Letter: Kratom distribution poses risks to people who use drugs

Graphic by Lori Deaton

Western North Carolina has experienced a surge of drug overdose deaths. COVID-19 increases overdose risks for people who use drugs; isolation leads to using alone; pandemics disrupt treatment and support; and PWUD (people who use drugs) suffer determinants of health that compound vulnerabilities. Overdose prevention strategies endorsed by the Centers for Disease Control and Prevention include naloxone distribution and syringe access programs. Harm reduction goes beyond, encompassing practical ideas to reduce negative consequences of drug use through advocacy, social justice and inclusion of PWUD in decision-making — with respect for the rights of PWUD.

Serving populations at increased structural risk for overdose without adequate information is dangerous. When entities without a proven history in community-based harm reduction use the language of harm reduction to describe work not guided by its principles, it threatens people they purport to help. This is seen, for example, when health departments start syringe service programs without involving local stakeholders and thereby divert funds from established community-based programs. Or when political organizations delve into harm reduction without a direct service background. A particular danger accrues from organizations promoting strategies and products not only inconsistent with harm-reduction principles, but scientifically proven to pose direct risks to PWUD.

As a registered nurse working full time in public health with the harm reduction community and an applied medical anthropologist engaged in research with community-based harm reductionists, it is our duty to report behavior detrimental to public health that threatens PWUD. Most recently, a local organization, SeekHealing, whose website describes it as a “nonprofit serving people at risk for overdose” and uses the term harm reduction to describe their work, distributed “herbal first aid kits,” including kratom, as part of a COVID-19 response. SeekHealing advertised the kits for people experiencing pandemic-related withdrawal. Kratom is an unregulated herbal opioid with known overdose risks. High-quality studies demonstrate kratom increases overdose death risks. This distribution violates the tenets of harm reduction.

Harm reduction requires determining, with well-designed research and input from directly affected local stakeholders, what practices keep people safe and empower them to live healthy lives. Evidence backs syringe access programs and drop-in wound care to protect the lives of PWUD. There is no evidence that kratom is effective or safe for opiate withdrawal, as SeekHealing claims. There is mounting evidence to the contrary. Toxicologists determined kratom increased the risk of adverse events, particularly when ingested with other drugs. Overdose deaths have been attributed to a combination of a synthetic opioid and kratom. Naloxone may reverse respiratory distress in kratom-only ingestion. Kratom contributes to respiratory depression, compounding death risk.

Withdrawal increases overdose risks. Offering kratom to people experiencing withdrawal increases vulnerability. Such distribution seems at minimum reckless and at worst predatory, especially when done without honest education and informed consent. SeekHealing introduced “herbal first aid” ostensibly amid concerns COVID-19 would disrupt the local drug supply, causing withdrawal for PWUD. SeekHealing mainly targeted unsheltered folks; partnering with a homeless service organization and an organization offering HIV case management for precariously housed clients and distributing naloxone and safe injecting supplies to PWUD (on a drive-thru basis during the pandemic). Yet kratom distribution began without SeekHealing consulting folks already doing direct service to PWUD. Despite other COVID-19 disruptions, we have not seen it affect local opiate supply or cause pandemic-related withdrawal.

Information distributed with the kratom covers its history but included no overdose warnings. Instead, it falsely claims combining kratom with other opiates “cancel[s] each other out.” Despite efforts to communicate with SeekHealing, discourage kratom distribution and encourage discussion about building trusting relationships when working with PWUD, SeekHealing’s reckless behavior continues. When individualized care and informed consent were suggested, a SeekHealing representative dismissed this as “prescriptive” and not rooted in trust. Those who witness community-based harm reduction know this dismissal is off-base. Individualized care is not only possible; it is imperative during a pandemic. PWUD are too often denied appropriate health and safety resources. Care is often relegated to cookie-cutter, non-evidence-based treatments. Integral to harm reduction is education about safer use and relative risk. Harm reduction isn’t about prescription; it’s about accurate, locally relevant education and supplies that don’t introduce new risks.

SeekHealing’s dangerous actions are in opposition to the harm reduction framework they co-opt. Years of well-designed research and advocacy by PWUD and those in service to them legitimized harm reduction. Reckless behavior under the guise of harm reduction endangers people at risk of overdose and threatens this legitimacy. Harm reduction should not be a buzzword tossed around to gain notoriety and funding. Introducing a new risk into a vulnerable community without education, while blatantly offering misinformation, does not reduce negative consequences of drug use, nor does it show respect for the rights of PWUD. It is not harm reduction. It only harms the efforts of principled harm reductionists, and, by extension, the health of those we serve.

— Vanessa Hixon, RN, co-director of The Steady Collective

and Bayla Ostrach, Ph.D., applied medical anthropologist and community research liaison with The Steady Collective

Editor’s note: The writers note that The Steady Collective is a nonprofit Asheville-based harm reduction organization with a goal of improving overall community health by reducing the rate of drug overdose and the spread of infectious disease with education, advocacy and direct services.

Xpress contacted the nonprofit SeekHealing with a summary of the letter writers’ points and received the following response from the SeekHealing board of directors — Luc Richard, Jennifer Nicolaisen, Dr. Rachel Wurzman, Jennifer Garrett and Joshua Ginsberg: “Unfortunately, this letter is factually incorrect. Not all kits contained kratom — in fact, most did not. SeekHealing did not distribute anything directly: We donated kits to partner organizations that distributed them through peer supports.

“Over two months ago, Steady voiced concerns about the inclusion of kratom. This was confusing because we had reached out to Steady for input on the project prior to launch, without response. Ever since they reached out, we stopped including kratom in kits while we revisited the literature.

“The research around kratom is highly inconclusive. Recent studies show that correlations with fatalities ‘cannot be established in almost all cases because of poly-drug exposure.’ [avl.mx/7rn]

“We offered these kits with compassion to support underresourced people during a pandemic when they were more isolated and unsupported than ever. Participants universally offered gratitude and positive feedback.

“To prevent overdoses as a community, we need more interorganizational cooperation and mutual respect.”



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33 thoughts on “Letter: Kratom distribution poses risks to people who use drugs

  1. Mittens

    Kratom is doing far more good than bad. I had a surgery a few years ago and I became addicted to the pain meds I was taking. It only took me a little over two years to completely ruin my life. Fortunately, I learned about kratom tea online and tried it and it b helped me immensely. It was always the opiate cravings that derailed me. The kratom tea doesn’t completely eliminate the craving but it makes them far more manageable. There have been 5-10 times in this last year that I know I would have relapsed without it. There’s no doubt in my mind that I would be dead or homeless and still addicted to heroin. I wound up in the emergency twice from overdosing on pain pills and heroin. I highly doubt that I would have survived a 3rd one. I’m happy for the first time in years but more importantly, my family is happy. I can’t imagine what they had been going through. If I never discovered that plant my life would still be a mess.

    • Lindsay

      Surely ur pulling stuff outta ur ass by saying Kratom increases opioid overdoses. Kratom was been a literal LIFE SAVER to me. After my partner died in my arms of an overdose, I am so glad I found Kratom and was able 2 kick opiates relatively painlessly, and without being stuck on maintenance drugs for the rest of my life . I only wish we had found Kratom sooner- maybe my partner would still b alive if we had.

  2. indy499

    Sounds like a lot of whining that their non-profit turf was somehow invaded.

  3. Kami Davis

    I’m getting VERY TIRED of seeing reporters or writers state LIES and make DEATH CLAIMS or claims to horrific side effects supposedly caused by Kratom. Where is the proof showing Kratom to cause hallucinations and seizures?? There are no emergency room visits/documentation of ppl complaining of seizures or hallucinations as a result of Kratom. Also, there is no documentation or record ever written in the history of mankind proving that a death resulted from Kratom alone.

  4. Big Al

    You are asking us to believe that this herbal opiate is MORE likely to cause an overdose than the heroine injected through the clean needles offered by the Steady Collective?

  5. Amy Wike

    The truth is, any substance can be addictive and if we banned every substance, there would be very little left to choose. Its has never been about the substance, it’s about the brain and the person. Kratom has the potential to be abused as much as sugar does. If a diabetic ate sugar by the grams, they would likely die but we dont ban sugar because it’s not deadly to the masses. The public needs accurate information that is unbiased and articles like this are not it. Kratom saved my life quite literally. I went from taking 3 different opiate pain meds to taking kratom daily and now I’m back at work. It is a great plant that had many benefits.

  6. ERIN A Arthur

    Oh Boy, I suggest you ask all the people that have successfully gotten off opiates/opioids & alcohol & leading healthy lives now because of kratom ..ask for testimonials !~ you will be amazed. If you don’t support it that’s fine but please do not spread untruths about kratom. 40 years I was on trexane, methadone, heroin, RX pills,,, Kratom is the only thing that has unenslaved me from these drugs. You should start asking why ?? why does it work so well for so many? Please check into PAT (Plant assisted therapy)

  7. TS Kane

    Kratom is neither a miracle cure-all nor a dangerous drug worthy of fear. Countless people have used it to relieve pain, ease addiction and withdrawal from actual opioids, manage depression and other things. I’m one of these people.

    Mitragyna speciosa is related to the coffee plant and has been used for millennia without issue in its native Indonesia. It doesn’t cause respiratory depression even in high doses, therefore it can’t increase the overdose risk of other drugs. Like all supplements, it’s capable of causing rare individual reactions like liver test abnormalities in a handful of users. And it should be reserved for adult use in those over 18 to avoid harm to kids (which is a parent’s job anyway). But in no way does it need to be banned or scheduled. That would hurt far more people than it helps. We should focus on implementing robust quality & purity standards like the American Kratom Association is already doing. People who use kratom tend to do so for the purpose of getting OFF more deadly drugs like benzodiazepines, opioids & Rx sleep aids, NOT combining it with other drugs. Unlike opioids, there is a ceiling effect to kratom’s mood boosting effects which makes it less likely to be abused in high doses.

    It’s time to start trusting adults to make their own health & wellness choices. We don’t need more gatekeepers such as doctors, pharmacists & the private insurance agency standing between us and our health. There’s enough of that already. Educate, regulate & tax is the best way to handle a drug epidemic. We’ve tried it the other way for 80 years & are failing miserably.

  8. Jim

    Good grief I wish journalism wasn’t dead. What a total hit piece full of lies.

  9. Jess

    Kratom has saved me!!! I researched on my own before I started. Kratom KEEPS people away from harmful drugs. Kratom is NOT harmful! I have read how this pandemic has caused many OD and if those people would have known about Kratom and how amazing it is they would probably not have OD.
    I just don’t understand how something that HELPS is getting called bad! I really believe Pharma is just scared Kratom will cause a huge dent in their profits, so they try to make it sound like the devil.

  10. kendell clark

    Kratom saves lives, not takes them. It gets people off of opiates, substitutes for opiates in people with chronic pain, and is an effective antidepressant. How many articles must I see like this before people start reading the science which proves this?

  11. kendell clark

    Someone is definitely whining about something. Kratom cannot be injected without causing serious and most likely fatal harm to your organs by trying it. It’s taken orally. It does not increase opioid overdoses, if anything, it prevents them. People do not take kratom along with their opioids or at least, they should not do so. People don’t use this drug to get high, they use it to get off of the pain killers they were given or bought illegally. Why you guys want to say such things is beyond me. Do you really think people are going to take an article like this seriously and abstain from kratom if they take it or avoid it if they don’t? You haven’t a clue what you’re rambling about. You literally took the quotes from the FDA, and repackaged it to look like you did your research. Type “kratom deaths from kratom alone” or something like it, into google. You won’t find anything. Actually search for scientific evidence on kratom and you’ll find the opposite of what you post hear. Can it be addictive? Yes. So can nicotine, coffee, and chocolate. Can it kill? Probably, yes, in high enough doses. Is it an immediate threat to public safety that requires emergency action? Absolutely, positively, not. This really saddens me that you say such things without any proof to back it up. For people, like me, and lots of others, that have chronic pain, but cannot get or do not want opioids, kratom is a lifesaver. And more and more people are going to come to it as more and more get cut off their pain meds and told to take tylenol. You clearly know this, do not like it, so you’re hoping to persuade people to steer clear of it. There are millions of us who will all help you write good, concise, accurate kratom articles,and there are millions of us who will blast you for writing bad ones.

  12. Sebastian Miller

    Kratom greatly improved my quality of life. I was obese 240 pounds and it motivated me to start exercising again and killed the pain from a hip condition I have. There’s nothing wrong with using a plant from the earth. Go write a smear article on caffeine since you seem to love controlling what people ingest.

  13. Christopher Evans

    Reading this article was very frightening in my opinion. Using kratom in opiate replacement therapy, has been far more successful and safe then using suboxone and methadone. We have been able to turn the lives of 132 addicts, so far here in Pennsylvania, into actual contributing members of society without the side-effects of methadone and suboxone. They all have been able to hold down jobs, keep relationships, and haven’t failed their random drug screenings in the last two years. Maybe you need to actually visit some of this rehab facilities, because looking at the kratom overdose statistics, which there has only been one confirmed overdose of only kratom, keeping in mind that young man had preexisting liver problems, you need to understand that kratom poses less risks then the majority of over the counter medications available at the moment. Your robbing some very mentally and physically ill people out of hope and a chance at a new life by writing garbage like this, feel free to e-mail me because your so far off base that I could at least show you actual studies and trials that completely tip the scale for kratom being a positive option for these people.

  14. Rebecca Zirkelbach

    Did you just pull this info out of your ass? Literal blatant LIES. It’s almost as if you did ABSOLUTE ZERO research.

  15. Joseph

    This is a letter from a nurse… hard to believe because most nurses are pretty well educated. Just gobsmacked by the lack of facts.

  16. Nik

    This is ridiculous. I’ve been taking Kratom for over 8 years now, instead of harmful pharmaceutical opiates to deal with chronic pelvic pain. So we’re just supposed to ignore all the success stories of this magnificent plant For this garbage ? Utter craziness

  17. Marcos

    Before writing lies about kratom, remember that lies have short legs and your name mrs. Hixon, will be forever in history. Kratom is not the panacea, but it is not by far the devil they want to make you see, surely we need a regulation and more information to avoid irresponsible use, as well as deepen its study before continuing to lie as you do here, but You cannot cover the sun with a finger, science advances and the beneficiaries are many, some even with a long history of drug and alcohol abuse for years who have seen in this substance what no medicine in the pharmaceutical megaindustry has achieved.

  18. mike

    Wow what nonsense. 10 years on pharmaceuticals lead my life down a tragic path. Guess what saved me. Yup Kratom. 2 years of nothing but this miracle plant and I am healthier than ever. Overdose? Haha you can’t OD on Kratom. If you take too much, You just puke and feel like garbage for a few hours and you make sure to not do that again. No point in taking large amounts because 1. It does nothing more for you and 2. Your body won’t take it. No hallucinations, no respiratory issues, you just get sick to your stomach. Thats harm reduction right there.

  19. Deb

    This article is straight up lies. Krstom saves lives and has helped many people Overcome addictions like alcohol and opioids!
    Only reason I can think that this nurse would publish such a thing is she is under a big pharma’s payroll!
    Shame on you!!!

  20. kratom saved me

    There’s absolutely no proof kratom causes respiratory depression. So far there have been 40 deaths and 38 had other drugs in there system. 1 was a cop who was a known steroid user and died of pulmonary edema which is the number 1 cause of death in steroid use plus he had like 100 time the average dose in his system. The other death was a 20 something year old who was known to take opoids and benzos plus his parents wouldn’t allow a full tox screen. So let’s say it was 40 deaths from kratom….compared to the 3,000 deaths a year from nails. Since the first supposed kratom death there have been atleast 12,000 deaths from nails like Tylenol,ibuprofen and aspirin. Don’t forget the countless lives kratom has saved from opoids such as oxymoron and suboxone both pharmaceutically approved plus they cause thousands of deaths each year. Do your research. Kratom is relatively harmless compared to anything pharmaceutical companies produce

  21. Max

    You are spreading misinformation on kratom, stop it and correct the information. It doesnt increase the risk of overdose it reduces it, there is no “high quality study” on that. You cant just say complete BS like that. If the organization distributing the kits are doing something wrong it dosent give you the right to encourage propagenda against kratom. Im waiting for your apologies

  22. Kyle Gibson

    You may be a medical professional but that doesn’t mean that you’re not capable of spreading ignorant, and quite frankly dangerous fake new, about kratom—which is a miracle medicine to millions.

  23. lee lovell vogt

    Total disinformation campaign against Kratom, a leaf thats saving lives.

    No one has ever overdosed on Kratom alone. Respiratory problems? You don’t smoke Kratom.

    Mountain Express is on my vast list of disinfo, conspiracy sources.

  24. Rob

    This article is filled with so many misleading statements… like Kratom increases opoid vulnerability. Thats BS! What it really is a threat to organizations like yours because it does work. I hope you realize how your spreading of this misinformation is fueling peoples want to get to know what Kratom is.
    Its a miracle plant that solves so many different difficulties that someday it might just take the place of the need for other things.
    God made this plant available to us, its only people like you that want to try and do God’s work that will mess things up…..especially when it comes to telling the Truth about this amazing plant.
    I think many out there who have read this are waiting for your apology for the BS you are trying to spread.

  25. violent gang members enforce prohibition

    we need to start holding accountable ALL those that participate in and facilitate drug prohibition… I don’t care WHAT it is.. if someone tells you that you can’t put something in your own body at gunpoint.. THEY are the criminal

  26. Cnel

    Sounds like it came right from the desk of the pharmaceutical and NGO collaboration, pharmaceutical companies make millions from methadone, suboxone and naloxone, there are more confirmed deaths from pharmaceuticals per day than the so called “Kratom related” deaths they have been able to conjure up over the last decade, this article is garbage, legitimately sounds like it was written by a corporate shill, I guess they think people are idiots and that we don’t know any better, I have been using Kratom for years and I feel pretty damn good, happy, healthy, motivated, the funny thing is I rarely ever get sick since I started using Kratom, I don’t know if there is any correlation nor will I claim any but I used to get sick at least 3 to 5 times a year and I can’t even remember a time where I have had a memorable illness in the last 6 years which is when I started using Kratom.

  27. melissa vidrine

    Kratom is a danger, it kills. My son died from Acute Mitragynine Toxicity in 2021.

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