By Pat Anson, PNN Editor

Here’s a trick question for you. Which substance is more dangerous – kratom or nutmeg?

News reports about a recent study that analyzed calls to U.S. poison control centers leave little room for doubt:

“Life-threatening kratom exposures rose by 5000% in 6 years,” is how the Daily Mail reported it.

“Poison Control Centers See Spike in Calls About Kratom Exposure,” was the headline used by WOSU Public Media.

While the headlines are technically accurate, the study published in the journal Clinical Toxicology did not focus solely on kratom. The herbal supplement was one of many naturally occurring psychoactive substances that resulted in over 67,000 calls to U.S. poison control centers from 2000 to 2017.

Marijuana was involved in about half of those calls, followed by plants and mushrooms that act as stimulants or cause hallucinations. Kratom ranked 7th on the list, behind substances like peyote and nutmeg. Yes, nutmeg.

POISON CONTROL CALLS (2000-2017)

1. Marijuana (31,628)

2. Anticholinergic Plants (14,236)

3. Hallucinogenic Mushrooms (10,482)

4. Morning Glory Plants (3,643)

5. Nutmeg (1,962)

6. Peyote (1,717)

7. Kratom (1,631)

8. Kava Kava (1,331)

9. Salvia (622)

10. Absinthe (65)

11. Khat (52)

In most cases, the calls to poison centers involved minor symptoms like upset stomachs or dizziness, but some were serious enough to result in hospitalizations and even deaths. Researchers said marijuana is particularly concerning because it is being sold in candies, cookies and other edibles that a child could get their hands on.

“These substances have been associated with a variety of serious medical outcomes including seizures and coma in adults and children,” said co-author Henry Spiller, director of the Central Ohio Poison Center at Nationwide Children’s Hospital.  “As more states continue to legalize marijuana in various forms, parents and health care providers should treat it like any other medication: locked up, away, and out of sight of children.

Why Did Kratom Calls Spike?

There were only 1,631 calls involving kratom made to poison control centers over an 18-year period. But the numbers started to rise sharply in recent years as more Americans discovered kratom — from 13 kratom calls in 2011 to 682 calls in 2017 — that’s where the 5,000% spike comes from.

The American Kratom Association estimates several million Americans now use kratom to treat chronic pain, addiction, anxiety and other medical conditions.

Side effects from kratom are relatively rare. But researchers say a high percentage of the calls to poison control centers about kratom resulted in hospital admissions and serious medical problems. The chief complaint for many of the calls, according to another study, was that kratom caused agitation, tachycardia (rapid heartbeat), drowsiness, vomiting and confusion.

Kratom comes from the leaves of a tree that grows in southeast Asia, where it has been used for centuries as a natural stimulant and pain reliever. Critics say calls to U.S. poison control centers are misleading and a poor choice for research.

“The data drawn from the Poison Control Centers are notoriously unreliable, inasmuch as they are anecdotal reports from the public that are gathered and reported in an unscientific fashion,” said Max Karlin, a spokesman for the Kratom Information & Resource Center. “In the absence of good data, you just end up with a garbage-in, garbage-out situation.”

Kratom has been banned in a handful of states, but is widely available online and in smoke shops. Spiller and his colleagues say it should be regulated in all 50 states.

“The continued rise in kratom usage coupled with the serious medical outcomes identified in our study support the need for federal regulation of kratom along with further research on this public health problem,” they concluded. “While rates of exposure to most natural psychoactive substances decreased during the study period, rates for marijuana, nutmeg, and kratom increased significantly.”

The study offered no explanation for the significant increase in nutmeg calls. Nor did it suggest that nutmeg be regulated.

Nutmeg is a spice known for its pungent fragrance and sweet taste, but in large doses it can also have a psychoactive effect.

As far back as the Middle Ages, people used nutmeg as a medicine and to get high. There is even a page for nutmeg on Reddit, where drug users swap stories and try to figure out the best way to ingest it.

“Do I need to ground them up to a powder or can I just make little pieces and swallow them with water? Can I smoke nutmeg? Can I snort it?” asked a nutmeg newbie.  Most people who tried nutmeg said it made them sleepy, nauseated and wasn’t worth the effort.

While any call to a poison control center is concerning, the number of calls about kratom and nutmeg that came in over an 18-year period pales in comparison to the calls that come in every day about children ingesting hand sanitizers, laundry detergent packets and other toxic products.

Which brings us back to our original question. Is kratom or nutmeg more dangerous?  When used in moderation and with common sense, millions of people will tell you neither one is.