The Centers for Disease Control and Prevention is warning the public to cease all use of kratom in any forms until experts find the source of a salmonella outbreak that has sickened dozens of people.
The updated announcement by the federal agency last week comes four months after the U.S. Food and Drug Administration advised the public to avoid using the opiate-like, plant-based substance, reporting that kratom has killed at least 36 Americans in recent years.
Kratom remains legal federally and in Arizona, though it has been banned in some cities and states. Here it is available for the public at various smoke shops and other retail outlets.
The CDC last week updated its original February 20 advisement, upping the number of salmonella-sickened victims to 40, including one in Arizona. But the CDC cautioned that illnesses sometimes take two to four weeks to be reported, meaning that people who became ill after February 6 might not be recorded yet.
People began getting sick from salmonella-tainted kratom in October, the CDC says. Unfortunately for kratom consumers, the CDC hasn't yet identified which of the many brands of kratom might be responsible.
"Despite the information collected to date about where ill people purchased kratom, a single common brand or supplier of kratom has not been linked to the outbreak," the agency's March 1 notice states.
The CDC referred calls for questions about the salmonella problem to Arizona's Department of Health Services. The ADHS did not return a message. (UPDATE: Chris Minnick, spokesman for the state health agency, emailed back later about the Arizona case: "This individual is a resident in Pinal County. The case reported consuming Kratom, but none was able to be tested. Arizona continues to monitor for additional cases that match this outbreak.")
The sick people known so far range in age from 6 to 67 years, with a median age of 41. Most are men. At least 14 of the victims were hospitalized, but no one has died from the outbreak. Salmonella is known to cause headaches, cramps, vomiting, diarrhea, or other symptoms, and in extreme cases, death.
The new CDC warning hasn't seemed to slow down kratom sales. One Phoenix smoke shop worker said he hasn't noticed any impact from the warning.
Anna Caffarel, owner of Tucson Kratom, said the CDC warning was another government attempt to smear the substance as something bad — which she insists it isn't. She's suspicious of the generic warning for all types and forms and kratom, something not usually seen with food-poisoning warnings about a specific brand.
"We have thousands of customers and no one has said anything about it," she said about the CDC's warning. "It's a great way to scare people without giving any sound science about it."
Most customers purchase kratom teabags or capsules with ground plant matter, she said.
New Times has written about the U.S. Drug Enforcement Agency's attempts to ban kratom since at least 2011. Ex-New Times scribe Stephen Lemons tried a relatively low does of it, writing that he felt relaxed but "not incapacitated in any way" for about four hours.
Kratom consumers typically report mild relaxation effects in low doses, and a narcotic feeling at high doses. Whatever the recreational-drug benefit, advocates consider it an effective herbal medicine, good for treating chronic pain and other ailments. It's also well-known for helping to wean addicts off heroin and other opiate-based drugs.
Dr. Frank Lovecchio, co-medical director of the Banner Poison and Drug Information Center in Scottsdale, said it may be most commonly used for self-treatment of opiate addiction.
Many heroin users take kratom to try and kick the harder drug, or use kratom to help them get through a dry period before their next fix, he said. They could go to a clinic and try methadone or suboxone, but "maybe they don't want to show up in the system." Lovecchio is also the medical director at Blue Door Therapeutics, an opiate-addiction treatment clinic.
Kratom, or Mitragyna speciosa, to use the Asian plant's scientific name, has compounds that activate opiate receptors in the brain, which is why in high doses it produces effects similar to opiates. Lovecchio said it can be addictive.
He hasn't heard of a kratom death in Arizona, but advises "extreme caution" based on the FDA findings. Kratom victims get so relaxed — well, as the MGMT song says, "we'll choke on our vomit and that will be the end."
Statistics from the Banner poison control center show that 11 people called about kratom in 2016 and 2017, with 10 reporting possible problems after ingesting kratom, and another caller seeking information.
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Lovecchio is skeptical of non-FDA approved drugs, noting that companies are allowed to put drugs labeled "supplements" on store shelves without regulation, as long as they make no health claims about the products.
"When you get these capsules, you could just make this in your backyard," he said. "You could put a turd in it ... Until someone gets harmed, they can't pull it off the shelf."
The CDC statement says the agency's investigation into the salmonella outbreak remains ongoing.
Meanwhile, according to the FDA's website, the agency has learned that more people than it originally thought have died from using kratom.