Interview with International Drug Policy and Harm Reduction Expert Pascal Tanguay

This interview is the text version of the audio episode #66 of the Kratom Science Podcast, posted December 2, 2021. It’s been lightly edited for clarity in reading.

Pascal Tanguay is originally from Montreal, Canada and has been living in Thailand for 20 years studying issues around people who use drugs, international and Southeast Asian drug policy, HIV, harm reduction, and human rights. He was featured on Vice News in 2017 in a report by Hamilton Morris on kratom legality in Thailand.

Kratom Science: You’ve done a lot of work on harm reduction and drug policy over the years. What do you do in your consulting work?

Pascal Tanguay: Exactly, I do something on what you said, essentially harm reduction, drug policy, broader public-health, HIV-related, communicable diseases, providing support to civil society organizations, non-governmental organizations, as well as governments, United Nations agencies, and development partners like donors. So my expertise is really to help facilitate dialogues between civil society organizations and governments and donors to facilitate consensus on strategic implementation of interventions that create public health benefits in the long term. My expertise has been for a long time around drugs, drug policy, criminal justice systems, and how that impacts and intersects with social justice and public health.

You’re originally from Canada, is that right?

That’s right. I’m originally from Montreal in Canada.

So what drew you to the Southeast Asian region? You’re in Thailand now?

Yeah, I’ve been in Thailand for almost 20 years now. Initially I came out here as a backpacker and got comfortably stuck in Thailand. So it’s not that I had a plan, it wasn’t part of a strategy, it wasn’t [that] I had studied Asian studies or anything like that. While I was doing my master’s degree, I left with some friends who were based in Auckland, New Zealand and we went for a backpacking trip for six months around Southeast Asia. 

I decided to stay at the end of the trip and got my first job, shortly after I decided to stay, at the regional organization called the Asian Harm Reduction Network which is a network-based organization that covers multiple countries in Asia to provide technical support on implementation of harm reduction strategies and programs. That organization has since closed. I worked there from 2004 to 2009, after which point I became a consultant in 2011. I was offered a job by a large American international NGO called Population Services International. I was the director of the national HIV response, targeting people who inject drugs for Thailand. Did that work five years, and after that project closed, I went back to consulting and I’ve been a consultant ever since. 

When I started to study kratom, one of the first videos I saw was you talking to Hamilton Morris in Thailand. Kratom just became legal there. What led up to the legalization in Thailand? Kratom is traditionally used there and it was outlawed in the 1940s.

Yeah that’s right. Kratom was made illegal in the 1940s because at the time, you have to understand that the Thai government still had legal drugs like opium, heroin, were being sold in pharmacies, and that represented a significant revenue for the state. Some estimates ranging between 8 and 20 percent of the national revenue was generated off the sales of legal opium through government outlets. So when people started using kratom, it meant a significant loss of revenue for the government. So they made kratom illegal in 1942 to protect the opium market, essentially. 

Drugs stayed legal in Thailand for a long long time. It wasn’t until 1959 that they made opium and heroin illegal, and then other drugs followed suit in the following 10 years. So by 1959, Thailand had essentially caught up to the rest of the world in terms of adhering to, let’s say the international drug control conventions that are shepherded, let’s say, by the United Nations Office on Drugs and Crime – so the kind of international framework that makes all drugs illegal at that stage. Kratom was still illegal but it wasn’t enforced because now that heroin and opium had become illegal there was no more reason to police kratom. 

It was wasn’t until 2003 or thereabouts when the prime minister Thaksin Shinawatra declared a bloody war on drugs that led to the extrajudicial killing of over 2,000 people suspected of being involved in the drug trade, which were mostly petty users and small time dealers that were extra-judicially assassinated by police forces across the country. At that point, then the police restarted focusing arrests on kratom, and the number of arrests increased gradually and radically over the next 15 years. Throughout that period, so since the early 2000s up until recently there were several attempts to decriminalize kratom because many communities in Thailand are indeed using kratom, and they’ve been using kratom since the earliest, that I was able to find, was officially in 1650s that people have been using kratom without much problems for traditional purposes and for medicinal purposes. 

The different proposals went in different directions proposing to now alleviate some of the laws = decriminalize, legalize, promote for market for export, for local use, for medicinal use, and none of that really worked up until recently, as you pointed out, it’s just in the past few months that kratom has been decriminalized in Thailand. So it’s not entirely legal but it has been decriminalized to the point where we have a big superstore, grocery store chain here called Big C, and now kratom is available at Big C in the produce section. 

Wow.

So you can buy five leaves for 75 baht which is the equivalent of about two dollars to two bucks fifty in the US. So five leaves, two bucks fifty, fresh leaves mind you, not sure to what extent the alkaloids, what the supply chain is like, so whether the alkaloids have survived the trip to the grocery store shelves is not clear. But it is available for public consumption with virtually no regulation. Although from what I understand, that wasn’t the original intent. The original intent of the decriminalization was really to join the, let’s say, the bandwagon where they can produce and export kratom to get in on the gravy train and make some money out of this. 

You say it’s decriminalized. I usually think of decriminalization as, if you get caught with illicit drugs then you might only get like a fine or something, but it actually can be sold in Thailand as well?

Yeah, I was quite surprised by that, because I was doing some reading today to catch up and prepare. There’s essentially three models for control or regulation of kratom. One is completely legal, for example in The Netherlands or Germany, people can possess and advertise and sell with no penalties. There’s models like the US where it’s partially legal depending on the states where you are, and where it’s just outright banned like in Singapore, where possession and sale are strictly prohibited, and where even the alkaloids that are found in kratom are also prohibited and controlled. So there’s different models, and from what I had initially understood, it seemed to be that Thailand was going for partial legalization or decriminalization. So it was mostly intended to be production for exports, a similar model as in Indonesia, with some exceptions for medicinal use and traditional use. However it seems that they’ve gone a bit further there. 

There’s a model that has been piloted since about 2016 for community control. So there’s some communities that have been able to establish a kind of community charter, where community members are in control. In that that charter they specify, for example, how many how many trees a household can possess, how they can dispose of the leaves, what they can do with the leaves, if they can dispose of trees, if they can prepare/make decoctions, or this decoction called “4X100”, which in Thai is called “sii khoon roi” – sometimes that’s not allowed. But the chewing of the leaves is allowed. So for example, that pilot which was done in one of the southern provinces which seemed to have been very successful allowed three or four trees per household. People were only allowed to consume the leaves freshly, so no decoctions, and they set age limits for, I think it was 18 years of age, for young people not to have access to the kratom, and it was supposed to be for medical purposes or for traditional use, so it wasn’t purely for recreational use to get high. That was kind of still frowned upon. And it was community enforced. It wasn’t that the police came in and arrested people. So that’s also a model of decriminalization. There’s still some controls that are in place, but there’s more tolerance and flexibility at the community level for how kratom is used and managed. There’s still an illicit kratom market.

In the Hamilton video, and this came out like in 2017, but Hamilton’s film crew was showing how people were just poaching the trees from the forest, and I noticed in my Google News alerts that people are still being arrested in Thailand for having kratom. So is that slowing down because of the decriminalization?

From the evidence that I’ve seen recently, there hasn’t been much change in the number of people who are arrested. I think there’s been a decrease in the number of people who are prosecuted. So the police are still arresting people. Also Thailand has, let’s say, a very strange approach to drug law enforcement where police salaries are extremely low. Police are very much underpaid here, so they they receive a financial incentive for arrests, especially for drug-related arrests, so there’s real incentive for the police to go out and arrest people who are involved in any kind of drug trade, whether it’s users or dealers, and obviously users are easier to nab than big-time producers or traffickers. So the police target their efforts on young people, vulnerable people who are visible and easy to catch. Kratom helps them earn and supplement their income like any other drug-related arrests, so police here get something like – it was 100 baht, so about three 300 baht.. So they get about ten dollars for every arrest that they make that’s drug-related. They also get a financial incentive for seizures, for example for methamphetamine pills they’ll get one baht, so the equivalent of three cents for every pill that is seized. In the equation that they use, there’s a first step that police have quotas as well. So a police officer working a specific beat will have a quota of drug-related arrests that they must make per month. So for example, I’m a cop in Thailand, my quota is 50, I need to get 50 arrests for drug-related issues in the next month. After I meet my quota, every arrest on top of the quota that’s when I get my financial incentive. So again, there’s a real demand for going out and arresting people. And again, targeting users is very easy, and that’s why you still see a lot of arrests. However, for kratom, given that the law has changed recently, then when it gets to court, often the charges either get dropped or not prosecuted or some settlement out of court happens. That’s not quite clear, but the data shows that the number of people who are prosecuted for kratom-related possession has decreased in recent months. 

You’ve written about the drug policy in Thailand, and it seems to have been pretty oppressive. You’ve written about forced rehabilitation centers. Sometimes when we think about drug courts, we think it’s a harm reduction measure because you’re not putting people in jail. But these rehabilitation centers are kind of like jails aren’t they? 

In a way, they’re kind of worse than jail. So at the point of arrest, when a police officer arrests someone for a drug-related charge in Thailand, usually they’ll get a urine test, and if they test positive that means they have used drugs. That can be used as evidence that they have consumed drugs. If there’s possession [of] a small quantity and a positive urine test, or just a positive urine test, then the police officer will give the individual a choice of going to a rehabilitation center or going through the criminal justice system. So, going through the criminal justice system means that they’ll go to a police holding, then they’ll get a lawyer, then they’ll go to trial, then the sentences are quite severe indeed. There was a famous case of a young woman who was arrested with one methamphetamine tablet and was sentenced to 25 years in a prison here in Thailand. So the sentences are pretty drastic. Very, very small quantities. So for a lot of people when they are offered the chance to go to a rehabilitation center instead of taking their chance with the criminal justice system, they jump at the chance. However, when people sign up for that process, they forego the due process. They do not have access to a lawyer. There’s no parole. Their chances of being released depends on a single person, often a single person or a small committee that is anonymous, that decides whether the person has beaten their addiction or whether they are ready to reintegrate society. There’s very limited oversight and transparency in regards to those decisions and very often some of those decisions are not even made by medical professionals. So in that sense, people can end up being arrested, choosing to go to a rehab center for six months, but they end up staying there for six years, and they have to pay out of their own pocket for some of the services that they avail themselves while they are in detention. There’s a huge miasma of human rights abuses that happen in these rehabilitation centers that have been extensively documented by organizations like Human Rights Watch, so it’s sometimes potentially even worse to end up in one of these rehab centers compared to going to prison. At least in prison, you might have a long sentence, but you still have some support with due process, parole, pardons, etc., that are possibly accessible to people with limited charges.

Since they’ve recently decriminalized cannabis and kratom in Thailand, is that a signal that the policies are switching from punitive to more harm reductionist?

No, not really. On the surface, I could see why it would make sense, but the interest here is not the interest of the Thai government here. They don’t have the interest of people who use these substances at heart, or people who need them for medical purposes. The real interest, I think there’s two compelling drivers or motivations for the Thai government to have decriminalized kratom and cannabis. The first one, and I’m not judging which one is more important than the other, there’s been a big push in the past few years to decarcerate. Thailand’s prison system is overcrowded. Prisons are at over 200% capacity, and have been for several years. Most people who are in prisons, like 70-80% of people who end up in prisons are there because of drug-related charges. So their interest is to reduce their prison population as quickly as possible, because prisons are extremely costly, even though the conditions are horrendous here and the services are very, very limited. It’s still a heavy financial burden for the government to maintain this overcrowded prison system. 

The second one is purely financial. They can see that there’s a gold mine. There’s a lot of money to be made in selling kratom overseas and producing cannabis and selling it, especially with COVID, the economy here has been heavily impacted negatively. They’re pretty desperate to make a buck, pretty much anywhere that they can. Even before COVID, before the economy had been heavily negatively impacted, there’s a major drive to join the market and create financial benefits for society. Recently I wrote an article about cannabis legalization, and what was driving this, and indeed when I did a media analysis, look through several dozens of newspaper articles, and when there’s a testimony from the government, when there’s an article published about cannabis legalization in Thailand, it usually ends up being in the financial sections, not in the health section, or the social section. The quotes from the government are usually “we decriminalize because we’re going to make money”, so they’re pretty open and direct about their motivations for decriminalization or legalization of cannabis. They’re interested in making money out of this. They see that it’s a large untapped market. They have the resources, they have a heavily agrarian society that is good for cultivating. They’ve got rich fertile soil. They’re ready to produce. One of the interviews that I watched with the director of the Office of the Narcotics Control Board here was also saying very clearly, we decriminalized cannabis to make money, we are not changing our drug policies, this drug will remain illegal for personal and recreational consumption. This is purely for medical purposes to make it available for patients who are suffering and to cover some of our costs.

It seems like they’re kind of following what Indonesia has done, because I think there are criminal penalties for use of kratom in Indonesia. Is that right?

That’s right. The way I understand it is that in Indonesia, the BNN, their narcotics control board, has allowed production for export, but local consumption and use of kratom is still criminalized and punishable through the criminal justice system.

What about American businesses? Are there investors in Thailand already wanting to set up  kratom manufacturing in Thailand and buy up some farms or deal with farmers there already?

I’m not too sure about what the situation is regarding kratom, but certainly in terms of cannabis, when the Thai government announced that they would be producing cannabis for medical purposes there, they received hundreds of proposals from investors from across the world, especially from the US, from Japan, from Canada and other countries to establish partnerships to buy land, to buy farms. However, the Thai government generally is quite protectionist, so they have very protectionist policies. They do not sell their land to foreigners. Partnerships, as I understand, are very, very difficult to establish for these kinds of projects. So there might be a similar kind of interest [in kratom] from foreign investors, but from what I understand, the government is very, very reluctant to engage with foreign countries and foreign business owners in terms of, at least, for cannabis, and I imagine that’s mirrored for kratom as well. So I think they will want to maintain control, maintain their insurance, protect their interest by retaining full control over the market as it develops here. I really do not see very strong partnerships with American businesses. If there is a partnership, it’ll be, “We will produce and you’ll buy our stocks,” but I think the production will 100% rest squarely in the hands of Thai people, Thai businesses, and the Thai government.

This is kind of a philosophical question, but why do you think governments continue with punitive measures to try to solve drug problems? It doesn’t really seem to have any benefit for anybody but the law enforcement agencies, and I don’t know why that’s enough for them to keep these policies going. What do you think their motivations are?

Well there’s certainly a financial motivation, I’ll come back to that. But I recently did some research about mapping the flow of funding for the drug response in Thailand, whether it be from the criminal justice system or for public health. It’s pretty clear that there’s huge investments. Moving from a punitive approach to, let’s say, a human rights approach, to a public health approach in terms of managing drug issues would create a significant impact for the country. So in Thailand, what I found was that the annual budgets for aspects of drug control were totaled in US dollars was close to two billion dollars. So, 1.77 billion dollars in 2019 that covered the Royal Thai Police, the office of the Narcotics Control Board, the courts, the prisons, and the probation department, and that’s only for drug cases. It’s not the entire police force, the entire court system. These are explicitly and specifically for drug-related cases, so that’s two billion dollars worth of jobs and positions and people with influence and power that would suddenly lose that influence, that power, that revenue. That represents a lot and especially in Thailand, in Southeast Asia, the drug control apparatus, the police force is heavily militarized. I think you can relate to that being from the US, and that also means that there’s a lot of vested power in the ministries of justice and the police force, and losing that revenue would also mean that they would lose that influence internally, so other ministries might become more powerful and more influential if they lost control over drugs.

When I was the director of the national HIV response for people who inject drugs here, I worked very closely with some individuals within the Ministry of Public Health, and there was always a reluctance on their part to challenge anyone from the Ministry of Justice, because Justice had so much more power and influence. Suddenly shifting the drug control response from a criminal justice response to a public health response would significantly upset the balance. So maybe not that entire 1.7 billion dollars would shift into the Ministry of Public Health and its affiliate organizations, but certainly a significant proportion of that 1.7 billion dollars would shift over to other ministries. That’s a huge loss. I think that means that the status quo is likely to prevail for a long, long time, even as governments increasingly recognize that the criminal justice approach has not been particularly effective, that there are better ways, more effective ways of dealing with drug-related issues. However, making that structural change and impacting powerful, powerful people’s pockets and budgets will take a long, long time to materialize in  my opinion. 

Do you think there’s any truth to the idea that pharmaceutical companies want to control these drugs so they can monopolize them? For example, with kratom there’s potential for it to be developed into a drug to treat opiate withdrawal. Do you think that there’s a benefit for big pharma to control kratom? 

Certainly I think that big pharma is paying very close attention to what’s happening in, let’s say, the plant-based sector to see where they can find their new pills that they can sell, certainly. I think even more importantly is that the pharmaceutical companies have a vested interest in avoiding that kratom, that is grown on, you know, someone’s land, can end up in the hands of someone that will use it and treat themselves, so that they won’t need to go to the pharmaceutical company or the pharmacy to get their drugs that they produce. So it’s not necessarily that pharmaceutical companies want kratom to extract mitragynine and transform it into this new magic pill. I think what they’re mostly afraid of is that kratom is in competition with their market and will reduce the sale of their products, whether it be methadone or buprenorphine or naltrexone or whatever other drug that they are peddling to solve health issues. I’ve heard that people use kratom to manage their diabetes and their glaucoma and other issues. So it’s not just for drug dependence that kratom is potentially effective, there’s a whole range of health issues for which people generally use drugs, medicines that could be substituted with a cheaper natural alternative, and I think that scares pharmaceutical company a whole lot more than their interest in acquiring and controlling the the market.

I was interested if people in Thailand use kratom mostly medicinally, or for pleasure like with the 4×100 consumption, or casually, like people drink coffee. 

The data that I’ve seen recently suggests that most people use kratom for medicinal purposes. So for medicinal purposes, that’s a large group of people, so to manage their diabetes, their glaucoma, or other health issues, to wean themselves off alcohol, tobacco, drug dependence and use. Certainly there’s another group of people who use it to work in the fields, so kratom has both an analgesic and stimulant property, alkaloids that produce analgesic and stimulant effects. People will use that when they go work in the fields, like in the rubber fields or in the rice fields, so that they can work longer hours in harsh conditions and have less physical pain or physical discomfort from their physical labor. So that’s certainly another large group and there’s an overlap between the group that uses it for work purposes, with some who use it recreationally. So in southern Thailand where kratom trees are indigenous and where it’s most often used, I would say some of these workers and other people use it socially. So they’ll go to a coffee shop in the morning, and check politics, and as they’re chatting politics the coffee shop owner will place a basket of fresh kratom leaves, kind of like we get peanuts at a bar, essentially. People munch on the leaves as they are talking, and they drink their coffee or their tea before they head off to work. So it’s generally socially acceptable for people to do that in community settings in the deep south of Thailand, and that would kind of constitute, in my opinion, some traditional use. I’ve seen it when I was in southern Thailand doing research. I’ve seen it used in puppet shows. So there’s these puppeteers who work late at night. They do shadow puppets, and the shadow puppeteers are especially famous for their use of kratom because they need to stay up late to perform their shows and to rehearse. So they use kratom as well. Most recently there’s this other group who has emerged who are, let’s say, younger teenagers, youngsters, youth, who will get some kratom leaves, boil that and water to make kind of a tea or a decoction. You mix that in with ice cubes, coca-cola, and cough syrup, and they drink that for recreational purposes to get high, essentially. I’ve also seen people who drink the tea unadulterated with other substances to manage their health symptoms. Most commonly, when you hear of the sii khoon roi is 4X100. The 4 stands for the four ingredients: the kratom (boiled kratom leaves), the coca-cola, the ice, and the cough syrup. So the base formula are these ingredients that make up the sii khoon roi and that has unfortunately attracted a lot of negative attention, a lot of stigma and discrimination, not quite as much but similar to the stigma and discrimination that’s associated with ice users or crystal methamphetamine users in Thailand, which are very much frowned upon. 

So these youngsters end up getting high in rubber plantations. They drink their sii khoon roi, their decoction, and there’s rarely any kind of negative impact relating to that, but in society’s eyes that is frowned upon, which is kind of unfortunate because there’s very limited negative health or social impacts from using kratom whether it be in in fresh leaf form or chewing or in this tea preparation. The biggest harms related to the use of sii khoon roi, in my opinion, and based on the research that I’ve done, is the additives. So people mix that in with cough syrup that contains either dextromethorphan or codeine, and obviously those substances are addictive and potentially dangerous, but these are supposed to be controlled substances, controlled products that are sold in pharmacies with prescription. But again, instead of going after the pharmacists who sell cases of cough syrup, literally cases of cough syrup over the counter to youngsters, they choose to go after the youngsters and demonize this concoction again, instead of going after the, in my opinion, the real criminals who are the pharmacists who try to make money off these young people trying to get high. If there were better controls on pharmacy sales here ,and it’s not like in the US or Canada, pharmacy sales here are technically regulated but they’re not always enforced, so that means that one of the interviewees, one of the respondents to my research was saying that once a week he goes to the pharmacy and buys a case of 24 bottles of coffee syrup, pays the pharmacist, walks out, and obviously the pharmacist knows. Another one was saying, the pharmacist doesn’t care, he knows that I’m doing this but he doesn’t care. And then he goes, oh well actually that’s not true, he kind of cares, because every time he sees me he hikes up the price and doubles the price from 40 a bottle to 80 a bottle. So again it’s a bit strange to me that the focus of society is on the people who drink the sii khoon roi and not on the pharmacists who are parents, supposedly medical professionals, but who enable and abet this kind of behavior. But we don’t talk about that here, we only talk about these youngsters who drink sii khoon roi. 

I think the media has played a huge part in the demonization of young people who are drinking this decoction, in linking the use with Muslim insurgents. In the southern provinces of Thailand, there is a separatist movement. The people in the three southernmost provinces of Thailand are majority Muslim, and they’re on the border with Malaysia. They would like to separate either to join Malaysia, or to have more independent control from the centralized government of Thailand. There’s been a lot of insurgency over the years to separate, and the media has linked the use of sii khoon roi with this insurgency movement. Again, I think that’s false, that’s propaganda, and the reason why I think it’s propaganda is when I talked to some of the insurgent groups when I was in the deep South, they were explicit that they recruit people who are not using drugs, and if they find anyone using any kind of drug including kratom they are kicked out of the movement, so they are very, very strict about accepting no one who is involved in the drug trade in their insurgency movement. However, having media reports enables the government, it facilitates the government, especially the police, to obtain warrants to search suspected insurgents by saying, “Ah, this person uses sii khoon roi, they must be an insurgent, then we can get a warrant and search their premises”. Whereas if they were just using any other type of drug, it might not allow access to a warrant to search their premises. I think there is again political motivation in how the government has linked sii khoon roi or the kratom decoction with the insurgency movement. It allows them to broaden police powers in the deep South which is a contested zone.

Researchers who wanted to research kratom, at least before decriminalization, had to obtain their samples illegally. With decriminalization, are there plans for expanded kratom research in Thailand? 

Yes, that’s already been piloted, I think since 2016, in parallel with that initiative I was talking about earlier where there was this community control. So this was set up in one area of the province and the special kratom region has better access for research as well. So academics, researchers, pharmacologists can get their kratom more easily with fewer hassles, with fewer permissions, so that they can conduct the research to accelerate the production of evidence to make effective decisions regarding both policy and practice regarding kratom. 

So, yeah, that has improved, but indeed when in 2011, when I was in deep South, I went to the Prince of Songkla University and talked to a young PhD student who was doing research on kratom and he was dismayed that he had to go to drug dealers to get his kratom to do his research because the procedure that to allow him access needed was centralized, so he would apply to the Office of Narcotics Control Board in his province which would be sent to Bangkok to the central office. Then it would take potentially weeks or months to get the approval, and by that time the kratom that he gets, the alkaloids have all dissipated and alkaloids in the kratom don’t stay in the leaves for very long, so if the leaf is not managed properly by the time the researcher gets the product, the alkaloids might have faded or dissipated and the product is essentially worthless for research purposes.

We talked about reasons for use. A lot of people will use it for coming off of heroin, and I’m just wondering if there’s any effort to actively introduce people to kratom who are addicted to stronger opioids, in Thailand or anywhere you’re where you’re looking at this, maybe by community organizations?

I know that there’s some research going on about this in Thailand, but unfortunately none of the civil society organizations, the community based organizations that I work with have introduced this. I think many of these organizations are essentially bound to promote services that are supported by evidence, so to pilot something that doesn’t have official endorsement by a UN agency is potentially problematic, and could compromise access to funding from foreign donors, or even local donors if they were to promote something that’s not accepted. I know that unofficially individuals do do that, and there’s enough of, I think, word-of-mouth in Thailand and the region for people to know that they can get kratom to manage their withdrawal symptoms if they are dependent on a substance. However, to my knowledge, no organization is in a position to promote this as an official service at this time because there would be too many risks.

What do you think about some of the efforts in the United States, like the kratom consumer protection acts? 

That’s an interesting question. I think that in principle the kratom protection act is largely a good thing, in as much as it helps prevent a ban or criminalization of kratom, or a federal ban on kratom. I’m also in favor of some kind of regulatory system being put in place, like for alcohol or tobacco, [so] that it doesn’t end up in the hands of minors. You know, the product is labeled and there’s been some analysis of content.

I think in principle that is good, however I think that it could easily be used for nefarious purposes. If the government realizes that suddenly they can’t control by criminalization, then they might use the protection act and put requirements in there that are so onerous that it will be difficult to meet, and therefore the product cannot be sold. So, for example, you know if the kratom protection act includes clauses and requirements that are more strict or more severe than for products like alcohol and tobacco, which we know carry a lot more potential for harm, then that would not be in line with the intent of the protection act. But in principle, as much as they have been deployed so far, I am in favor. I do think it’s a good idea. 

That being said, from the research I have done, all the evidence I’ve seen, kratom is not harmful. I get, politically it makes sense to have a kratom protection act to prevent the government from criminalizing kratom, and for the DEA to move in on this substance. That makes a lot of sense strategically, however in an ideal world we wouldn’t need that because kratom is not dangerous. So whether you know someone who’s 16 or 14 or whatever age, they consume a couple of leaves of kratom, it’s not going to cause any real harm. I’m all for having some kind of regulation to ensure that the product that people consume is safe, in the sense that there’s no mixed in adulterants, that the product doesn’t contain contaminants. I think that’s very important. I don’t think that’s necessary in the US, I think that’s more important for upstream in the supply chain. For example, most kratom in the US now comes from Indonesia. I think it’s important for Indonesia to put in place some measures to control their supply chain and certify their product as safe and have their analyses done to reassure customers abroad and even locally if there are any that the product is safe and does not contain adulterants 

In 2018 I was working with a colleague from Oregon who was interested in exactly this – helping strengthen the supply chain in Indonesia. We put in a proposal to develop an evaluation assessment of what was going on in Indonesia to make formal recommendations on how to strengthen the supply chain. Unfortunately, our project wasn’t funded but we did do quite a bit of research, and what I saw in the promotional videos from Indonesian home producers was they do this on their farm, in the garage, wherever, and there’s chickens running around in the kratom leaves that are drying and that means that they can do their business in the kratom leaves and that might cause salmonella. The kratom itself is not dangerous, but the way that the supply chain is managed could potentially open up users to significant risk.  So in that sense I do think some regulation is needed. I don’t think it should be in the US. I think that if the US government is concerned about the safety and security and the health, safety and security of consumers in the US, then they should exert pressure on Indonesia to deploy effective controls and certifications to ensure the quality of their product. 

So in the research that I was doing we found that the World Health Organization, in 2003 released guidelines called “Guidelines on Good Agricultural and Collection Practices for Medical Plants” and there’s a certification program for this, so I think that that should be applied to the kratom supply chain rather than using the stick and the carrot to put better controls in place. But not the stick where you punish people for using or making it a criminal substance. I think that’s not the right strategy. There’s a win-win opportunity here for both the Indonesian government and producers and other producers in Southeast Asia to continue to sell their product provided that they meet certain quality standards that will reassure authorities in foreign countries like the US, Canada, and Europe that the product that they are importing and using is safe and will not harm their citizens. I think that’s a much better strategy than outright criminalization. There’s still a lot of benefit for parties at both ends of the supply chain to benefit from an arrangement like this, whereas criminalization benefits absolutely no one. 

Do you think there’s any difference between consuming a lot of the dried kratom substance like some Americans are doing, and the fresh leaf? Is it like the difference between chewing coca leaves and extracted cocaine?

I’ll be careful here. Based on the medical evidence that I have reviewed, I was not able to find a single case of deadly overdose of kratom use in Thailand. And again, they’ve been using kratom for centuries here, and there is not a single medically documented case of a deadly overdose. There were some anecdotal reports of psychosis. That’s an overdose that leads to some kind of psychosis, a mental breakdown, but again with some very, very mild symptoms, like disorientation, mild confusion, stomach pains, vomiting – nothing that was worse than an indigestion, essentially. 

I don’t want to say that consuming large quantities of kratom is innocuous. I think that over consumption of any substance carries risk. People can die if they drink too much water. Water is a pretty benign substance that we absolutely need to survive. It’s a matter of being careful. I met some heavy kratom users when I was doing my research in 2011. Some were using like 80 to 120 leaves a day, and they had been using for decades, and they were fine. I don’t want to say that that’s going to be the case for everyone. I think that moderation for any substance that we consume is a lot healthier, carries less risk. But again, I haven’t seen any evidence that consumption in large quantities would result in any significant health risk.

Do you have any successful strategies or tips from your experience for somebody who wants to be a harm reduction, drug policy, or kratom advocate?

Well, several things there. I think, first of all, it’s always good if you’re doing advocacy on behalf of an interest group, to get down to the grassroots level and work with the users. I can’t stress that enough – the importance of that is critical for successful advocacy to be actually representative, to have that participatory strategy, to engage with kratom users or drug users to achieve policy goals is absolutely critical. It’s sometimes challenging but it is absolutely worth bringing the users on board from the very beginning in the design of the strategy and the implementation of the strategy and the monitoring and evaluation of that strategy as well. I think that’s very, very important. 

I also think there’s essentially two strategies that are in my opinion very complementary. So there’s a lot of activists and there’s advocates. So activists might be a bit louder and confrontational and kick doors in and be up in people’s faces and be very challenging, and they are needed. People who are activists are absolutely needed to open those doors and initiate and put the issue on the agenda, if it’s not already on the agenda. Once the issue is on the agenda, another group, the advocates, need to come in and work with the activists but perhaps change the focus and change the lead, and where the advocates negotiate compromise, find common ground with decision-makers to come to a consensus and move things forward. Usually a consensus means that everybody who leaves the room is not happy. Nobody got exactly what they wanted, but we have progressed. We moved forward and we’ve made progress for everyone. So I think that’s an important strategy: to decide if you’re going to be an activist or you’re going to be an advocate, and to work across those streams without competing or being frustrated that there are activists if you’re an advocate, or frustrated at the advocates if you’re an activist. I think both need to work in tandem in joint strategies to be most effective. 

One last thing, follow the money. The money is usually where people will find a lot of evidence. It’s a compelling strategy to change people’s minds if you have financial evidence documented, data about where the money goes, how much is being spent. That’s sometimes a lot more compelling than an emotional argument, or an argument based on your desires, your interests. Financial interests usually trump, unfortunately, everything else, so following the money trail is very important. 

So we’ve talked a lot about Thailand and the US, but both countries operate under these international treaties called the drug conventions. The international drug conventions – there are three of them that regulate, essentially, drug markets. So medicines to illicit drugs are regulated under these three treaties. These treaties are essentially managed by the United Nations Office on Drugs and Crime, and there’s been growing interest in kratom because there’s been emergence on in the drug policy sphere about these “new psychoactive substances”, and new doesn’t necessarily mean that they’re new, because they were just produced or they were just found. It means new in terms of their preeminence on the market. So kratom has been included in these new psychoactive substances and the United Nations Office on Drugs and Crime has been able to kind of maneuver kratom into that group by essentially largely exaggerating the risks relating to the use of kratom. It’s a network called Early Warning Advisory System for New Psychoactive Substances that was set up specifically to track emerging new psychoactive substances that could potentially cause a threat. They made specific recommendations on kratom now in their reports. It included a graph that showed that 46 of reported fatalities were related to kratom, which is huge, even more than synthetic opioids, which was 17. So that graph showed kratom is significantly dangerous. However, there was a little asterisk somewhere and the text explained that there was 47 cases all reported from the US and Thailand, where there’s millions of kratom users in both of these countries. So 46 is not 46% of the people who are using kratom. On top of that, there was a note that said that the identification of kratom did not necessarily mean that it was causal to the death of the person that was reported. They also clarified that there were no cases in which kratom was deemed to have caused or have significantly contributed to death. So again UNODC has positioned visually a graph in their early warning reports to say, like ooh be scared, be scared, and essentially there’s nothing. They created this false threat.

Again, I’m sorry to repeat this, but if you follow the money, UNODC has been struggling to find funding for itself, so the creation of a new threat allows them to mobilize resources from governments and to convince them, look, there’s this threat here, kratom, give us money so that we can fight this threat, which is a non-starter because it’s not a threat. So again, it’s very important to understand the global context when we work on kratom in a specific legislation or a specific jurisdiction, whether it be a state level, or a country level. It’s really important to understand what’s going on internationally because this helps frame the discourse and the  ideas and the arguments that we want to bring about when we do our advocacy work to try and convince governments. If we show that this is not a threat, that there is no evidence, that there aren’t fatalities or dangers relating to kratom, then that becomes essentially moot.

Now kratom is scheduled to go through this Expert Committee on Drug Dependence for review. I believe this year and they are essentially supposedly a panel of medical professionals who will look at the evidence and could make a set of recommendations. Essentially there’s four, let’s say large potential outcomes. So the expert committee might decide not to proceed with a critical review, that would be because there’s insufficient evidence of any harm, and then it wouldn’t get scheduled in the international conventions as a dangerous drug for international control where member states of the UN are mandated to put in laws to criminalize that substance. They could also decide to undertake a critical review that might lead to scheduling, or not, and then it depends on which convention it might end up being scheduled. So if it ends up being in one of the 1961 convention, then that would mean that all countries would have to criminalize the plant and the alkaloids. If it was in the 1971 convention, then there could be exemptions for fresh leaves but a ban on the alkaloids, so that would be a bit tricky. At the end of the day, there is potential for them to say that it needs to be regulated under international control through the conventions and force all countries to decide to criminalize the plant and the alkaloids. So there’s still a lot of options, and advocates who are involved in negotiating and advocating for kratom decriminalization and regulation should be very mindful of the decision of this expert committee that will come out in the next few months, I believe. I think this is an important step in the battle or the engagement on kratom that we are seeing globally. I think this decision has a big chance of influencing even national or sub-national level advocacy work for regulation and decriminalization of kratom.

Do you think they’re likely to go back on it like once these things are placed on that list? Do they usually go ahead and recommend scheduling all the time, or do they sometimes leave these things out? There are seven substances this time that they’re considering  recommending for scheduling.

I think one once things get into the conventions, they’re very, very, very hard to remove. These conventions aren’t reviewed very often and the committee that is involved in overseeing work on the conventions is very conservative. It’s gotten better over time, but I believe that they’re very conservative, I think. That committee is part of the United Nations Office on Drugs and Crime and their infrastructure, the expert committee, is part of the World Health Organization. The World Health Organization and UNODC are two separate organizations, although they are both part of the United Nations system. The World Health Organization has a mandate to review, especially, medical health issues. If they determine that it is up for scheduling, then it gets into the conventions, which are managed by UNODC. 

Most of the United Nations agencies have a humanitarian assistance mandate. They’re there to help. UNAIDS is there to prevent and support HIV, and UN Women is there to promote equality for women. UNICEF is there to protect children, etc. ILO, the international labor organizations that promote workers rights. The United Nations Office on Drugs and Crime is very unique in the UN family because their mandate is not humanitarian assistance. Their mandate is law enforcement. Their members, their people that they talk to are cops, they’re ministries of justice, they’re police, they’re investigators. They’re not there to help drug users, they’re not there to stop the spread of HIV. They’re there to empower and enforce cryptocurrency anti-terrorism, drug control, etc. They’re there for cops, for legal purposes, to reinforce and improve criminal justice systems, essentially. So it would be to their advantage if kratom ends up in the conventions because it gives them broader power, and, that is, they can mobilize more resources to ensure the survival of their organization. Essentially, in my opinion ,there’s kind of a conflict of interest there. Fortunately, they’re not on the expert committee that will decide whether kratom goes in the conventions or not, but if it does, then it’s essentially squarely in their hands, and that’s why the committee that oversees the conventions is very conservative, because it’s part of the UNODC infrastructure, and therefore they don’t have much interest in saying no, this drug is no longer a threat. Well we can decriminalize that, it’s fine. Well, many countries have decriminalized cannabis. Cannabis is still in the conventions, because again the committee that oversees the conventions doesn’t have interest in descheduling cannabis. It will reduce their power, so it’s not a good idea for them to do that. It doesn’t make sense. 

If [kratom] does end up [scheduled] it would give UNODC a lot more power than they already have because of this early warning system on new psychoactive substances. The fact that they’ve included kratom in there, they’ve essentially manufactured the threat where there is none. I’m using Noam Chomsky’s language about “Manufacturing Consent”, but here they’ve manufactured a threat. There’s an organization called the Transnational Institute that’s based in the Netherlands that have essentially published a paper just recently about a month ago called “Kratom: the creation of a threat” which is exactly about this how UNDOC has manufactured this threat around kratom, when there is none. So it’s an important document and that points out this process of approval by the expert committee.

In terms of media sensationalism, we who listen in the United States understand, especially about kratom, that television evening news media coverage of drugs is just not a place to go for accurate information. It’s more like drug horror fiction, I call it. Does that also go on in Thailand and does it happen with kratom, or does the public not buy it since it’s such a traditional plant there?

Yes, it certainly does happen in Thailand, unfortunately. It happens especially around this sii khoon roi, the decoction, the boiled kratom leaves mixed in with the cough syrup. There’s been a whole lot of demonization around that, and again that big link with the media to insurgency. So if people do buy that, because the majority of Thai citizens are Buddhist, and there’s a small minority of Muslims, and people are aware of the world that we live in, and there’s been significant demonization of Muslims all over the world, so that kind of reinforces the fear around Muslim people that they are also using these drugs and that that all gets kind of mashed together in these stereotypes of dangerous Muslim insurgents who are high on drugs. It just accentuates people’s fears. 

I remember a couple of years ago there was a wave of unexplained deaths in northern Thailand in Chiang Mai. Several tourists died with certain mysterious circumstances in hotel rooms mostly in northern Thailand, some in the south as well, on the party islands. At that point when it was still unexplained there were investigations that were going on especially from the countries from where these citizens were from, including from Canada. There were two young girls from Canada that died. I was actually contacted by the National Coroner of Canada to discuss what had potentially happened, because the Thai government had attributed these strange deaths to consumption of kratom. That kind of made waves in local media as well. They were saying that it’s not murders, it’s not anything we did, these crazy tourists they come here they take drugs and then they die mysteriously in their hotel rooms, and obviously that was not the case in the end. It was something else. It was insecticides and pesticides that had been oversprayed in some of these hotels that are frequently used by tourists, and the tourists just suffocated and died. But the Thai government went forward and said publicly and even to authorities of the National Corner of Canada, there were some Australians that died as well, and they blamed the individuals and said that they had been using kratom and that’s why they died, which again doesn’t really gel with the evidence, because again there’s been not a single case, at least in Thailand, but to my knowledge there has not been a single case of medically forensically documented kratom leading to a death here, so it would have been pretty surprising that suddenly there’s a wave of, in one year, 13 foreigners from six different countries who die because they they had too much kratom. That didn’t make sense, but it certainly played out like that in the media. I don’t think they ever issued a correction to say, well actually it wasn’t kratom, it was pesticides. So people are left with the idea that these 13 foreigners mysteriously died because they took too much. 

With the media here, it’s more profitable to just scare people rather than do good journalism. Does that go on there? I know that in Thailand there are some speech restrictions, but is there a threat to journalists if they speak against the official narrative on kratom or anything else there?

I don’t think so. I mean, there’s certainly some limitations and some laws that prevent journalists from saying some things, but it’s generally mostly related to the monarchy, and there’s less major state laws that prevent any kind of disparaging of the monarchy, of the king. There’s some pretty open journalists, but unfortunately there’s also more sensationalist journalists out there and as you said, it pays well to scare people, and a scared population is easier to control and to manipulate. I think there’s just generally an interest in selling these kinds of bad news, then saying that kratom is inoffensive and can actually be a boon for a lot of people who are sick, that’s less newsworthy than saying, this tourist has died because they ate too much leaves. There’s more and more openness about discussions on reforming drug policies in Thailand, especially, as I mentioned earlier, with this push for decarceration and reducing the prison population here. So there’s been a lot of efforts to try and find solutions to that. That has included discussions around policy reform. 

In 2016 there was this minister of justice who was very, very bold who suggested decriminalizing/ legalizing kratom, cannabis, even methamphetamines. He was tired of seeing the prison so filled with methamphetamine users and [he suggested] we’ll decriminalize it. Shortly thereafter he was moved out of his position, so that didn’t last long, but it was the first high-level Thai official who went on record and said the war on drugs has failed. We have done a crappy job in Thailand. We need to find alternative solutions. We need to rethink the paradigm about how we manage drug-related issues in our country and let’s consider all options including decriminalization and legalization of some of these substances.

Subsequently, I was hired as a consultant to work for the NGO owned by one of the princesses of Thailand to evaluate the decriminalization models in five European countries, kind of unpack the decriminalization models and see what components could apply to Thailand without upsetting the balance, let’s say. The report is online, I can send you a link if you’re interested. Unfortunately, it was never really used by authorities because this report was meant to go to this very forward-thinking Minister of Justice named General Paiboon Koomchaya. Unfortunately, like I said, he was moved to another office and the project kind of fell apart. The report was produced. I managed to get it out there, but it was never used for consideration of policy decisions here in Thailand. But again, at least it means that there is some openness. There’s been more and more discussions on kratom, cannabis, and other drugs and looking for alternatives. It’s going to be a very slow process, but I do think that in the next 10-15 years we will see some changes in Thailand’s drug policies. 

Thailand is a central country in ASEAN, in Southeast Asia, in the Association of Southeast Asian Nations. I do think that if they make decisions to decriminalize, to change their model, to change their paradigm, to introduce harm reduction, they stand to gain significantly in terms of showing leadership and being emulated by other countries. Unfortunately, Thailand has been emulated by other countries in terms of their drug policy. The Filipino government, the Duterte government has been implementing a bloody war on drugs that has led to tens of thousands of people being extrajudicially executed by police forces and the Duterte war on drugs is a copy-paste identical model to the strategy that was used in 2003 by Thaksin Shinawatra when there was this bloody war on drugs here that I mentioned at the beginning of our interview. So unfortunately, governments don’t necessarily just pick up the good things, they also pick up some of the bad things. But again, I think that Thailand is moving away from these punitive approaches. It will take time before drug policies are reformed and aligned with evidence and in line with good practices like the harm reduction models that are happening in some of the European countries like the Netherlands, Germany, Czech Republic, Switzerland, etc. I think we’re still decades away from that but there is openness and possibilities that weren’t there ten years ago, even 20 years ago when I started working on drug related issues. Here we’ve made some progress. There’s been several steps back, but we’ve made some progress moving forward. So for that I have to say that the Thai government has learned some lessons, but it’s it’s a very slow learning curve 

What about Malaysia? It seems like they made some moves. I’m looking at an article from 2019 about Penang farmers wanting to cash in on the kratom crop. I had Darshan Singh on the podcast. At his University of Science Malaysia they’re doing a lot of really good kratom research, and I know they’d love to see the research open up. Do you think Malaysia is going to follow suit?

It’s certainly a possibility. I think it will take time as well. Again there’s significant conservative elements that are against decriminalization of any kind of substance here, so in Malaysia they’ve got a similar structure as in Thailand where the anti-narcotics police the AADK [Malaysia’s drug law enforcement agency] and the national police are not really interested in and are very much against decriminalization. But there’s growing interest from academics, civil society organizations, and even medical professionals, also agricultural groups to look at the potential for  financial benefits or medical benefits that that would bring. So again, certainly if Thailand paves the way and does well with their decriminalization, and I think a lot of people in this region are keeping their eyes on Thailand, waiting to see the results, if crime increases or if there’s any problems in the country, which I don’t believe there will, but people will wait some time before making their own decisions, so there is certainly a possibility, though I wouldn’t be holding my breath, because it will take potentially a few years before there’s any kind of real movement to decriminalize.

I know also that just last year or the year before in Indonesia, there was a proposal to, I think the Senate to criminalize once again the entire supply chain of kratom production that would have compromised access for the US that was voted down. But there’s always this push and pull in Southeast Asia around drugs which is a central issue for virtually all parties that go for elections that vie from power, so in that sense, we get more liberal government, there might be some changes, and then a couple of years later there’s a conservative government. We’ll see that being undone and the changes reversed. I  think that we also have to expect that it’s not going to be a clean trajectory towards decriminalization or legalization, whether it be cannabis or kratom or other substances. There’s going to be some move forward, some steps back. It’s going to be more like a see-saw where we move up and down across the timeline and certainly, again, there’s growing interest in the region to explore rescheduling of kratom, and also I believe that governments will have an easier time making decisions once the WHO expert committee makes its ruling on the dangerousness, or the risks, the harms related to kratom.

I guess that’s going to be a make or break kind of decision.

It’s going to be a landmark thing, that’s for sure. It’s going to have far reaching impact on producer countries and on consumer countries, so again, that’s why I was saying earlier this decision is going to be a critical aspect for any kind of advocacy work relating to kratom. It’s going to be a critical landmark event for good or for bad.

You said going back to 1650 you found the use of kratom. Does that come from writings? And has it ever been used in religious ceremonies? I’ve seen some reports, but I don’t know how accurate that is.

I don’t think it’s been used in religious ceremonies. It’s been used for traditional purposes. Certainly I’ve seen several reports that specifically say that, in general, that has been “used for centuries” blah blah blah so that’s pretty vague. I was reading this scientific paper earlier today and there was a specific reference to 1650. I could send you the title. I was able to download. It’s a public document. It says specifically kratom was referred to as a medicinal herb in Thai pharmacopeias dating from the 1650s, as was indicated for the treatment of stomach aches, severe diarrhea, and opium withdrawal. The reference here is the Office of the Thai Traditional Medicine Wisdom Protection. The paper is by a research group based in Thailand that is also pushing for decriminalization, so TNI has referred to some of their reports and this study I was reading was specifically looking at attitudes towards decriminalization of kratom and the community control model that I was talking about, that pilot that was implemented to see if the community could regulate home use and cultivation in their space. So, it’s an interesting paper. 

In some of the scientific studies they’ve said that Thai kratom contains maybe like 66% of mitragynine in alkaloids, and Malaysian kratom only contains 12% mitragynine, and then they could barely find traces in the Philippines. Do you know anything about whether Thai kratom is stronger or contains a different alkaloid profile?

No, I’m not sure about that. Obviously, I will say that when I was doing my research down south that the kratom users were able to distinguish five different strains or subspecies of kratom. So there was the maeng da, there was another one where the central stem on the leaf was kind of reddish, one was green … so they were able to distinguish and they had some anecdotal reports about this one is stronger than that one, this one has more analgesic property, this one has more stimulant properties. At the time when I was doing that research, I think the the access to kratom in Thailand was so limited, that the pharmacological studies around it was rather limited, and my area of expertise is, although I’m interested in the pharmacology, it’s not my primary area of expertise, so I wouldn’t be able to comment with certainty about the the content of one leaf over another. I do know that there is likely to be variation in the mitragynine content, all the alkaloid content from country to country, and region to region. That just has to do with weather patterns and the quality of the soil, etc. So of course there will be variation how that impacts the effect and how that impacts the alkaloid profile of each leaf. I can’t comment for certain 

I will send you a link to that report that I did for the for the royal family. It’s a long paper, 250 pages long, it’s a book essentially. But the section on Thailand specifically contains a history of the drug control system in Thailand from the 40s or the 30s all the way up to 2020 or or 2018. So it talks about kratom, cannabis, heroin, methamphetamines, etc. It gives you a historical overview of the development of the system and what’s in place and what changes have happened over time and what made those changes possible. So perhaps some of your readers who are more interested in the policy context in Thailand might find that interesting.

###