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On 30 August 2016, the U.S. Drug Enforcement Agency (DEA) issued a press release announcing their intent to effectively ban a little-known herbal compound called kratom as of 30 September 2016. The DEA's release held that kratom poses an imminent hazard to public safety, adding that 660 calls had been made to poison control centers about the substance over a five-year period. The notice reported that 15 kratom-related deaths had occurred between 2014 and 2016 and stated that the supplement was being reclassified as a Schedule I drug: The DEA linked to a notice of intent published in the Federal Register [PDF] on 25 August 2016 which included further justification for the ban, alongside links to a document which in part detailed purported deaths associated with kratom. That August 2016 document (Background Information and Evaluation of ‘Three Factor Analysis’ for Temporary Scheduling) cited published case reports [which] describe events where individuals sought medical care for the purported use of kratom, along with incidents wherein deaths were purportedly linked with the herbal supplement. In nearly all cited cases from both the United States and other countries, the deaths involved numerous other substances. For example, a cluster of nine deaths in Sweden appeared to be attributed to a separate adulterant known as O-desmethyltramadol in a 2011 study of the fatalities: The DEA's list of other kratom-associated deaths primarily described polypharmacy (mixing multiple drugs) as a factor in those fatalities, many of which involved benzodiazepines, sleep-inducing hypnotics such as zopiclone, and opioids such as fentanyl: The DEA's assertions about kratom-related deaths were contradicted by Pascal Tanguay, director of a Washington D.C. based drug harm reduction organization, who said of kratom in 2013 that: A Forbes editorial opposing the addition of kratom to the DEA's Schedule I noted that the listed deaths overwhelmingly included strong or dangerous coingestants, positing that mention of poison control calls (also cited by the Centers for Disease Control) was misleading: A Huffington Post reporter who consulted with a pharmacology expert about the DEA's classification of kratom alongside heroin and other Schedule I narcotics wrote that: Published research on kratom is scarce, but most medical literature notes that the substance has been widely used for over a century (to address chronic pain and opioid withdrawal symptoms) and is typically not associated with adverse outcomes unless additional substances are a factor. A 2008 study held that adverse outcomes overall for kratom use were poorly described, concluding: Per the DEA, kratom will be classified as a Schedule I narcotic as of 30 September 2016 under the terms of the Controlled Substances Act. Experts expressed mixed opinions about the move, with several stating kratom was improperly described as an opioid by the DEA, and a We The People petition beseeched the White House to intervene and stop the ban. A cited list of kratom-related deaths is not restricted to the United States and is largely populated by incidents of toxicity involving multiple drugs (such as fentanyl and zopiclone), and scant published research on kratom is available for review. The DEA cited 660 calls to poison control centers in five years, use of kratom as an opioid substitute for drug cessation, increasing popularity of the herbal supplement, and potential for abuse as reasons for the temporary Schedule I classification, but kratom users cited opioid-free pain relief for severe conditions such as fibromyalgia, self-reported drug cessation success, and a lack of demonstrated harm as reasons to oppose the classification. On 26 September 2016, a bipartisan group of lawmakers in Congress sent a letter [PDF] to the DEA requesting the agency delay finalizing the move placing kratom on Schedule I. In a separate letter to Office of Management and Budget (OMB) Director Shaun Donovan [PDF], the congressmen and women urged him to step in and stop the DEA from acting on 30 September 2016. Neither office immediately responded to the letters.
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