"About  customers a day walk through the doors of Holy Smokes a vape and smoke shop in Philadelphia looking to buy kratom the herbal product derived from the leaves of a Southeast Asian tree. Users and businesses that sell and manufacture it say kratom pronounced Kraytuhm helps to relieve pain gives a mild boost like coffee the tree is part of the coffee family  and can even help ease the pain of opioid withdrawal. The U.S. Food and Drug Administration says the product  not regulated as a drug because it is classified as a dietary supplement  is a dangerous addictive substance that acts on the brains opioid receptors and has been linked to  deaths. There is no evidence to indicate that kratom is safe or effective for any medical use FDA Commissioner Scott Gottlieb said in February. And claiming that kratom is benign because its just a plant is shortsighted and dangerous. The agency issued a recall  https November because of possible health risks. Earlier this month the Centers for Disease Control and Prevention linked kratom to a multistate outbreak of salmonella  https has so far sickened  people in  states and issued a recommendation that people not use it in any form. Several states including Alabama Arkansas Indiana Tennessee and Wisconsin ban the substance others have legislation to ban it pending.  It is also listed as a controlled substance  like heroin  in  countries including Thailand and Malaysia where it is grown the FDA reports. The warnings havent stopped the clients at Holy Smokes  S. Juniper St. said acting manager Charlie Goodine. We sell a lot of kratom he said. Some customers use the product to help with opioid withdrawal or as a replacement for prescription opioids such as OxyContin and Percocet. Its pretty much the cure for opioid withdrawal. Goodine said. It takes about two weeks for the physical symptoms to subside he said.  Scientific studies have indicated that the most effective treatment for opioid withdrawal includes the medically supervised use of opioid medications such as methadone. http But the FDA has said there is no reliable evidence that kratom can safely be used this way. The FDA stands ready to evaluate evidence that could demonstrate a medicinal purpose for kratom. However to date we have received no such submissions and are not aware of any evidence that would meet the agencys standard for approval Gottlieb said. Goodine is aware of the FDAs position on kratom and thinks the agency is siding with big Pharma and against any product that might interfere with the sale of prescription drugs. Kratom is sold online in gas stations and in smoke shops. It is also known as Thank Kakua thom Ketom and Biak and is typically brewed as a tea chewed smoked or ingested in capsules. Holy Smokes gets kratom directly from Indonesia and not from the Oregonbased PDX Aromatix in Portland which recalled its kratom products due to salmonella Goodine said. The bitter taste could be compared to a really strong matcha powder made of groundup green tea leaves Goodine said. Ten onegram capsules of kratom cost  while  grams of powder is .. Goodine has used the herb and compared it to taking an aspirin and drinking coffee. Not surprisingly the American Kratom Association insists the substance it is not dangerously addictive and it is not dangerous said Mac Haddow the director of government relations for the group. The deaths associated with kratom have with one exception not been caused by the substance but by other drugs that were found in combination with kratom he said. You cant take enough to hurt yourself Haddow said echoing Goodines contention that opponents just want to cut out competition for the pharmaceutical industry. Haddow produced reports indicating kratom is a safe way to get a mild mood boost and some pain relief.  He acknowleged some of the research was paid for by the association. He contended that kratom does not act on the brains opioid receptors the way prescription painkillers and heroin do. But back in  the Journal of the American Chemical Society httpscen.acs.orgarticlesiRecreationaldrugkratomhitssame.html reported that kratom indeed works this way. Last month an FDA study https found that  of the  of the most prevalent compounds in kratom do bind to opioid receptors and so should be considered an opioid. The study also said most deaths did occur in people who used kratom in addition to other drugs though in one case only kratom was detected. The Philadelphia Medical Examiners Office has not attributed any deaths to kratom nor any of its active ingredients said James Garrow spokesperson for the Department of Public Health. However given that it is the subject of a voluntary U.S. FDA recall is currently implicated in a nationwide outbreak of salmonella and there exists no scientific evidence that it is safe or effective for any medical use it is our recommendation that people not consume any brand of kratom in any form he stated in an email. NMS Labs http a nationally known forensic laboratory in Willow Grove started testing for mitragynine the active component in kratom about five years ago said Kelly Ciliberto toxicology administrator. We see it fairly frequently in our post mortem case work Ciliberto said. Between  percent and  percent of the cases contain some evidence of the substance but it is found mostly alongside other drugs. The samples come from all states she said. The facility performed the toxicology tests in the August accidental death of a New York police officer from Tupper Lake a community about  miles north of Albany who had been making the powdered kratom into a paste and eating it Ciliberto said. Sgt. Matthew Dana died of a hemorrhagic pulmonary edema or blood in the lungs which resulted from an overdose of mitragynine the Adirondack Daily Enterprise reported. http If people are saying kratom is like coffee that is misleading and dangerous Ciliberto said."