Notwithstanding its century-long history of use in the region, evidence of seriously problematic use has yet to emerge. While some negative consequences have naturally been documented, these are generally relatively mild and are mostly associated with intense and prolonged use. These notably include constipation, weight loss, insomnia, skin pigmentation, as well as lower sexual drive.3 In addition, some level of dependence is also known to occur, although here again, withdrawal symptoms such as joint pain, sweats and sleeplessness, tension, decreased appetite and watery eyes, have been described as relatively mild.4
Besides traditional usages, new forms of kratom use have also emerged in recent years, in particular among youths from urban areas. Cocktails involving a mix of kratom powder, cough syrup, yoghurt and coffee, commonly known as ‘Asean’, have become more popular in Myeik and certain towns in Mon State.5 Similar beverages are consumed in Thailand too, where cocktails composed of infused kratom leaves, coca cola, cough syrup and ice cubes are known as “4x100” (‘Sii khoon roi’).6 The principal risks of these cocktails, however, are likely due to the presence of pharmaceutical products such as cough syrups, or in some cases benzodiazepines, due to interactions which can amplify kratom’s effects. The addition of other unusual and potentially harmful adulterants, such as crushed mosquito coil and gas extracted from fluorescent bulbs, has also been occasionally reported in media. No consistent evidence, however, has emerged to support these sensationalist claims.
Globalisation of practices and the emergence of a ‘kratom threat’
In recent years, the United States (US) and a few European countries have expressed growing concern that kratom, while having no recognised therapeutic use, could pose a serious risk to public health and society. It is noteworthy that kratom use was introduced in these countries only relatively recently, and therefore lacks the cultural and social significance it has acquired in Southeast Asia. In the US and Europe, numerous kratom products are sold as processed food supplements, some of which contain high contents of isolated mitragynine and other alkaloids, in contrast with kratom leaves in their natural form as they are consumed in Myanmar and other Southeast Asian countries. A number of lethal overdoses and severe intoxications, presumably due to kratom, were reported during the past few years. Blood analysis and other medical investigations, however, revealed that in almost every instance, other psychoactive substances were involved in the overdoses, making it difficult to establish causality.7 Moreover, claims that kratom has no recognised therapeutic value are considerably at odds with the long and documented history of medicinal use in Southeast Asia. In reality, such assertions reveal deeply entrenched ethnocentrism and biased assumptions, and ignore a growing body of evidence that shows the potential of kratom to be safely and effectively used to relieve opioid dependence.8
As previously mentioned, kratom is currently not included among substances that are placed under international control. UN member states, as a result, are not compelled to control or criminalise its cultivation, use, possession, production, distribution and trading. Some countries have nevertheless decided to do so, while others have chosen to allow kratom to be freely grown, consumed and sold. In practice, the legal status of kratom can vary significantly from place to place. Kratom is for instance legally regulated in several US States, although a few have also decided to ban it. Kratom remains fully illegal in Australia, where it is placed on the most restrictive level of the Australian National Drugs and Poisons Schedule, but can be legally sold and consumed in New Zealand upon presentation of a medical prescription. In Southeast Asia, the region where it originates, kratom remains illegal in Singapore, Vietnam and Malaysia, but also in Myanmar. In fact, the 1993 Narcotic Drugs and Psychotropic Substances Law prescribes that the cultivation, possession, distribution and transportation of kratom are criminal offences punishable with long-term prison penalties. Although kratom is usually not considered as a priority target by law enforcement agencies, a number of arrests and eradication campaigns have been reported in the country in recent years, notably in Tanintharyi region.9 In the absence of serious harms to the health of users and society at large, the criminalisation of kratom seems unnecessary and even counter-productive. First, repression has done little to curb the availability and use of kratom, which remains common in the country’s south, and has not prevented the emergence of new practices among youths, such as the consumption of ‘Asean’ cocktails. Second, criminalising kratom requires the mobilisation of significant human and financial resources in the form of law enforcement operations and personnel, judiciary procedures and detention facilities. In addition, continued focus on repression has directly contributed to prison overcrowding. Finally, enforcing kratom bans in areas where it has long been used for traditional and medicinal purposes is a violation of indigenous cultural rights and heritage.
In stark contrast, Thailand recently decided to decriminalise kratom and took steps to establish a legally regulated market. This is a promising development, considering the country’s decades-long prohibition of the tree. In fact, Thailand was the first country in the region to introduce a national ban on kratom, as early as 1943. Revenues collected by the State on opium, legal at that time under a State monopoly, started to decline when a growing number of users switched from opium to kratom use, due to increasing opium costs. The Kratom Act was then introduced as an attempt to stem that movement and suppress competition in the opium market. The ban, however, remained only loosely enforced, including after kratom was rescheduled to category V, the least restrictive category, in 1979. This changed significantly at the turn of the century, when the Prime Minister Thaksin Shinawatra launched a war on drugs that resulted in thousands of extra judiciary killings.10 Repression became especially stringent in the country’s south, where kratom use and cultivation had long been prevalent, especially among the ethnic Malay Muslim population. Kratom law enforcement was used to justify military operations against Muslim communities, who were seen as supporting the armed insurgency in the area. Thousands of kratom related arrests followed over the next fifteen years, fuelling high tension and resentment among local communities.11 In a dramatic turn of events, Thailand decided to break with this heritage of repression, and in 2019 allowed kratom – as well as cannabis - use for medical purposes. Kratom cultivation, possession and use were also decriminalised in southern provinces under an innovative community control model. Two years later, kratom was finally removed from the Narcotic Drugs Act and Thailand became the first Southeast Asian country to fully, legally regulate kratom cultivation, use, trade and manufacturing.12 A similar evolution might take place in Indonesia, despite the country’s National Narcotics Board’s push to put kratom in the strictest Schedule I in the narcotics law – a move criticised by local authorities in Borneo, from which kratom is exported. In 2019, the Ministry of Health conducted a study that highlighted kratom’s valuable botanical and chemical properties and its significance as a source of livelihood and traditional or indigenous medicine, as well as its ecological importance and its potential in supporting sustainable development.13
Rehabilitating kratom cultural heritage through decriminalisation and legal regulation in Myanmar?
As the WHO’s Expert Committee on Drug Dependence holds its pre-review meeting on kratom, an honest assessment of current policies is urgently needed. Rather than continuing on the path of prohibition and criminalisation, Myanmar and other Southeast Asian nations have a unique opportunity to embrace and experiment an alternative approach based on the recognition of the region’s traditions and cultural heritage. Myanmar has had a long history of mostly unproblematic kratom use and cultivation. Authorising and regulating kratom production, trade and use, would provide multiple and immediate benefits to both authorities and communities: health programmes and interventions, including pilot kratom substitution programmes, could be introduced and implemented; rigorous quality control and distribution mechanisms could be set; new and legal livelihood opportunities could be created in areas where kratom trees can be grown. Moreover, the decriminalisation of kratom would relieve pressure on the criminal justice system and end a legacy of human rights abuses and violations.
The recent international developments linked to cannabis reform can provide valuable insights and lessons to learn from, in particular to ensure that commercial interests do not ultimately prevail over public health and social justice objectives. Keeping this mind, it is especially important that local regulation and enforcement mechanisms are defined in close collaboration and with the meaningful involvement of affected communities.
Drug policies, all around the world, have for too long fuelled conflict and division. The vicious cycle of repression can no longer be ignored. More than ever, it is time for local communities and all relevant actors to find new ways to address drug-related issues in the country. This should start with the recognition that the decriminalisation and legal regulation of kratom have an important role to play in building safer and more resilient communities, promoting development and supporting peace efforts in Myanmar and beyond.
1. Balasingam Vicknasingama, Suresh Narayananb, Goh Teik Benga, and Sharif Mahsufi Mansora, ‘The informal use of ketum (Mitragyna speciosa) for opioid withdrawal in the northern states of peninsular Malaysia and implications for drug substitution therapy’, published in International Journal of Drug Policy 21 (2010) 283–288;
2. Assessment conducted in Mon State in 2020 by Mon Area Community Development Organization (MACDO), upcoming report;
3. Singh D, Narayanan S, Vicknasingam B, ‘Traditional and nontraditional uses of Mitragynine (Kratom): a survey of the literature’, Brain Res Bull. 2016;126(Pt 1):41–46. doi:10.1016/j.brainresbull.2016.05.004
4. Singh D, Muller CP, Vicknasingam BK, ‘Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users’, Drug Alcohol Depend. 2014;139:132–137. doi:10.1016/j.drugalcdep.2014.03.017
5. Thura Myint Lwin and Renaud Cachia, ‘Methamphetamine use in Myanmar, Thailand, and Southern China: assessing practices, reducing harms’, TNI
6. Pascal Tanguay, ‘Kratom in Thailand: Decriminalization and Community Control?’, TNI and IDPC
7. UNODC, Current NPS Threats, Volume II, January 2020, p. 2. https://www.unodc.org/documents/scientific/Current_NPS_Threats_Volume_II_Web.pdf
8. See: https://ufhealth.org/news/2020/kratom-tea-study-stirs-new-support-relieving-opioid-dependence
9. UNODC, Patterns and Trends of Amphetamine-Type Stimulants (ATS) and Other Drugs of Abuse in East Asia and the Pacific 2006, A Report from Project: TDRASF97 Improving ATS Data and Information Systems, June 2007, p. 121.
UNODC, The Challenge of Synthetic Drugs in East and South-East Asia and Oceania, Trends and Patterns of Amphetamine-type Stimulants and New Psychoactive Substances, A Report from the Global SMART Programme, May 2015, p. 30.
10. See: https://www.hrw.org/news/2008/03/12/thailands-war-drugs
11. Pascal Tanguay, ‘Kratom in Thailand: Decriminalization and Community Control?’, TNI and IDPC
12. Kratom production needs FDA approval, Bangkok Post, 4 September 2021. https://www.bangkokpost.com/thailand/general/2175551/kratom-production-needs-fda-approval
13. Wahyono, S, et al., Kratom: Prospek Kesehatan dan Sosial Ekonomi, Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan, Kementerian Kesehatan Republik Indonesia, 2019.