This Opioid Alternative Is Fueling an Addiction Crisis

0:05Over the past few years, an herbal product has been exploding in popularity. It's called kratom. It's made from the leaf of a tree that grows in Southeast Asia, but you can buy it in most states across the U.S. Kratom can be bought almost everywhere, in gas stations, online, and convenience stores. Our colleague Sumathi Reddy writes about health and medicine. People say it can act like caffeine in small doses. It's like, you know, it just gives you more energy, maybe makes you more alert. It can be more sedative and have a different effect. So there are some people who say that Kratom is a great product for pain relief.

0:48In June, Kratom was the subject of a city council meeting in Idaho. When this back injury flares up, I can barely move. It is totally incapacitating for that time. But with Kratom, I can at least function. That's Chris Diotis, who runs a Kratom business. He was in the city of Idaho Falls to share why Kratom has been helpful for him. And he was wearing a T-shirt that read Kratom Saves Lives. And he spoke about how plain leaf Kratom, you know, has kind of made his life bearable, particularly with a reoccurring back injury. People who used to take opioids also say it's like a good sort of alternative.

1:28They don't want to be in a bed or a wheelchair if they don't have to. They don't want to take prescription drugs. National Kratom works for them. And likewise that. The reason Chris was testifying is that the Idaho Falls City Council was considering a citywide Kratom ban. Some doctors and public health officials say Kratom can have serious health risks, that it can be addictive and serve as a gateway drug. There have also been thousands of deaths associated with Kratom. One person speaking in favor of banning Kratom was Tia Rustici. Kratom killed my daughter. Now I'm a straight-throw. I've never stopped since it was Kratom.

2:09It was this product that you can buy anywhere and that's marketed as natural and safe. And this is something she does over and over again, a lot of the parents do. this sort of disbelief that, like, why, how could my child have died from something that's just, like, available like a piece of candy. The reality is that parents often do not know what Kratom is. Young people still don't show us and assume it must be safe.

2:33In the aftermath of the opioid epidemic, Kratom has become a multibillion-dollar industry that's largely unregulated. And that city council meeting in Idaho captures a growing nationwide debate. Should Kratom be legal?

2:51Welcome to The Journal, our show about money, business, and power. I'm Jessica Mendoza. It's Monday, August 17th.

3:05Coming up on the show, the fight over Kratom.

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4:55Usually, kratom comes in powder form. It can kind of look like matcha, although it has a more bitter taste. These days, though, it comes in the form of gummies, seltzers, tablets. There are all kinds of products. Kratom kind of grew in popularity as opioids were becoming a big problem. So doctors, you know, kind of stopped prescribing opioids and people needed something for pain relief. And so some people started turning to kratom, which apparently can be pretty effective for chronic pain. Kratom has two key psychoactive compounds. They're called metragenine and 7-OH. They both bind to the same brain receptors as opioids.

5:37That's why many people say kratom is great for pain relief. But it becomes addictive for some people and you need larger and larger doses. And then there started being these newer products that were more potent, which were causing even more addiction. And some people who wanted to stop taking these things found out that the withdrawal symptoms can be quite severe. In recent years, the Kratom market has been growing, with new products that are highly concentrated and sometimes made synthetically. Medical officials say these stronger products have dramatically increased the number of people reporting withdrawal symptoms and seeking help for addiction.

6:21In June, Sumathi flew to Idaho to hear from both sides of the Kratom debate. While she was there, she visited Tia Rustici at home, the woman whose daughter, Kylie, died of a Kratom overdose. They spoke in the backyard. So she would, um, she was very outgoing, very social. And you grew up, she grew up here in this house? We moved here in 2013. So Kylie was a 23-year-old. She was attending online college. She wanted to be a forensic accountant. She was diagnosed with two chronic conditions, sort of in the later years of high school, maybe in her early 20s. So she dealt with a lot of pain from those conditions.

7:01Kylie Rustici's pain was debilitating, enough that she needed to see a pain management specialist. She also had depression and was taking an antidepressant. At one point, she moved in with her grandmother. And so what happened once she was at Grandma's?

7:43But it's hard to tell from afar. Tia Rustici didn't know that besides her antidepressant and some over-the-counter medications, her daughter had also started using Kratom. She kind of kept it a little secretive, but she was taking the powder only. And I guess it just sort of ramped up where she started taking more and more and more. On a Sunday evening in March, Kylie Rustici was found dead on her bedroom floor. There were a few bags of natural leaf kratom powder on her dresser. She had overdosed. An autopsy report listed the cause of death as kratom intoxication. When they said kratom, what did you...

8:23I didn't know. I started Googling, what's kratom? So, and then, the more I found out, the more shocked I was.

8:36Reports to poison control centers involving kratom have been on the rise. And between 2020 and 2024, the CDC recorded more than 5 ,000 fatal overdoses in which kratom was detected. Though Sumathi says it's not always clear if kratom is the sole cause of death. In many cases, there are other substances involved. I mean, sometimes, you know, it's something like heroin or fentanyl, but other times it's something like Benadryl or an antidepressant. So there are questions about, well, does Kratom interact with some of these other things that people routinely take? Like a lot of people take antidepressants or Benadryl or antihistamines.

9:16So is that raising the health risks? And we don't really know because that research hasn't been done. What about Tia Rustici? What has she decided to do? So she's become quite an advocate for Kratom bans. There's a bunch of parents that she's become close with. Some of them have started organizations. And they kind of just go and testify at every hearing that they can. Like at the city council meeting in Idaho Falls. Who are anti-Kratom advocates up against? That's next.

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10:32During her trip to Idaho, Sumathi also went to visit one of the biggest kratom companies in the U.S. It's called Happy Hippo. The company runs a 20 ,000 square foot facility with colorful signs that say things like live happy. So Happy Hippo, it's a very cheerful place. They definitely mark themselves as like a wellness company. Okay. And one of the big things they do is distribute Kratom. While she was there, Sumathi met CEO Chris Diotis, who had spoken at that same Idaho Falls City Council meeting. Well, I want to hear both about the company as well as your story, so I don't know which one you want to start with.

11:11Yeah, let's start with mine. Chris describes himself as like a fitness bro. So he had a lot of injuries just from sports and exercise. And in 2006, he had a bad knee injury. I really got injured playing a football game. A silly football game. It was on Memorial Day weekend. Tackle football. Chris says he was prescribed Percocet, an opioid. And after about five or six months of taking it, he started to feel like he was building a dependence on the drug. And being the resourceful 20-year-old that I was, I was looking for alternatives. And I found Kratom, and I tried it. And I was just like, wow, this does really dull.

11:56Because at the time, it was probably like mild to moderate pain. It wasn't the intense acute pain coming off post-op. I was like, this is really good. It doesn't impair me either. And I was like, there's really something with this. Chris still uses Kratom today to treat chronic pain from a back injury. He founded Happy Hippo in 2013. These days, the company ships out more than 100 kilograms of kratom a day. It specializes in plain leaf kratom powder and capsules, but also sells things like kratom gummies and taffy. Their products are, you know, they're marketed in a very sort of friendly way. They're very colorful and they have cool flavors and stuff.

12:34And he says that, you know, his clients or customers are, you know, there's a very wellness, fitness sort of driven demographic. Like a lot of middle-aged moms taking this for energy or to improve their sleep or, you know, those kinds of things, wellness type things. But Chris says when it comes to Kratom, there's a line he won't cross. You know, one of the things he stressed a lot when I was there was that they've taken a sort of hardline stance against manufacturing products that are like 7-OH. 7-OH, one of the psychoactive compounds naturally found in kratom in very trace amounts. And over the last few years, some companies have started focusing on concentrated 7-OH products.

13:20They're way more potent than natural kratom. Chris says these products are giving his industry a bad rap. Cradum is closer to a food or dietary supplement or beverage. And 7-OH is closer to a drug. It is, especially how it's made these days. And once upon a time, the 7-OH on the market was possibly extracted from cradum leaf. But the proliferation of it now, it's all just made in the lab. These 7-OH and sort of stronger products are definitely causing addiction. and other health issues. When you talk about natural kratom, there is a little more of a divide. Some of the people I've talked to will say that they see problems with 7-OH, but they also see it with natural kratom.

14:08So they would support a broader ban. But others will say, I think if we solve the issue with 7-OH and the stronger products, we'll be okay.

14:21In the end, the city of Idaho Falls voted unanimously to ban all kratom products. That ban went into effect in July. That city joins a growing list of places in the U.S. that are cracking down on Kratom. And while a few states have banned it statewide, a lot of this action is happening from town to town. Idaho does not have an all-Kratom ban. They considered one. But because some of the states are not acting, there are a lot of cities and towns who are acting on their own. And Idaho Falls is one. Why is this being discussed, you know, at the local and state level? I mean, isn't this something that could or should be regulated at the federal level?

15:00There have been attempts to regulate Kratom before. The most serious one was back in 2016. And there was such intense backlash and opposition that the federal government sort of backed down. A lot of that backlash and opposition was coming from lobbying groups. One group in particular, the American Kratom Association, has played a major role in keeping Kratom on store shelves. They have a Consumer Protection Act they kind of drafted and they give to a lot of the states that introduce these acts. And so it's various things to like have a minimum age for people who can buy this stuff, to have labels that reflect what's in it and the strength and the dose, to be more clear on the labels like is a 708, what's in here and some other things.

15:47and there's a number of states that they've been able to get the regulation acts passed in. While the American Kratom Association lobbies to keep Kratom accessible, it supports banning stronger products like 70H. Federal regulation could echo that line of thinking. The Drug Enforcement Administration is now considering placing those stronger products under Schedule 1, which basically means they'd be considered as dangerous as heroin.

16:19What are you watching for in terms of how this debate develops, how the regulation evolves? You know, I think one of the things is that we don't know a lot about Kratom and how it impacts our health. I mean, there really isn't much research. This is a problem we had with cannabis too, right? It was illegal, so we had never done any research on it. I'm hoping this will lead to consumers understanding what this is better. Like, what is this? Is it dangerous? Can it interact with antidepressants? You know, what's the highest dose we can take? What's the toxic dose? We don't have answers to any of these questions.

16:59So hopefully, hopefully we'll get some answers.

17:15That's all for today, Monday, August 17th. The Journal is a co-production of Spotify and The Wall Street Journal. If you like our show, follow us on Spotify or wherever you get your podcasts. We're out every weekday afternoon. Thanks for listening. See you tomorrow. Thank you.