicted and need help,” he wrote in his email. “We need to take that seriously. There are reports of ‘helping’ such people by putting them on buprenorphine but that should be done with great caution because buprenorphine actually is an opioid. Is that like helping someone get off caffeine with amphetamine? This needs study.”

Screenshot of the Kratom Information and Resource Center's home page, which proclaims kratom is "no more habit-forming than caffeine or chocolate."

Studies not funded by American Kratom Association, however, find kratom addiction is common.

Three researchers who surveyed 293 regular kratom users in Malaysia found more than half “showed signs of severe kratom dependence.”A different study by different researchers who conducted 562 in-person interviews of kratom users found that 87% reported they were dependent on kratom and could not stop using.

Contemporary kratom addiction testimony is easy to find.

A Reddit forum boasting 25,000 members, r/quittingkratom is dedicated solely to people trying to kick their kratom habits. In a thread someone posted celebrating their year off kratom, I mentioned that my nephew was not able to quit.

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“I’m still stuck on it like your nephew,” another user responded. “If I don’t dose every 4 hours, I feel sick. I even wake up in the night to take a dose. I never sleep more than 4 hours, my hair is falling out in clumps and I’m miserable. It’s so hard to get off this crap. So many people think this is a God send. I was on pain management for Crohn’s getting percs [Percocet] and wanted off. Kratom seemed like the best thing. In the beginning, you have less pain, more energy and it seems like the best thing you could have done for yourself. Fast forward 2 years later...hair still falling out, no energy, frequent cavities despite good oral hygiene and regular dentist appts, swollen liver and elevated liver enzymes, thyroid out of whack and depression!! Good luck to your nephew and good luck with your article.”

I responded that my nephew had died from an overdose. The moderators banned me.

Later, a user who claimed he was a physician and a “public figure” recounted his struggle. “Finally I took time off and got help from friends of mine who are doctors. They are medically removing me from my 80gpd [grams per day] addiction. (I've been sober off alcohol for 3.5 years).”

Eighty grams is 10 times what AKA says is an average daily dose. It’s close to the amount that killed my nephew.

Many kratom partisans tout its effectiveness in blunting opiate withdrawal symptoms. Henningfield and other researchers argue outlawing kratom would send users back to heroin and other opiates, and plenty of users say the same. I asked my own doctor, a 22-year Maryland general practitioner who has treated thousands of addicts.

“As yet I have not had a patient who has successfully used it as a detox medication,” Dr. Karl Spector said in a phone interview. “I have seen patients on oxycodone, Percocet, OxyContin or heroin... that have tried to use kratom as a way to detox off. And what most of them found was, if they did get any effect, they were just replacing one for the other.”

Sean Nicholson, a former recovery house manager in Maryland, says he has “never once seen anyone have sustainable recovery with” kratom.

“I just know from a personal experience of managing people at a very high level that it has opiate effects,” he said, citing itching, nodding and pale complexion: “It causes people to become very sporadic and combative. . .so you can’t manage this person.”

Still, he’s not ready to write kratom off.

“I guess there are plenty of people who have had success and have balanced their use of this in detox,” he said. “Maybe it’s a lesser of the evils in that stage in life.”

Wednesday: How the AKA dominates the kratom debate

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