WHO foregoes recommending ‘critical review’ of kratom

An expert committee of the World Health Organization (WHO) has recommended kratom not be subject to a “critical review,” potentially allaying fears that the botanical will be controlled internationally as a drug.

Following a pre-review of kratom and its constituents during an October meeting in Geneva, WHO’s Expert Committee on Drug Dependence (ECDD) concluded there is inadequate evidence to recommend a critical review of kratom. With the exception of one member, the expert committee also reached the same conclusion about two constituents in kratom, mitragynine and 7-hydroxymitragynine.

The ECDD, an independent group of experts in the field of drugs and medicine, recommended kratom, mitragynine and 7-hydroxymitragynine be kept under surveillance by the WHO Secretariat.

Kratom advocates had feared a worst-case scenario ahead of the WHO meeting: the U.N. Commission on Narcotic Drugs (CND) would eventually move to “schedule” (as a drug) kratom internationally, requiring dozens of countries—including the U.S.—who are parties to the 1971 Convention on Psychotropic Substances to ban the substance.

But such fears may be put to rest, at least for now, since kratom is not recommended for a critical review.

WHO initiated a pre-review of kratom and its constituents based, in part, on a “country-level report indicating the potential for abuse, dependence and harm to public health from mitragynine and 7-hydroxymitragynine,” according to a Nov. 18 document summarizing the ECDD’s recommendations. The document also cited a report from an international group detailing fatalities associated with use of kratom.

Related:Kratom consumers oppose ban in comments to FDA

“Kratom can produce serious toxicity in people who use high doses, but the number of cases is probably low as a proportion of the total number of people who use kratom,” WHO stated in the document. “Although mitragynine has been analytically confirmed in a number of deaths, almost all involve use of other substances, so the degree to which kratom use has been a contributory factor to fatalities is unclear.”

Tens of thousands of consumers sent comments to FDA and WHO, many opposing a ban of kratom and hailing its benefits. In a Dec. 7 email to its members, the American Kratom Association (AKA) described WHO’s recent announcement as “an enormous validation of the comments you submitted and science we presented to the WHO ECDD.”

"The AKA, and kratom consumers around the world, are extremely grateful for the extensive review and the overwhelming consensus by the ECDD that [there] was insufficient evidence to recommend kratom be subjected to a full critical review," Mac Haddow, senior fellow on public policy with AKA, said in a press release.

Haddow added, "There can be no doubt that kratom should not be scheduled and that it should be responsibly regulated to protect against dangerously adulterated kratom products."

AKA, however, cautioned it remains to be seen how WHO’s recommendation will impact future reviews of kratom.

“What exactly this will mean for kratom internationally and potential future reviews is unclear, but we can be certain that kratom's enemies will try to bring it up again,” observed the kratom group in its email, which acknowledged one member of the ECDD was in favor of a critical review of mitragynine and 7-hydroxymitragynine.

Kratom is used commonly to treat chronic pain and opioid withdrawal symptoms, and consumption of the herb can lead to such adverse effects as constipation, nervousness, respiratory depression, vomiting and weight loss, according to FDA.

“Kratom has been reported to have both narcotic and stimulant-like effects, and withdrawal symptoms may include hostility, aggression, excessive tearing, aching of muscles and bones, and jerky limb movements,” FDA noted in a 2021 Federal Register notice announcing WHO’s October meeting to review kratom and six other substances, including phenibut.

FDA for years has maintained an import alert on dietary supplements and bulk dietary ingredients that contain kratom. And recently, a manufacturer of kratom supplements entangled in a lawsuit with the U.S. Department of Justice agreed to destroy articles seized by the government.

FDA declined to comment on the ECDD’s recent recommendations pertaining to kratom and its constituents.