Kratom is a psychotropic plant sold over the counter as a supplement. Users claim it is helpful in treating opiate addiction, while medical professionals say it is itself a dangerous addictive drug. Some estimate that 3 to 5 million people in the United States use the drug, and studies show that overdose/poisoning is on the rise. The Child Mind Institute’s vice president of research, Michael P. Milham, MD, PhD, and clinical director Paul Mitrani, MD, PhD, recently wrote a New York Times letter to the editor concerning the dangers.

A recent article on kratom (“Nature’s Answer to Opioids,” Jan. 17) by Alex Williams discusses the controversy surrounding this psychotropic plant. While we are sympathetic to concerns about classifying the plant as a schedule I narcotic, the risks of freely available kratom are under-represented.

Should a “supplement” with opiate-like qualities and clear addictive potential be freely available over the counter? Few would say yes, but this is a reality with kratom. Moreover, addiction professionals are increasingly seeing problematic kratom use by college and high school students without any history of opiate dependence. Considering the growing outrage over JUUL use among youth, kratom use has the potential to be far worse.

Kratom may very well deserve a place as a replacement therapy in the treatment of opiate addiction, but the proven risks demand that it be regulated so that the “replacement” does not lead new users to become addicts. There are other schedules available (II or III seem appropriate) to regulate it such that those who can benefit have better access, while the broader public remains protected. We suggest the ongoing conversation be broadened to include these less restrictive, but potentially life-saving, regulatory solutions while research continues.