A substance marketed as an herbal alternative to prescription painkillers contains the same chemicals found in opioids and could be addicting, according to new research by the U.S. Food and Drug Administration.

The public health agency issued another harsh warning on Tuesday against kratom, which grows naturally in Southeast Asia and is sold in a powder capsule in Maine stores and online. A controversial, private opioid recovery program slated to open in Portland in March plans to use kratom and cannabis to treat patients. It is used to treat pain, anxiety and withdrawal symptoms, although the FDA has not approved any of its uses and has found no reliable evidence to support its purported health benefits.

“FDA is concerned that kratom, which affects the same opioid brain receptors as morphine, appears to have properties that expose users to the risks of addiction, abuse, and dependence,” the report said. “Kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids.”

The FDA has warned that the unregulated substance could have dangerous side effects, like seizures and vomiting, and has tried stop imported kratom products from entering the country illegally. Proponents have said it reduces pain, and surveys have estimated that between 3 million and 5 million Americans have used the supplement, The Washington Post reported.

Kratom has been linked to 44 reported deaths associated with its use — an increase from the 36 fatalities the FDA drew attention to in a November 2017 public health advisory. The FDA is still investigating those cases, and it has not yet concluded whether kratom was a fatal factor, either when ingested alone or with other substances. The Tuesday report did not say whether any of those deaths occured in Maine, where opioid overdoses kill nearly one person a day.

The Northern New England Poison Center, which serves Maine, has seen the use of kratom rise exponentially in the last year, according to Medical Director Dr. Tammi Schaeffer. The center had 16 calls involving the herbal supplement in 2017 — up from 4 in 2016, she said.

FDA researchers have been studying kratom since 2016, when the U.S. Drug Enforcement Agency tried to categorize it as a controlled substance in the same grouping as heroin, according to the Post. But amid the desperation for new ways to battle the national opioid crisis, the move received pushback from lawmakers, who instead urged the FDA to evaluate kratom for potential beneficial uses, the Post reported.

Other medications used to treat addiction, such as methadone and suboxone, have also come under scrutiny for simulating the effects of opioids, but unlike kratom, those substances have gone through rigorous testing to define safe dosages and use, Schaeffer said.

“I would love to see more studies on this,” she said of kratom. “But at the moment, we don’t want to replace hope for safety.”

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Callie Ferguson

Callie Ferguson is an investigative reporter for the Bangor Daily News. She writes about criminal justice, police and housing.