Support for NPR and the following message come from the William and Flora Hewlett Foundation. Investing in creative thinkers and problem solvers who help people, communities, and the planet flourish. More information is available at Hewlett.org. Hey everyone, Emily Kwong here, just a word before today's episode. 2025 is almost over, and at NPR and our local stations, we are excited to begin a new year. This year was tough. The loss of federal funding for public media, attacks on the free press, but despite it all, we are not shying away from our jobs. From exercising the critical right to editorial independence guaranteed by the First Amendment. With your support, we will continue our work without fear or favor, and we will continue to produce a show that introduces you to new discoveries, everyday mysteries, and explains the science behind the headlines. If you're already an NPR Plus supporter, thank you. And if you're not a supporter, please become one today, before the end of the year, at least, at plus.npr.org. Sign up to unlock a bunch of perks like bonus episodes and more from across NPR's podcast. Plus, you get to feel good about supporting public media while you listen. So end the year on a high note and invest in a public service that matters to you. Visit plus.npr.org today. Thank you. From NPR. Okay, complicated. 7-0-H That was FDA Commissioner Marty McCary during a press conference in July. And that's when the FDA said they were recommending certain 7-0-H products be scheduled alongside opioids. But not every researcher I talked to was ready to sound those alarm bells. They told me Kratom and 7-0-H are at the heart of a big public health debate right now. Mmm. Past estimates for how many people use Kratom every year run anywhere from 2 million to more than 10 million. But there's not that much recent data. And those numbers include people who use Kratom or 7-0-H to wean themselves off opioids like heroin. Or as a way to manage chronic pain without prescription drugs. Oh, okay. I can see why people are so drawn to it. Because of course opioids are known for being really addictive. Yeah, I mean, according to the CDC, 76% of drug overdose deaths in 2023 involved opioids. I can imagine having an alternative a way out of using opioids would be really appealing. For some people it is. And some researchers say further restricting access to these products could affect those who've benefited. Others say Kratom and 7-0-H products have addictive properties themselves and that they should be better regulated. So today on the show, what we do and do not know about Kratom, why people are drawn to it, what it does to the body, and what happens when the drug market gets ahead of the science. You're listening to Shortwave, the science podcast from NPR. This message comes from WISE, the app for international people using money around the globe. You can send, spend, and receive an up to 40 currencies with only a few simple tabs. Get WISE. Download the WISE app today or visit wis.com. Tease and seize apply. Support for NPR and the following message come from the William and Flora Hewlett Foundation. Investing in creative thinkers and problem solvers who help people, communities, and the planet flourish. More information is available at Hewlett.org. Okay, Rachel, so you've been looking to a whole suite of products sold under the names Kratom and 708. What exactly do these products look like? Yeah, naturally, I wanted to know that too. So when I started reporting on this, I went to go look for some. What'd you find? I found so many different permutations of it on shelves, pills, tablets, gummies, seltzers, kind of like your average alcoholic seltzer beverage thing. Some companies even make chocolates and it's available in smoke shops, liquor stores, gas stations, a lot of places. But it originally comes from a plant, right? Yeah, it comes from a tree in the coffee family and traditionally people brew the leaves like a tea or they'll pick them off and chew them. Wait, if it comes from a tree in the coffee family, does that mean it's a stimulant? So it's a little weird because in smaller amounts, Kratom can be a mood booster. I talked to David Epstein. He's a senior investigator at the National Institute on Drug Abuse or NIDA. He wasn't speaking on behalf of NIDA when we talked, but he said it can make people feel energized, more focused. And often actually they do compare that feeling good to what a cup of coffee does. Some people even use it to manage depression, anxiety, PTSD and ADHD. But in larger doses, they also compare it a little bit to what opioids feel like. Which is what FDA Commissioner Marty McCary was referring to earlier. It can relieve pain, make people feel kind of calm or even euphoric. Okay, interesting. And like you said earlier, the term Kratom can refer to a lot of different things, right, when people are talking about it. Right. The Kratom plant contains different compounds called alkaloids. Metrogenine and 7-hydroxy-metrogenine, 70H, are two of the major psychoactive ingredients. Metrogenine binds to opioid receptors, but also things like serotonin receptors in the brain. And in the Kratom plant and in natural Kratom leaf products, 70H shows up in tiny quantities. But what about products that have higher concentrations of 70H? What does that do to the brain? 70H does seem to bind more exclusively to opioid receptors in the brain, just like heroin, morphine or fentanyl. Your classic opioids. Yeah. So I would see 7-hydroxy-metrogenine more as an opioid than Kvartom. That's Oliver Grundman. He's a professor at the University of Florida College of Pharmacy. Okay. So he's saying that it's a compound of Kratom that's really worrying people because it's so potent. Yeah, the concern is that there are a lot of new 70H products popping up, like extracts and pills that are much stronger than the Kratom products researchers have been studying for the last decade or so. Got it. Okay. So 70H, it binds to opioid receptors. Does it make those products more addictive? I asked Ed Boyer that. He's a medical toxicologist at the Ohio State University. And that means his job is dealing with things like poisonings and overdoses in humans. Can you get addicted to Kratom? Yes. Can you get addicted to 7-hydroxy-metrogenine? Yes. Is the propensity towards addiction greater for Kratom than other opioids? I don't know. Is there any data about this? There's not a lot, but there's some. One study surveyed around 2,000 people who used Kratom in the natural leaf form or concentrates or extracts, and a little over a quarter met criteria for Kratom use disorder. Okay. David Epstein told me those symptoms typically include withdrawal, increased tolerance, and cravings, which look like mild opioids withdrawal when they try to stop using it. And they need to keep using it in order not to have those symptoms. Gotcha. But what about 7-OH products? Are there reports of addiction concerns? I have seen anecdotal reports on addiction. There are Reddit channels devoted to people quitting Kratom in 7-OH products. Of course, there are also ones where people say they've benefited. But when it comes to the research, there's even less data on that. Some animal studies and early data suggest 7-OH could be more addictive, especially because there are some products that are manufactured specifically to have a stronger impact on the body. When you think about something that is, for example, a nasal spray or something that is a tablet that dissolves under the tongue, then you actually circumvent many of the processes that would potentially prevent 7-hydroxymetrogen from getting into the bloodstream and then through the bloodstream into the brain. Wow. Okay. Given that, how are 7-OH formulations affecting people? There have been deaths related to Kratom in 7-OH, but the numbers of how many deaths are tricky. A lot of them involve other substances like drugs or medications. And then, of course, there's the fact that Kratom in 7-OH aren't regulated by the FDA in the same way that prescription medications are. And that's created some health scares. Over the years, the FDA has recalled Kratom products for salmonella contamination and for unsafe levels of heavy metals like lead and nickel. And then, there's the fact that the products may not be labeled well to begin with. Yeah, right. So people don't always know then how much of these different ingredients they are taking. Yeah, you might not. Here's what Albert Garcia Romeo told me. He's an associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine. The real problem, too, is that even some of these products that are extracts that have high levels of 7-OH are not labeled as such, they often just say Kratom. So it would be like picking up a bottle of beer that should have 5% alcohol in it and actually getting a bottle of Everclear that has very high content of alcohol. Oh, that doesn't sound good. Okay. Rachel, at the beginning of our conversation, we talked about how the FDA wants to schedule 7-OH products, which would be a big deal. It would regulate them. Do you think this could actually happen? It's really tricky. A similar question came up almost a decade ago, August 2016. The Drug Enforcement Administration, or DEA, wanted to make those two active ingredients in Kratom we talked about, metrogenine and 7-hydroxy metrogenine, controlled substances, meaning Kratom would go from being widely available to highly restricted. And there was a huge wave of protest following that announcement. People were sending letters, writing comments, saying, like, don't touch our Kratom. Don't regulate it. Right. And after getting all those comments, the DEA decided not to move forward. Wow. So it's possible 7-OH could follow a similar path. But for now, it's up to states. There are some like Ohio, Florida, Rhode Island, Vermont, Indiana. They have either bans, limitations, or age restrictions on either Kratom or 7-OH. There are also some countries where Kratom products are illegal, including Australia, Sweden, France. And after reporting all this, I feel like we're in ethical and legal limbo. Where are the lines when you're weighing the risks of a drug against its potential rewards? Ultimately, whether or not 7-OH is scheduled will be up to the DEA. So I'm interested to see where they draw this line. And what happens next? Rachel Carlson, thank you for diving into this. I learned a lot. Yeah, you're welcome, Emily. This episode was produced by Rachel Carlson and Anna Chin. It was edited by Rebecca Ramirez. Tyler Jones checked the facts. Jimmy Kealy was the audio engineer. Beth Donovan is our vice president of podcasting. I'm Emily Kwong. Thank you for listening to Shortwave from NPR.
