Readily available but unregulated: What risks do so-called ‘legal drugs’ pose?

Readily available but unregulated: What risks do so-called ‘legal drugs’ pose?
Published: May. 19, 2022 at 4:55 PM EDT
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WILMINGTON, N.C. (WECT) - For most people, convenience stores are a place to get a drink and maybe some snacks, But for others, they serve as a place to get their next high.

Kratom, spice, Delta-8, tianeptine, CBD, bath salts, synthetic marijuana or ‘spice’ --- they’re names you might have heard or even seen in convenience stores and vape shops. Some of them are promoted as healthy alternatives to prescription drugs and promise to relieve symptoms of anxiety and pain, but these substances aren’t without their own risks.

For the most part, they’re not illegal. Some of them are synthetic, while others are derived from plants. One thing they have in common, their unregulated status by the Food and Drug Administration.

While they might seem innocuous since they are so readily available, knowing what you are getting is not quite as simple as reading the ingredients label.

Substances like CBD are increasing in popularity and research continues as states and the federal government relax the laws on industrial hemp products. CBD does not have psychoactive effects on those who take it, but other substances can have those effects on users.

Due to their legal status and gray areas in the law, even when some of the synthetic drugs are made illegal, slight tweaks to chemical makeup can make them legal once again.

“We obviously have those synthetic drugs out there that are sold at different stores … once the state or federal government does make them illegal, they [manufacturers] just change one molecule, and it’s back out rebranded [at] the same store,” Lt. Jerry Brewer with the New Hanover County Sheriff’s Office said.

So, how can you know what is safe to take, and what might have some unintended consequences? It’s a question without a clear answer since the research for many of these substances is not readily available. Two of the more common products gaining popularity are kratom and CBD, but just because they’re all around, doesn’t mean they are inherently safe.

Kratom, an alternative to opioids?

Kratom is an extract from a plant in Asia that the FDA says affects opioid receptors, the same way as morphine. While morphine is a controlled substance, kratom is not federally regulated, and is legal to buy and possess in North Carolina. The substance however, does not come without side effects and has been linked to addiction.

Some users reportedly take it to help with opioid withdraw symptoms, according to the National Institute on Drug Abuse.

Despite efforts to label substances like kratom illegal at the federal level, legislators have stopped short. Some states have outlawed the product -- but in North Carolina, there are no laws against it.

In 2016, a bill was created in the General Assembly to add it to the list of schedule 1 drugs, however, that didn’t happen.

Proponents for the plant-based product are pushing back against restrictions. There’s even an organization, the American Kratom Association, that advocates for its use and helps provide education on kratom.

At a local shop in Wilmington, Port City Vapor, which sells kratom, an employee explained their products do undergo testing so customers can be sure they know exactly what they are buying. But, not every shop goes through these efforts. For those buying these products at stores without those efforts, you don’t know the quality of the products.

For those consuming kratom, the effects vary depending on the dose and the individual.

“At low doses, kratom produces stimulant effects with users reporting increased alertness, physical energy, and talkativeness. At high doses, users experience sedative effects. Kratom consumption can lead to addiction. Several cases of psychosis resulting from use of kratom have been reported, where individuals addicted to kratom exhibited psychotic symptoms, including hallucinations, delusion, and confusion,” according to the Drug Enforcement Agency.

A quick online search for kratom reveals around 10 million results ranging from medical reviews on the plant, to user reviews with well-known celebrities, like Joe Rogan, discussing his experience taking the supplement.

“That stuff gets you high!” Rogan said on his podcast, the Joe Rogan Experience.

Without more research on potential side effects of kratom, there are suspected dangers associated with its use. The FDA and the DEA both released reports citing dangers associated with its use.

Those dangers are something that Tamie Keel knows about all too well.

Keel lost her husband, a veteran police officer, to suicide, and attributes his death to kratom, to which she says he was addicted. Keel said she didn’t realize the dangers of the seemingly harmless drinks her husband was drinking until it was too late.

“He was spending there at the very end, he was spending somewhere between $750 to $1,000 a month on these bottles that I thought were Five Hour Energy drinks,” she said.

Its addiction potential is something that has been noted by federal agencies, as well as, a website “ … dedicated to providing accurate information so you can use kratom safely and get the most out of this useful herb’s numerous health benefits.”

The FDA also says it poses the risk of ‘addiction, abuse, and dependency,’ and is has been linked to at least 91 overdoses, according to the CDC. However, of the overdoses studied, kratom was detected in less than 1% of those deaths.

Keel said the addictive nature of kratom is something she saw first hand in her husband.

“I never ever anticipated the fact that what he was drinking is addictive. I mean, I’ve done a lot of research on that specific thing and kratom is addictive. And I’ll be honest with you, if I had to say he was addicted, I would say absolutely 100%. He was addicted to drinking these things, because when he didn’t get them, it was bad,” Keel said.

Those pain-relieving effects are a common talking point online for users of the substance in forums like Reddit, where people share their experiences and discuss the supplement.

Keel said her husband’s addiction to kratom progressed over the months in similar ways of other addictions to illicit or even prescription medicines.

“I remember conversations that we had about it because again, he was spending a lot of money you know, [he said] well they they just seem like they help me, you know, it helps with the pain,” she said.

Instead of reliving pain, she says it caused it for her and her family, and she started to notice something was off when the amount of money her husband was spending on kratom started significantly increasing.

“It started out, him spending a couple hundred dollars, then … August, September, it increased a little bit more, then October or November, it was just a little bit more. By December … he was spending $700 to $1,000 a month,” she said.

The decision to take kratom, or any unregulated products, is ultimately a personal choice, but knowing the possible side effects is important, as is ensuring your doctors and pharmacists are aware of everything you take, even if it’s just vitamins or other supplements.

Customers might believe since these substances are so readily available and are not illegal, they must be safe, but that’s not always the case.

Geena Eglin, a Clinical Pharmacist practitioner at Novant Health New Hanover, says there are big differences between drugs you get from a doctor, and these unregulated substances.

“Without an approval FDA process, there’s a lack of understanding about how these work in the body. And ultimately put our patients at risk for things like side effects that, you know, we might not even understand very well,” Eglin said.

Kratom is just one of the many supplements and herbs on the market, while it might be a more niche product, there is another one that you have likely seen on shelves in stores across the region, including some pharmacies.

From lotions to pet treats, CBD is everywhere

It’s derived from the cannabis plant and -- but it’s not marijuana -- it’s called CBD. There’s more research on the product, and the FDA has even approved its use for one particular drug to treat seizures.

CBD is currently legal under both federal and state law, and it does not affect users the same way as illegal marijuana which contains more THC.

“No one’s buying CBD or to get high, you know, it’s something that hopefully will help heal you,” Lt. Jerry Brewer with the New Hanover County Sheriff’s Office said.

Despite the legality of CBD in North Carolina, there are some concerns that without a quick legislative change to state laws, it could become illegal once again. State Senator Michael Lee said it is something he thinks lawmakers will work on before that happens.

But there is one thing Brewer said can present a problem for law enforcement. That’s the fact that CBD flowers and pre rolled joints look, smell, and taste like illegal marijuana.

So if you happen to get pulled over with, it could land you in police custody -- at least until they figure out what you have.

Safe or not?

As for its safety, the World Health Organization put out a report saying CBD has a ‘good safety profile,’ and there is no known addiction potential with its use.

People readily consume the products and there are even entire lines of it dedicated to pets. But when it comes to buying these products, like kratom, it can be difficult to know exactly what you’re getting.

That’s why Mike Rivenbark, owner of Exotic Hemp, takes extra steps by providing lab testing, and displaying the breakdown of the products in the store.

“It shows you the amount of CBD in it, and it shows you all the cannabinoids they tested for in this lotion, it just shows everything, they just dissected the whole process,” Rivenbark said.

However, the unregulated nature of CBD means testing isn’t required so there’s always a chance you could be getting something other than what you think.

“There’s a saying that not all hemp or CBD is created equal, that’s why it’s important to do the tests and have these tests done and have it available for people to look at.”

Eglin says the popularity of CBD will likely lead to even more research to determine efficacy and safety.

“I do anticipate in the near future, because it’s becoming more available that we’ll hopefully be able to use some of these substances in trials so we can start to understand it better,” Eglin said.

There’s a lot of cannabinoids in the cannabis plant, another popular product that comes from it is known as Delta-8 THC. It’s different than Delta-9 THC, which is the mind-alternating cannabinoid in illegal marijuana, but can have intoxicating effects.

“Delta-8 THC is one of over 100 cannabinoids produced in the Cannabis sativa L. plant but is not found naturally in significant amounts. Concentrated amounts of delta-8 THC are typically manufactured from hemp-derived cannabidiol (CBD) and have psychoactive and intoxicating effects,” according to the FDA.

The Food and Drug Administration recently issued a warning to five stores selling Delta-8 THC for illegal marketing of the products. As more research is conducted on the possible therapeutic uses of CBD, more information will be made public, giving consumers the most knowledge they can have, when it comes to taking these products.

At the end of the day when it comes to anything, whether it’s vitamins, food, or supplements like CBD -- experts agree that knowing what you’re putting into your body is key. And when you buy these products without in-depth testing, you’re relying on the retailers to sell you what you think you’re buying.

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