Megan Hanley hadn't heard of kratom prior to last year.
An epidemiologist for the Tazewell County Health Department, Hanley was working on researching trends in the county's overdose deaths as part of a state grant program.
Her goal was to identify various trends that would aid the county's overdose prevention efforts — tracking things like demographics or what substances were involved in reported overdose deaths.
"I started noticing, when doing that overview, that there were a number of deaths related to kratom, or the drug name which is mitragynine," Hanley said in an interview with WGLT. "We had six overdose deaths in Tazewell County in 2023 that were related to kratom, or that kratom was involved in. That's about 19% of our overdose deaths for that year, which is significant."
The deaths weren't caused by kratom alone: As Hanley researched, she found that in each of the six deaths, the people who had died also had psychiatric drugs in their system alongside the kratom.
That "basically led to what we call in the science world a synergistic effect," she said. "The way that kratom works in the body is it binds to an opioid receptor and it causes respiratory depression just like an opioid would. ...That basically gets to a point where, when you pair that psychiatric medication with kratom, it causes too much of a respiratory depression that they can't overcome it."
Kratom, which is derived from a tree native to southeast Asia, isn't required to have any packaging that identifies potential interactions the substance may have with prescription drugs. And the way it makes a person feel depends on the dosage: At a low dosage, it can act as a stimulant. At higher dosages, the effects are more sedative.
Hanley took her concerns to state Rep. Bill Hauter of Morton, a physician-turned-lawmaker who used to sit on the Tazewell County Board.
Hauter, who represents parts of McLean County, filed HB3127 in February, hoping to get legislation on the books that would formally regulate the sale and use of kratom in Illinois.
"I was hoping that with this information from the [Tazewell County] Public Health Department, specifically naming kratom as a cause or a co-ingestion with another drug as a cause of death, that would bring more light to the subject," Hauter said in an interview. "Maybe more interest in making it safer for all Illinoisans."
Currently, there is no regulation of the herbal substance at either the state or federal level.
"There's a wild west mentality that's out there right now. The barriers are not necessarily the manufacturers — the biggest barrier is going to be just people [going] like, 'What in the world is this and is this really a problem?'" Hauter said.
Hauter isn't the only Illinois lawmaker proposing some sort of regulation of kratom: Republican Sen. Sally Turner of Beason and Democratic Reps. Marcus Evans and Curtis Tarver, both of Chicago, have also filed similar legislation.
All are seeking to fill gaps created by a lack of regulation at the federal level — particularly the Food and Drug Administration [FDA]. Without regulation, kratom products do not have to be sold with warning labels about their psychoactive properties, potential to become habit-forming, or even adhere to a set of formulation standards.
Brenda Fuss, a nurse practitioner at Carle BroMenn Medical Center in Normal, works in the hospital's addiction recovery outpatient unit. She said she's seen the dangers of unregulated kratom up-close.
"You have no idea how much of the active ingredients you're getting. There's no way to dose it appropriately. And it's also habit-forming: We have patients in detox right now that are here just for kratom use, who use kratom to get off of something else and now they can't get off the kratom," Fuss said.
Fuss said the explanation of increased kratom dependence could be two-fold. As the opioid epidemic played out, some people may have turned to kratom to try to kick their other habit, since the lack of regulation has made it easy to stock and sell at gas stations, smoke shops and supplement stores, to anyone.
"It's more marketed now. You can drive around and see kratom signs in the windows — kind of like we used to see CBD signs five or six years ago. ... I think it's just becoming more visible and people see how easy it is to kind of get their hands on it," Fuss said.
She also said some people have used kratom to treat anxiety or depression because they feel they don't have any other options.
"I have some patients that got on it because they didn't have insurance and they couldn't get their hands on something that was FDA-approved. Sort of in the time of desperation, that's what they turned to," she said. "We're in such a mental health crisis that it scares me to have people using something that is not regulated and you don't know what you're getting because you never know what those outcomes are going to be."
The American Kratom Association [AKA] puts the number of kratom users in the United States around 20 million, up around 3-5 million in 2016. While the FDA warns people to stay away from kratom altogether because of the possibility of forming a habit, Mac Haddow, a senior fellow of public policy for the AKA, blames the FDA for failing to regulate the product.
"The [FDA] abandoned its statutory responsibility to protect the American public from adulterated or badly formulated kratom products — they seek only to ban it," Haddow said in an interview. "The FDA has fostered a wild west mentality that allows anybody to jump into the market that wants to."
Formed in 2014 to advocate on behalf of kratom users, the AKA has since created model legislation for states to regulate kratom on their own. The Kratom Consumer Protection Act has passed in 14 states, Haddow said, including Utah, Georgia, Arizona, Oregon, Florida and Texas.
"The foundation for consumer safety on all of the federal and state laws relies upon the consumer having a sufficient amount of information to responsibly use any product. It's particularly, acutely, important for those that are dealing with substances that have psychoactive properties," Haddow said, adding the AKA backs other regulatory measures, including formula standards that ensure adulterated products are not sold on the market and companies cannot advertise their products as providing any sort of "cure."
Similar legislation is pending in the Illinois General Assembly, though Haddow said the AKA is not supportive of Hauter's bill after an amendment was filed that would classify kratom as a Schedule III substance. Schedule III substances are those with a moderate-to-low propensity for physical or psychological dependence, as defined by the Drug Enforcement Administration, and include drugs like Xanax, valium, ketamine, anabolic steroids and others.
Other lawmakers have introduced legislation without that provision; Hauter said matters of health and safety are bipartisan, and he could be willing to support another lawmaker's bill, if needed.
"This is just one example of how we can be bipartisan and work together on some many things — not only healthcare but there's a lot of things down here that we all agree on and we try to do what's best for Illinois," he said. "But this in particular, I think, is an area that both sides are interested in making common-sense regulations to keep Illinois safer."
