On Morganford Road in Tower Grove South, between a fitness studio and a sports bar, sits CBD Kratom. What at least a few neighbors have mistaken for a large pot leaf is decaled on the store's window. Written in chalk on the sign out front are the questions, "In Pain? Anxious?"
Inside, the wall behind the counter is lined with jars filled with kratom, a drug that looks like pale green sawdust. Affixed to each jar is a label: Red Bali, White Gold, Green Sumatra, Yellow Borneo. There are more than 40 different strains.
The menu is helpful for first-timers, breaking down where each kratom strain originated from and how it affects the user. Yellow Borneo, for instance, is said to provide "euphoria, a strong clear minded energy." The Green Maeng Da is described as a "very effective pain reliever" that also "gives you a strong boost of energy." Variations of "euphoric" — a "simple euphoric effect," an "intense euphoric effect," "extremely euphoric" — appear all over the menu. Some strains are better used as a pick-me-up, others ideally taken before going to sleep. If you have questions, the woman behind the counter can tell you more about kratom than most Starbucks baristas can say about coffee.
Kratom powder looks like it should dissolve in liquid, but it absolutely will not do that. It's like sand in that way. It's also incredibly bitter on the tongue. Some consumers brew it into a tea; others scoop the powder into a capsule. Many settle for what is called a toss and wash, putting kratom on their tongues and washing it down as quickly as possible. Kratom is sticky, though, and a toss and wash is a lot like trying to do the same thing with cinnamon; it's probably going to take several swigs. David Palatnik, the 28-year-old owner of CBD Kratom, takes some of the energy-boosting Green Malay strain every morning in lieu of drinking coffee. He mixes it in a smoothie or, if he's feeling lazy, washes it down with orange juice.
The powder sells for around a dollar a gram, and typically users take around three grams a serving, more if they want a more potent effect. A few customers who live in rural parts of Missouri and Illinois come once every couple of months and buy the product in bulk, but Palatnik says it's much more common for customers to spend $15, $20 on enough product to last a week or so. A handful of regulars stop in every morning — the shop opens at 8 a.m. — to buy a single serving to go with their morning coffee.
A lot of the people who stop in CBD Kratom think of their purchase the way most people think of coffee: a little boost to make the day easier. Others swear kratom is a wonder drug, something just short of a miracle. It alleviates their chronic pain. It cured their depression. The Food and Drug Administration and the Drug Enforcement Agency both say kratom is deadly and should be illegal.
Thirty-nine-year-old Boska Hunter-Hannan falls squarely into the "wonder drug" camp. Since high school he managed pain from a degenerative disk with the prescription opiate Vicoprofen, taking a pill every four hours and facing withdrawals when his most recent dose lost efficacy or when he wasn't able to refill his scrip.
Then one day last July his wife, who works at a tea shop in Columbia, Missouri, brought home a sample of kratom that had been sent to the store as a promotional freebie.
Hunter-Hannan said his first inclination was to throw away the powdery substance. It looked a little bit like instant coffee and nothing like the tea leaves his wife normally sold at the store. He thought that maybe he'd heard of kratom and that it was bad. Nonetheless, he googled it and read that kratom allegedly helps in the management of chronic pain. He was dubious, but he'd been taking prescription painkillers for so long he was willing to give kratom a shot. He doubted it was going to do much of anything one way or another.
"Twenty minutes later," he says, "my pain was gone and I was telling my wife, 'Wow, this is not a joke. This is real. This is awesome.'"
Seven months later, Hunter-Hannan describes that day as his "aha" moment. He'd found something that not only managed his pain but was also all natural with fewer side effects than the opiates he was prescribed. Now he tells anyone who will listen about kratom. He's given kratom to friends. When his boss at his IT job complained of chronic pain, Hunter-Hannan gave him some, too.
By taking kratom in the morning, followed by another dose or two throughout the day, Hunter-Hannan has been able to more than cut in half the amount of Vicoprofen he needs. Vicoprofen made him drowsy, but he compares kratom to a strong cup of coffee that also makes him feel good.
"It's got the opiate feel," he says. "It's got a little bit of that euphoria that you're not going to get with coffee, but the high is not like what you get with Vicodin or anything like that. It's really simple and not something that you crave."
Afterwards, did the tea store where his wife works start stocking kratom?
"No," he says. "They didn't. They didn't want to get into all that."
By "all that," Hunter-Hannan is referring to kratom's precarious legality and the swirl of controversy that has recently surrounded it. Right now kratom is illegal in seven states, and in 2016 the DEA tried unsuccessfully to outlaw it nationwide.
Last November, the FDA signaled intentions to try to do the same. The agency issued a public health advisory that stated in part, "Evidence shows that kratom has similar effects to narcotics like opioids, and carries similar risks of abuse, addiction and in some cases, death." The advisory cited reports of 36 deaths in the U.S. associated with its use and claimed kratom causes seizures, liver damage and withdrawal symptoms. The agency said it was particularly disturbing that kratom was being sold as a safer alternative to opioids and that those addicted to painkillers and harder drugs were using it without doctor supervision as a way to detox. Also, the FDA said, some people use kratom recreationally, just to get high.
No one is more aware of kratom's recent bad press than Palatnik, the owner of CBD Kratom. He's eager to talk to anyone, media included, about his product, which he sees as being seriously misunderstood. Of course he has a lot to lose financially if kratom were to be made illegal, but he seems to believe sincerely in what he sells. He's quick to refer skeptics to websites, news articles and YouTube videos, giving the impression he genuinely thinks that the whole debate over kratom could be cleared up if only the naysayers would bother to do some research.
Palatnik says that kratom's bad rap ultimately boils down to "a lot of politics." The FDA, he says, makes a lot of claims that don't add up with its own records. He's also quick to point out that the FDA itself is largely responsible for the opioid epidemic by failing to keep doctors from over-prescribing painkillers in the first place.
Kratom, he notes, is completely natural. Kratom (scientific name Mitragyna speciosa) technically refers to a tree that is in the same family of plants as coffee and is native to southeast Asia. The leaves of the kratom tree are harvested and ground into the very fine powder Palatnik sells in his store. This powder is not an opiate, but once ingested it activates the same opioid receptors as such drugs, hence the killing of pain and the euphoric effects.
"There is no safety issue with kratom," Palatnik says. "We've been selling it for years, to thousands of people, and we've never had a single customer who has ever said anything bad has happened."
But what about those 36 deaths the FDA attributes to kratom? Is the stuff really killing people? Palatnik says no. "When you look at those cases, they involve other stuff," he says. Palatnik points to the case of a man who died of a heart attack and had kratom in his system. The FDA counted his death among the 36 caused by kratom, ignoring the fact that heroin was in his bloodstream as well.
It should be pointed out the information Palatnik is citing comes from the American Kratom Association, a Colorado-based nonprofit formed in 2014 to increase access to the substance. However, data from Columbia University researchers does show that, while kratom engages the same opioid receptors as drugs like heroin or Oxycontin, unlike those substances kratom does not depress respiration. That's a key difference, medically; according to Mothers against Prescription Drug Abuse, the cause of death from opioid overdose is "almost always" respiratory failure.
Locally, Suzanne McCune with St. Louis County's Office of the Medical Examiner said that she could find no cases of kratom's active ingredient, mitragynine, being included in a recorded cause of death in the past two years. However, it was only very recently that "kratom, designer opioids, fentanyl analogs, bath salts and a host of other chemicals, legal and illegal" became part of a standard toxicology panel in the county. Previously, investigators didn't search for evidence of such substances unless they had special cause to look for it. In January 2017, the office began using a new instrument to provide a more comprehensive analysis that will, as a default, include kratom.
Though Palatnik says he's never heard of a bad kratom experience from a customer, many kratom users have written on erowid.org — a website where users document drug experiences of all types — about its effects, both good and bad. In addition to euphoria and pain relief, users reported increased energy, sociability and empathy. Reported negative side effects tend to be mild: nausea and vomiting, dizziness and chills. However, an analysis of all the kratom-related posts to erowid.org found that one in ten individuals reported some type of negative feeling associated with withdrawal.
Palatnik says many of those negative side effects stem from a lack of education around kratom. He says that's in part why he opened the store in the first place.
Palatnik already owned the Mr. Nice Guy chain of smoke shops in St. Louis when he first encountered kratom three years ago at a trade show. He tried a sample himself, liked it and, after doing some research, decided to start selling it. He noticed that a lot of places in town were also selling Kratom, but nowhere was it a business' primary product. Also, the places offered little education to consumers. They didn't know the differences between strains and couldn't answer customer questions about effects and dosage. That's when Palatnik got the idea to open CBD Kratom, making sure employees undergo a lengthy training so they can recommend to customers what is right for them. He opened his first store in July 2016 in Chicago's Bucktown neighborhood. The Tower Grove location followed in the spring of 2017.
"The education is what I'm really passionate about," Palatnik says. "A lot of smoke shops like Mr. Nice Guy sell kratom, but kratom really should be in a special place where employees are knowledgeable about it and people can get the right service. I think when you educate people they'll be happy to be your customers and stay your customers."
In its statement, the FDA says it is working to "actively prevent" kratom from entering the country and that the agency had "detained hundreds of shipments of kratom." When asked if this posed any risk to keeping his shelves stocked, Palatnik says there was "already a similar enforcement placed on kratom imports, so not much has changed at all recently. We're well stocked as of now and expect to be for the future."
But, he adds, "customers are very scared. They don't want kratom to be taken away from them."
Dr. Evan Schwarz is an assistant professor of emergency medicine at Washington University's School of Medicine and director of the school's Medical Toxicology and Addiction Medicine Clinic. Schwarz, who spends most of his time in emergency medicine, is also the section chief for the medical toxicology section. He sees a lot of overdoses, people who have come into the ER after accidentally or intentionally taking too much medication or having complications after taking illicit drugs. He also practices addiction medicine, working with individuals abusing opioids, and it's in this part of his job that kratom comes up.
Patients he counsels do occasionally ask about kratom as a potential therapy, and Schwarz says he advises against it. More commonly kratom becomes part of Schwarz's conversation with patients because they are already abusing it or because someone asks if kratom could be the cause of a complication they're experiencing.
"One of the biggest problems we have is that what's being sold here isn't the same as what's being taken straight from the plant," he says.
For instance, the packets sold around St. Louis often have much more 7-hydroxymitragynine, which is the specific metabolite that engages the user's opioid receptors, than would be found in the kratom plant itself. Schwarz says he has taken care of people who have had liver complications and bleeding in the brain from kratom.
Making things worse, Schwarz says, is that kratom is as unregulated as bath salts and K2, which have both caused serious harm to users. When doctors have analyzed K2, for instance, they have found a lot more than just the "fake weed" present in the product. Schwarz says it's likely the same goes for kratom sold over the counter. Lacking regulation, when people buy kratom there is no way to be certain exactly what they're buying.
"When you go to the pharmacy to get medicine for your blood pressure," Schwarz says, "what you get is exactly what you asked for and were prescribed — there's not, like, four different kinds of blood pressure medication in there just because someone decided to throw them in. When you buy this stuff from head shops or wherever, you never know what's in what you're buying. and some of the stuff people put in there could make you really sick."
Schwarz acknowledges that placing kratom on the list of Schedule I narcotics will make it very difficult to research further, and that is a legitimate reason to oppose the FDA's push. "But," he says, "that shouldn't be the deciding factor."
While Palatnik and Schwarz are defnitely not on the same page when it comes to kratom, there is a certain resonance between what the two men have to say. Schwarz says the problem with kratom is that users have no idea what they're taking. Palatnik says he opened his store because kratom needed to be in a "special place," because most sellers had no idea what they were selling. His kratom, he says, is just the ground-up leaf, with nothing added. There's no reason to doubt him but, absent any regulatory oversight, customers have to take Palatnik at his word.
Hunter-Hannan says he avoids the head shops and gas stations that sell kratom in Columbia and instead buys his kratom "exclusively online" from distributors he trusts. "You never know," he says. "People could be putting stuff in their kratom, but I don't want any filler, and when I buy from these distributors I feel like they're giving me what they're supposed to. It smells good, it's all the same color. It's all the color it's supposed to be."
The lack of serious research into kratom makes it difficult to know how many people in the U.S. are using the drug, especially since most standard drug tests don't detect it. But, Schwarz says, data suggests a recent increase in overall use — or at the very least an increase in reported serious complications associated with it. One CDC study, for instance, found a tenfold increase in kratom-related calls to poison control since 2010. What's behind this trend is hard to identify, but Schwarz says that the drug being easily accessible in most states is likely a factor.
Much of the press coverage around kratom has placed it in the context of the country's larger opioid crisis, focusing on the subset of kratom users who take it as an alternative to illicit opiates. But Palatnik says that while people certainly take kratom for those reasons, to focus solely on them overlooks the majority of people who come into his store.
"Government agencies try to say [getting off opioids] is the main reason people are taking kratom," he says. "It's not the main reason. I know it's not because I'm here at the shop all the time, and people tell me why they take it. I know better than the FDA."
One customer overhears Palatnik talking and, though he asks that I not print his name, confirms that he is a pulmonary physician in the area. He's been using kratom for more than fifteen years, he says, primarily as a way to relax in the evenings after work, not unlike how a lot of people have a beer.
"It's used by law-abiding citizens who own businesses and have professional jobs, people who have marriages and children and successful occupations," he says. In the past, he adds, he's stopped using kratom cold turkey with no negative effects.
It can seem contradictory when Palatnik and other kratom supporters speak about both the product's near-miracle and euphoric effects as well as the notion that it's a mild substance. But to Palatnik's larger point, the people who come in and out of his store look like patrons of any other business — an older woman after a yoga class, a couple of younger guys, a middle-aged couple, a man in a suit, a man whose inquisitive conversation with the clerk lasts nearly as long as my interview with Palatnik — decidedly unlike people who look in desperate need of some sort of fix.
Leaving CBD Kratom, I bump into Fred, who is wearing painter's pants and a sweatshirt speckled white and brown. He doesn't want to give his last name, but he says he takes "a pinch of Green Maeng Da every morning with orange juice" for the pain caused by being on his feet all day. Kratom allows him to work an eight-hour day and, just as importantly, he says, "lets me stay away from the stupid stuff. I don't want to get addicted to anything."
When I ask if he's ever used prescription drugs for his pain, he looks at me like I'm crazy. He wouldn't even touch aspirin, he says. He isn't interested in ruining his life with an addiction.
Ryan Krull is a freelance journalist who teaches in the Department of Communication and Media at UMSL.