Chad Butterfield is in a rebuilding phase, working to mend his relationships, his career and his faith in the future. The Holladay, Utah, man is also, at age 40, fighting a battle, trying to resist an expensive, all-consuming craving for something he thought was going to help him give up his unhealthy addiction to alcohol. Instead, he got hooked on something else.
Tiffanie Brown’s on another battlefield, facing the same foe. She was suffering from migraines and ulcers when someone recommended a “safe, natural” product that would help. Like Butterfield, the 41-year-old West Valley City mom became addicted to kratom, an herbal supplement that has been called “gas station heroin” because over time — sometimes not much time — it can create something that very much resembles an opioid addiction, acting on the same receptors in the brain. And it’s widely available.
She bought a packet of little chewable tablets and “it worked amazingly. It got rid of my headaches.” She said her stomach felt better. “I just faithfully was taking it every day because it made me feel good.”
Health experts say, however, that perhaps as many as 1 in 8 people who begin taking kratom will end up dependent on it, similar to the share who drink alcohol and become addicted. Brown and Butterfield find themselves in kratom’s unhappy group.
Mental health providers, addiction specialists, in some cases lawmakers and particularly those trying to come off kratom warn that although kratom-containing products are readily available in service stations, convenience stores, smoke shops and plenty of other locations, they can be dangerous. It’s hard to predict who will or won’t have their life derailed.
Said Brown, who readily admits she’s embarrassed she got addicted, “It’s just not worth the risk. It totally destroyed me. I didn’t even know it existed. And I knew nothing about addiction.”
Butterfield’s older brother Brian had recommended kratom because he was using it for his own addiction and believed it would help his brother; they both became addicted. Butterfield watched the brother he loved go from working on his life and having a good job to spiraling. Eventually, Brian took his own life. Butterfield believes his inability to conquer that addiction contributed to Brian’s death.
Dr. Spencer Hansen, an Intermountain Health addiction psychiatrist, said when people go through withdrawal, suicidal thoughts may come out of the blue and people don’t know where to get help. He said recognizing that as a withdrawal side effect helps.
But knowing that doesn’t ease Butterfield’s pain.
“People say anything could be dangerous, like if you drink too much water, it could wipe out your electrolytes. Well, this is designed to hit the same receptors in the brain as OxyContin and Percocet. I don’t know why the government is dancing around it,” Butterfield said.
He and his dad feel strongly enough about the risks that they’ve talked to Utah legislators about it a number of times.
His personal wreckage includes losing a great construction job and the tremendous stress the addiction places on his marriage. He estimated he “probably spent $20K a year” on kratom and tried stopping multiple times. “I could not get away from it. It made me this crazy liar — whatever it took to get it.“
He’s trying to put things back together and make amends. “Kratom can destroy lives,” he said baldly. “Don’t even try it.”
A tree, a leaf and, for some, a risky choice
Kratom is Mitragyna speciosa, a tropical tree growing in Southeast Asia. The U.S. Food and Drug Administration says its leaves are in products sold online and in retail shops, from teas to energy drinks to gummies, powders and more. Although making medical claims about supplements is not legal, manufacturers, retailers and users often hint that kratom is a do-it-yourself remedy for everything from pain, cough and depression to diarrhea, addictions and more.
Kratom is not approved by the FDA for any medical use.
Lots of people are drawn to kratom products. The Substance Abuse and Mental Health Service Administration’s National Survey on Drug Use and Health estimated that 1.7 million Americans 12 and older used kratom in 2021. The number is believed to be growing.
Kratom has two main biologically active components, mitragynine and 7-hydroxymitragynine. The latter is usually called 7-OH for the sake of ease. 7-OH is the stronger component and its synthetic version is especially addictive, so it’s the subject of some states’ bans and others’ attempts at regulation. Chris McCurdy, a professor of medicinal chemistry, told Axios that kratom leaf products are a “light beer” as far as potency. 7-OH is more like Everclear, a grain spirit banned in Utah, with alcohol content by volume as high as 95%.
Dr. Elizabeth Howell, an addiction psychiatrist at Huntsman Mental Health, says the synthetic 7-OH form is 10 to 12 times stronger than morphine and that’s where most people find themselves in trouble. She said kratom has both stimulant and sedative effects, similar to nicotine, depending on the dose. In small amounts, it provides some energy. At higher doses, it has a sedative effect.
Sometimes consumers think they are purchasing low-potency kratom and end up with high-potency instead, according to the California Society of Addiction Medicine.
It’s possible to overdose on kratom, though overdoses typically involve 7-OH along with something else.
If you look up side effects of kratom online, you sometimes find it linked to seizures, decreased sex drive and organ failure.
The Texas Department of State Health Services just three weeks ago warned people not to use products containing 7-OH, which can create nasty symptoms like nausea and vomiting, agitation, confusion, sweating, fast pulse, hypertension, breathing problems, sleepiness, unconsciousness, seizures and depressed breathing.
Online forums are full of stories of people who became addicted to something they thought was going to help them and shared advice on getting well.
Stories like this one, posted on the North Dakota legislative page: “I fell victim to Kratom 8 years ago. It was described to me as a ‘safe and healthy’ alternative to alcohol. It was marketed as a ‘supplement,’ similar to a vitamin that would give you energy and focus. I was not told I would become dependent. I was not told it was a legal opioid (which I had never used in my life). It destroyed my life, my skin, my drive, my desire to do my favorite hobbies and almost destroyed my marriage. It gave me nose bleeds, high blood pressure, heart palpitations, panic attacks, severe depression and uncontrollable vomiting. When I would go a few hours without drinking it, the piercing stomach pains and body aches deterred me from staying off. After a few years my personality began to fade, I became a shell of a person, and all I could think about was having my next dose of kratom.”
In late July, the FDA announced plans to “protect Americans from dangerous, illegal opioids” by asking Congress to schedule some 7-OH products under the Controlled Substances Act. The FDA calls 7-OH the most addictive component of the kratom leaf. Right now, it’s not scheduled and it may not become scheduled. The DEA listed it as a “drug and chemical of concern” in 2016 and said it would put it in Schedule 1 alongside drugs like heroin.
The effort died after public and congressional pushback.
Some states ban kratom, including Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin. Others regulate it, including Utah, Nevada, Arizona and Georgia. They each have their own rules, which could include age restrictions, labeling requirements or bans of adulterated or synthetic kratom products. Some limit potency.
Many other states have left kratom alone.
It’s an issue internationally, too. Australia and several EU nations ban it entirely, while some countries treat it as a controlled substance or require a prescription. Some focus solely on 7-OH. Many don’t indicate kratom’s on their radar.
How Utah regulates kratom
Utah passed the Kratom Consumer Protection Act in 2019, effective that May. It’s codified under the Utah Agricultural Code Chapter 45 and that department is in charge of implementation and enforcement. Retailers and manufacturers must register with the department and products containing kratom sold in Utah must be registered, too, quantifying mitragynine and 7-OH. They cannot contain synthetic versions of either alkaloid. 7-OH is capped at 2% (exceeding that is a Class C misdemeanor).
In August, KUER reported that some retailers in the Beehive State still sell the synthesized and concentrated 7-OH. The drug that’s been called “legal morphine” has been found in high levels even in states with tough regulation.
The law requires that purchasers be 18 or older. Many forms from powders to liquids and pills to tea bags are acceptable. Any combustible or vapor-friendly version is not. Nor can they mimic candy or be intended to mix into other foods.
There are penalties for not complying with labeling or registration rules. According to the Utah agriculture department’s September kratom newsletter, there are about 396 kratom products registered in the state, with another 56 pending.
The Grow Kratom website warns, “DO NOT use our products if you are subject to any form of drug testing.”
The Utah attorney general declined through a spokesperson to talk about kratom or whether there are other plans to regulate it.
A brutal withdrawal
Deseret News met Brown and Butterfield through Hansen, who is treating them. The addiction psychiatrist is convinced the public needs to know kratom is dangerous because it can lead to a painful, life-altering addiction, but also that it’s treatable.
Brown, who’d never been addicted to alcohol or drugs, had decided she needed to stop taking kratom. That hasn’t been as simple as not buying more. “I’d never dealt with withdrawals before, so I didn’t know what was going on, but I was deathly ill. Sweating. Burning up. My nose was running.”
The clerks at the smoke shop where she bought kratom said she was in withdrawal, which made no sense to her because she didn’t crave it. As a group they decided if she took a little kratom and felt better, that would prove it was withdrawal. One pill and the misery left.
“I thought, this is something I’m going to have to try to get off of,” she said.
The journey has been fraught, relapses a big part of her story. She experienced severe withdrawals that only more kratom could calm. On several occasions she’s gone to the emergency room because the withdrawal was so terrible. They gave her Suboxone to help — a treatment often used to help people get off heroin and opioids. When that ran out, she gave in and took kratom so she could function and go to work.
“It’s just been a really crappy cycle. I’ve been off (kratom pills) for a few weeks now, but it still really messes me up. I still feel out of whack. The fact I couldn’t get off them made me very depressed. I missed work, though I didn’t lose my job. It’s just been horrible. So bad.”
Nor is kratom inexpensive, especially if one is addicted. Brown was spending $50 every two or three days, but the longer she used, the more she needed. Butterfield said he was eventually spending $60 to $100 a day. He borrowed on his mortgage, lied to his wife and was totally in the drug’s throes. It’s a source of sorrow and shame.
Hansen said he’s had a lot of people walk into his clinic, desperate for help to leave kratom behind them. He raised the issue with Deseret News because “it’s very difficult to come off. And when you do stop it, if you’re dependent on it, it’s very similar to heroin withdrawal, so it’s no small thing and people have been getting really discouraged because they don’t know where to turn and they don’t know who to talk to about it.”
He called it important to know treatment works. And tragic to know something so readily available can create that need — and so much misery.
Kratom discussions are raging
Dr. Michael Moss, medical toxicologist and medical director of the Utah Poison Control Center, said kratom is a hot topic with legislatures, patients and the public discussing it more and more. He doesn’t have a number for whether kratom cases are going up, but conversations about it certainly are, he said.
The Poison Control Center has seen cases increase two- to threefold in the past four years, Moss said. Withdrawal is a big issue and a lot of health care providers are not familiar with kratom or its challenges.
“It is an opioid and it does produce dependence and withdrawal, just like heroin or OxyContin or fentanyl.” Addiction specialists have seen people accidentally take too much and some who tried to use kratom to end their lives.
Asked who becomes addicted, Moss answered, “those who use the products regularly.” He describes people he’s known who used it to treat pain after losing insurance or having a doctor cut off access to prescription opioids. Why not? It’s billed as natural and safe.
Kratom is an opioid that “lives in this weird regulatory state,” he said. Some people are fine, others have quite a bit of tolerance, especially those with chronic pain who had already been on opioids and switched to kratom with an existing tolerance that has not gone away. It is clearly the ones taking more and more to conquer pain he hears about. “It’s not popular to go and get high on. It’s not a heavy hitter like Oxy or Dilaudid,” he said.
He hears mostly about users trying to overcome an addiction, like Butterfield. Or treating pain, like Brown.
Moss said the withdrawals are not typically life-threatening, but can be absolutely miserable. Hansen and Howell both said kratom’s not an easy thing to get off if you start using it regularly.
Hansen likens it to alcohol addiction in that some people can have a drink and walk away. Some can have kratom and walk away. … But once some find what kratom can do for them, it quickly overwhelms their capacity to regulate their intake and becomes a problem.
Hansen’s also concerned that the brains of people who struggle with addiction work somewhat differently and they understand substances differently, which makes it hard to use the substance in a helpful or healthy way.
“Kratom can become another of those substances quickly that overwhelms them and makes it so they lose control over their capacity to control how much they take,” he said. “Those are the people I’m seeing. Or people going through a really hard time and then finding this product that, if they take a lot, will relax them.”
It’s not everyone who tries kratom, he was careful to emphasize.
But it’s not just people with addictions who fall prey to kratom’s worst effects. Brown wasn’t an addict, he said, and she didn’t find kratom until middle age, “but it satisfied an important need for her at that time and it quickly became out of control. I think anyone that uses kratom has to understand the risk that it can be very addictive and it can be, at that point, dangerous to stop on your own if you don’t know what’s about to come with the withdrawal effects.“
Getting off kratom is similar to coming off pain pills, heroin or fentanyl. It’s an opioid withdrawal syndrome, Hansen said. The American Society of Addiction Medicine recommends symptomatic treatment for people, similar to how you would treat opioid withdrawal: some prescription medications, over-the-counter meds or Suboxone.
Hansen knows people who spend $100 to $200 a day on kratom. If the government finally bans kratom, where are all these people going to go, he wonders.
That happened with prescription opioids; people turned to heroin. They were ashamed or embarrassed and didn’t turn to their doctors. Often, “it was the doctors who put them in this place. There’s a lot of resentment there.” Doctors aren’t addicting them to kratom, but many still don’t want to talk about their dependence.
He said Suboxone as a substitute to aid withdrawal is not forever. “As soon as they feel strong enough, mentally and physically, spiritually, in their relationships, then we can start a taper plan off Suboxone as well, but at any point along the journey, they can go back on Suboxone, rather than have to go back to kratom.”
This week, Brown said she is managing now without Suboxone’s help.
There are other tools, too. For instance, kratomquitters.com has three daily meetings, akin to Alcoholics Anonymous, online.
Moss predicts Utah lawmakers will do something more with kratom soon, whether it’s better warnings, education or deciding to regulate it more.
Anyone with questions about whether they’ve had too much, he added, can call the Poison Control Center at 800-222-1222.