A mysterious 'pain-relief' supplement has been linked to salmonella in 41 states

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Kratom is an opioid derived from a plant native to Southeast Asia. It can be consumed in the form of pills, powder, or tea.
The drug, often called an herbal supplement, has been linked to a salmonella outbreak that has sickened 199 people.
On Thursday, the Centers for Disease Control issued its fifth warning in the last two months about kratom and salmonella.

A supplement with a viral following has been linked to 199 cases of salmonella across 41 states, according to new numbers from the Centers for Disease Control and Prevention.

Kratom is derived from a plant native to Southeast Asia and often sold as pills, powder, or tea. It has gained popularity among people who say the supplement helped them step down from powerful painkillers like Vicodin. Kratom taps into some of the same brain receptors as opioids do, which spurred the Food and Drug Administration to classify it as an opioid in February.

On Thursday, the CDC reported 67 additional cases of salmonella linked to kratom, up from the 132 cases reported in April. It was the agency's fifth and final warning about salmonella-tainted kratom in the past two months. The CDC warned people to avoid the pills and powders altogether, since salmonella bacteria can cause diarrhea and abdominal pain lasting up to a week.

Advocates of kratom say it helps curb the symptoms of opioid withdrawal, a conclusion that some scientists say makes sense. But because kratom is classified as a supplement and has not been developed as a drug, it is not subject to much federal regulation. That means tainted kratom pills and powders can easily make their way to store shelves.

The risks of taking kratom

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Kratom is increasingly raising eyebrows among several regulatory agencies, including the CDC and the Food and Drug Administration.

On Tuesday, the FDA sent warning letters to kratom sellers in California, Colorado, and Missouri accusing them of health fraud. Some marketers tout kratom as capable of boosting strength, delivering feelings of euphoria, improving focus, and even treating cancer — despite no scientific research supporting those claims.

This is the first time the FDA has cracked down directly on makers of the supplement. In a statement, FDA commissioner Scott Gottlieb said the three companies were engaged in scams that "pose serious health risks."

The weak regulation of supplements means those who take kratom have no reliable way to determine the proper dose or verify a kratom supplement's full ingredient list. It's also difficult to account for potentially harmful interactions with other drugs or medications.

Kratom is currently banned in Australia, Malaysia, Myanmar, Thailand, and several US states (Alabama, Arkansas, Indiana, Tennessee, and Wisconsin). Across the US, several reports of deaths and addiction led the Drug Enforcement Administration to place kratom on its list of "drugs and chemicals of concern." In 2016, the DEA proposed a ban on kratom but backtracked under pressure from some members of Congress and an outcry from kratom advocates.

'Contaminated products may still be available for purchase'

Since the first kratom-related illnesses were reported in January of last year, the CDC has regularly updated its total case count and conducted interviews with sick people across the US. Thursday's case count, however, was the agency's final update. The investigation is now considered over.

But the CDC warned consumers on Thursday that contaminated kratom products "may still be available for purchase." That's because the investigation was unable to pinpoint a single source of the tainted products.

Out of 103 people the agency interviewed, roughly three quarters said they'd consumed kratom in pills, powder, or tea across 41 states.

"People should be aware that kratom could be contaminated with salmonella and could make people sick," the agency wrote in a statement.

You can find a list of all the kratom products that the FDA has recalled here.

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