Recent media reports about kratom-related deaths are leaving out basic information about these tragic events. Preexisting conditions and possible drug interactions are sparsely mentioned or left out of reports entirely. Media is also using the term “kratom” to describe all products, from fresh leaf to extract to kratom products mixed with other substances (such as phenibut, tianeptine, and kava).
For example, in a recent New York Post article, Jeanette Settembre wrote of Krystal Talavera, “her partner found her collapse beside a cup of hot coffee and an open bag of ‘Space Dust,’ one of the names under which kratom is marketed.” The only companies we have found selling a product called “Space Dust” is Kratom Distro, who sold this as an extremely strong extract to Ms. Talavera, and another company who was selling regular leaf powder, not an extract, under the same name.
We emailed this company in December 2022 to ask them about this product. Since they have nothing to do with this case, we will keep them anonymous. They replied:
Our SpaceDust is just a blend of regular, lab tested kratom powders. It generally tests around 1.4% [alkaloid content], with no extract added. Kratom Distro had a bad habit of stealing another company’s product pictures, strain names, etc, so this may be the SpaceDust strain name connection you’re seeing. We have not done business with Kratom Distro, as they did not meet our company’s GMP standards.
The Post article did include a quote from Ms. Talavera’s son, Devin Filippelli, who said “There’s no labels on this stuff. No one knows what’s in it. They’re concentrating it. That’s the problem.” But the message of the article entitled “‘My mom thought kratom was healthy. It killed her’: Fears over growing toll of ‘health supplement’” clearly leans toward kratom being a poisonous plant in general, rather than a largely unregulated substance that carries risks sold in various concentrations.
A recent article in The New York Times contained slightly more comprehensive information, yet failed to differentiate between kratom leaf and extracts, only mentioning that “larger doses can bring steeper risks”.
In a CBS News report, lawyers representing a family who sued a kratom company for wrongful death said of kratom manufacturers: “what they do is they take the most potent and toxic portions of that plant, and they concentrate them.” Despite some scientific inaccuracy (most extracts are full spectrum, and every compound is toxic but only at a great enough dose), in including this quote, the report approached the status of evidence-based for those listening very closely. Left out of the report, however, is that the decedent purchased kratom at two gas stations shortly before his death to get multiple doses of liquid extract, and that he was also taking prescription drugs that could have interacted with the extreme doses of extract he was consuming.
As with past drug war propaganda, kratom misinformation in media can leave audiences ignorant about the nature of various substances and the responsible vs. irresponsible use of these substances, and distrustful of not only media, but government agencies and scientific institutions. This can obviously lead to poor choices and negative outcomes.
Different Journalistic Standards for Different Substances
Alcohol and caffeine are treated differently in media. Because of well-known, widely accepted use of standardized alcohol products (beer, wine, liquor), the general public understands that violence and death related to consuming alcohol is from irresponsible, high-dose use beyond one’s tolerance, not from a drink or two. Caffeine is so commonly, responsibly used in the form of coffee that caffeine dependency is widely accepted and easily managed by most. Caffeine may be something to avoid by those with certain health conditions. Yet, it is not widely understood that caffeine can be both detrimental to health and deadly if over-consumed.
For example, a UK man died of a caffeine overdose in 2022. This BBC report is quick to explain precisely what happened in the lead: “A personal trainer died after taking caffeine powder the equivalent of up to 200 cups of coffee, an inquest heard.”
In a 2017 NBC News report, a 16 year old from South Carolina was killed from a caffeine overdose from drinking coffee, Mountain Dew, and energy drinks. The report was thorough enough to include a quote from coroner Gary Watts to explain what happened:
“The purpose here today is not to slam Mountain Dew, not to slam cafe lattes, or energy drinks. But what we want to do is to make people understand that these drinks — this amount of caffeine, how it’s ingested, can have dire consequences. And that’s what happened in this case,” Watts said.
Applying standards used to report on kratom-related deaths to caffeine-related deaths, BBC would not have differentiated between coffee and caffeine powder, and NBC News would not have explained in detail that an excessive amount of caffeine drinks were consumed in a short period of time. Using kratom reporting standards, possible headlines for these stories would have been: “Man Killed by Coffee” and “Mountain Dew Kills Teen” with no attempt to explain the unusual circumstances that led up to these deaths.
Media Playing Up Risks; Downplaying Benefits
The Times article, like other media reports, seemed to be playing up risks by selective quoting. The Times reporter quoted Dr. Marc Swogger as saying, “From an evidence-based standpoint, it’s not super scary”, in reference to risk of toxicity and death. She also quoted him as saying, “There are some people who really do have a difficult time getting off kratom” on the topic of dependency.
Dr. Swogger commented on the article on Twitter: “What I actually said is that the harms of kratom are over-represented in studies of less rigor (e.g., case studies). The more rigorous observational literature does not support dire assessments of kratom’s potential harm. Dependence is real for a minority of users though.”
While we disagreed with some kratom advocates that the Times article is negative or inaccurate, Dr. Swogger replied that he thought it was “Not inaccurate, but incomplete in a way that implies more likelihood of harm than it would if the complete data provided to the reporter were more scientifically distilled.”
Plants vs. Extracted Compounds: A Free Guide for Journalists
As “kratom” is not the same as “kratom extract shots”, neither is light beer the same as grain alcohol, coffee the same as extracted caffeine powder, nor coca leaf tea the same as cocaine.
Pointing this out would be of service to public health, specifically to those who are thinking about consuming kratom or other substances. Journalists, as well as kratom advocates and prohibitionists, need to differentiate between these substances to have a more productive conversation based on accurate information. Proper regulation (see below) will inform consumers of these differences. It’s plausible that some consumers who developed a kratom addiction did so not knowing the difference between milder leaf material and stronger extracts.
Miscommunication within the kratom-consuming community may also be a contributor to negative outcomes. Those who have a very mild experience with kratom leaf may have trouble conceptualizing a more intense negative experience, addiction, or toxicity resulting from heavy use of kratom extract shots, and vice versa.
|PLANT MATERIAL – FRESH/DRIED/MINIMALLY PROCESSED||EXTRACTED or SYNTHETIC – HIGHER CONCENTRATION OF COMPOUNDS|
–Traditional use/socially accepted in regions of Southeast Asia.
–Fresh leaf Ingested via chewing/tea. Dried leaf ingested via tea/mixed with beverage/capsules
–Lower percentage of alkaloids
–Milder stimulant/partial opioid agonist effects
–Lesser chance of serious dependency, drug interactions, toxicity
|Kratom liquid extract shots/powder extract|
–Widespread use only recently, mostly in the West
–Higher percentage of alkaloids
–Stimulant and stronger opioid agonist effects
–Greater chance of serious dependency, drug interactions, toxicity
–Traditional use/socially accepted in regions of South America
–Fresh leaf chewed or prepared as a tea
–Lower percentage of cocaine
–Milder stimulant/dopamine effects
–Lesser chance of serious dependency, toxicity
–Widespread use in the West as medicine, then recreationally
–Ingested via snorting powder, IV
–Higher percentage of cocaine in powder
–Stronger stimulant/dopamine effects
–Greater chance of serious dependency, toxicity
–Traditional/socially accepted use worldwide
–Beans brewed into beverage
–Lower percentage of caffeine
–Milder stimulant effect
–Lesser chance of dependency, related health issues, toxicity
–Used as a dietary supplement
–Powder is swallowed
–Higher percentage of caffeine
–Stronger stimulant effect
–Greater chance of dependency, related health issues, toxicity
–Traditional/socially accepted use in North Africa
–Fresh leaf is chewed
–Lower percentage of cathinones
–Milder stimulant effect
–Lesser chance of dependency, negative effects, toxicity
|Synthetic cathinones (“bath salts”)|
–Used primarily in the West, sold as “bath salts”
–Powder is swallowed/snorted
–Higher percentage of cathinones
–Stronger stimulant effect
–Greater chance of dependency, negative effects, toxicity
What Can Be Done About Strong Extracts?
Many in the kratom community are becoming vocal about the need for stricter regulations for extracts than for lower-risk leaf material. We agree that extracts should not be consumed by those new to kratom, only by responsible long-term consumers. At the very least, adequate information should be provided at every point of sale. But we also can look at the history of the failure of prohibition of virtually every other substance, and conclude that the likelihood that prohibition of kratom would do even more damage is very high.
Toxicologist Fabian Pitter Steinmetz, former president of European Coalition for Just and Effective Drug Policies (ENCOD), laid out a basic plan for drug regulation in a 2021 interview with Kratom Science. He suggested that one model could occur in three basic tiers, depending on how much risk is involved with each drug. We charted this idea, pasted below:
Three Categories of Legalized Drug Regulation
|1||Recreational drugs freely available that can be used in a social setting, like a social club. Some amount of education should be available when these are purchased, as with cannabis purchased in a dispensary. People are free to grow their own plants. Examples: Cannabis, coca, khat, kratom, beer.|
|2||Drugs that require more education than category 1. These can be purchased in small amounts. The dispensary must employ a person educated in pharmacology or social science to give the consumer a one-on-one advisory talk. Medical history and other drug use will be considered. Examples: amphetamines other than methamphetamine, psychedelics like LSD and psilocybin, hard liquor, low dose versions of opioids like opium or poppy seed tea, and possibly even strong kratom extracts.|
|3||Drugs available from a physician via a prescription. Examples: Heroin, cocaine, methamphetamine. This is similar to the harm reduction model ongoing in several countries where those with a heroin use disorder are provided a safe supply of heroin via a physician.|
For the benefit of public health, media needs to get away from what we call the “drug horror fiction” genre of news reporting. Scaremongering as a way to entertain people is directly detrimental to millions of lives. A person who is misinformed cannot make logical choices about what to safely put into their body.