Thai police seized kratom leaves picked from 6,000 krathom trees planted near a house in southern Prachuab Khirikhan province in June, 2014. The stimulant is popular in southern Thailand and across much of Southeast Asia. Photo: AFP/Bangkok Post/Chaiwat Sardyaem

A prescription painkiller and a herbal infusion used for thousands of years to overcome tiredness are leaving a trail of misery in Asian communities, and taxing the resources of narcotics agencies. Yet both are totally legal.

While demand for amphetamines, opiates and cocaine continues to surge in the region, it is the abuse of everyday over-the-counter medications that has triggered alarm in health systems, according to the 2018 World Drug Report from the United Nations Office on Drugs and Crime (UNODC).

Tramadol, an opioid used to treat moderate pain in adults that is sold under brand names like Ultram, Conzip, Rybix ODT and Ultram ER, has caused a wave of addictions in Africa and Asia. Similar to morphine, it can create a dependency after only two or three weeks of consumption and may have lethal effects when combined with alcohol or other drugs.

Low-cost supplies of the drug have flooded “darknet” narcotics websites and are also being shipped from Asia to Africa and on to the Middle East. Countering its spread is difficult, as there are no international controls.

“While some tramadol is diverted from licit channels, most of the tramadol seized worldwide in the period 2012–2016 appears to have originated in clandestine laboratories in Asia,” the UNODC noted.

“The impact on vulnerable populations is cause for serious concern, putting pressure on already strained health-care systems.”

Legal ambiguity is also frustrating efforts to contain the spread of kratom, a natural stimulant from the mitragyna speciosa plant in Southeast Asia that boosts alertness and energy levels when its leaves are chewed, used in tea or smoked. More recently, kratom has been packaged as a capsule.

A popular psychoactive substance in Europe and North America as well as Asia, kratom is used to treat pain, anxiety and withdrawal symptoms from drugs like heroin and induces a similar “high” to opioid drugs in big doses. It is also known as kakuam, ithang, thom, biak-biak, ketum and mambog.

“The potential dangers of kratom are not fully understood. On its own, overdose is rare, but when combined with alcohol or drugs, dangerous side-effects can occur,” the American Addiction Centers warned. These can include mood swings, hostility, confusion, hallucinations and delusion.

In February, US Food and Drug Administration commissioner Dr Scott Gottlieb warned that kratom, which is still being legally marketed as a diet or nutrition supplement, had a “potential for abuse, addiction and serious health consequences, including death.” “There is no evidence to indicate that kratom is safe or effective for any medical use,” he added.

In 2016 the US Drug Enforcement Agency announced it would be placing kratom in Schedule 1 of the Controlled Substances Act, which would give it the same health ranking as drugs such as heroin and effectively prohibit possession and supply. The DEA backed down after a public outcry.

Other countries are taking action, even though the drug and plant are not listed in any United Nations Drug Conventions. Thailand, Malaysia and Myanmar, three of seven countries where the mitragyna speciosa plant is found, now control kratom distribution, though it remains available as a capsule through legitimate pharmaceutical channels; no controls exist in Indonesia, Vietnam, the Philippines and Papua Guinea.

Narcotics agencies are still able to suppress kratom sales by shutting down unregistered retailers, especially online. Usually sold as leaves, the illicit production is thought to be mostly occurring in Indonesia. In 2016, the most recent data available, about 500 tons of kratom was seized globally.

This represented a three-fold increase on 2015 and exceeded the global seizure of 247 tons of amphetamine-type stimulants, which are mostly manufactured in East and Southeast Asia. Only 60 tons of amphetamines were seized in those two areas in 2016, behind some other years, but there are worrying signs users are shifting to crystal methamphetamine.

The quantity of cocaine seized in Asia also tripled between 2015 and 2016, and increased ten-fold in South Asia, indicating that the Western party drug is taking hold. Seizures doubled in South-West Asia and the Middle East and were also much higher in East and Southeast Asia.

Asia first emerged as both a transit route and final destination in 2015, when Bangladeshi police intercepted a shipment of liquid cocaine worth US$14 million that was probably intended for affluent users in India. Hauls have also turned up in East and Southeast Asia, after probably being taken by mule trains from South America to India via Afghanistan or Kathmandu.

In Afghanistan, smugglers use routes that ship opium from the world’s  main cultivation area for poppies: output rose 87% to 9,000 tons in 2017 from the previous year due to political instability, a lack of government control and other factors. Afghanistan accounted for 75% of the cultivated area in 2017, with the remainder mostly occurring in Myanmar and Laos.

Addiction levels in Asia stayed fairly stable, indicating that most opium and its heroin derivative were intended for markets in Western countries.

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