The wave of debates over the legalization, regulation, or prohibition of cannabis and kratom has subsided since President Petr Pavel signed the amendment to the Act on Dependency Producing Subtances but has not entirely disappeared. Moreover – what may not be a problem in Czechia could cause significant issues in Slovakia. Marek Lončík and Josef Düringer from the Czech-Slovak Kratom Association (ČSAK) discuss this and more.
The amendment will come into force in 2025. However, you were quite active even before its adoption...
M. Lončík: Yes. The Czech-Slovak Kratom Association strongly supported strict regulation and oversight of kratom vendors to ensure that all conditions set by the new psychoactive substances legislation would be fully adhered to even before it comes into force. For instance, we went beyond the current law and introduced mandatory kratom testing for microbiologicals and heavy metals. This proactive approach is crucial for protecting consumers, especially young people, who should not use perception-altering substances during their development. We place particular emphasis on ensuring consumer safety, including preventing dangerous combinations of kratom with medications or other substances (whether legal or illegal), as these can increase health risks. ČSAK is also committed to promoting awareness, harm reduction programs, and an open societal debate based on facts and expert discussion. Our goal is to create a safe and informed environment for everyone.
Is kratom sufficiently studied, and are there any significant risks associated with its use?
J. Düringer: Kratom is covered by dozens of publicly available studies and was extensively examined by the World Health Organization (WHO) in its 2021 report. The conclusion was clear: the WHO does not recommend globally banning the substance, as it does not pose significant risks to healthcare systems. On the contrary, the substance needs further research. Notably, there has not been a single known case of death solely due to kratom. It is technically impossible to consume such a large quantity that it would result in death. All fatal cases associated with kratom consumption were in combination with other substances, such as cocaine, heroin, methamphetamine, alcohol, and others. However, there is indeed a risk of addiction. According to publicly available data, dependence occurs after three to six months of regular excessive consumption. Experts describe the addiction as “stronger than coffee but weaker than cigarettes,” incomparable to heroin or other potent opioids, to which some people liken it.
People sometimes clump together kratom with products containing the cannabinoid HHC. Are they part of the same group, or are they unrelated?
M. Lončík: Kratom and HHC cannot be compared. The substances differ in origin, mechanism of action, and effects. Kratom is a purely natural substance that has been used in Southeast Asia for hundreds of years for various purposes. It is part of traditional herbal medicine there, used to treat various health problems, particularly pain. It is also used to boost energy and reduce fatigue (especially among manual laborers) or as a substitute in opioid addiction treatment. In Czechia, it is sold in powdered form, made from the ground leaves of the coffee-related plant Mitragyna speciosa. HHC, on the other hand, is a semi-synthetic cannabinoid, meaning it is created in a laboratory. Its effects are reportedly similar to THC, and although it was first synthesized in 1947, it only gained popularity in the past three years. Its research is still limited, so we cannot yet say with certainty what long-term risks its use entails. What we can say for sure is that after the ban on HHC, the Czech market was flooded with derivatives of the substance, which can be many times stronger, and studies on them are virtually nonexistent. There are dozens of these derivatives, and new ones are constantly being created.
When we first spoke before this interview, you mentioned I should be cautious if I were traveling to Slovakia with a bag of kratom in my pocket. Is the situation with our neighbors really that different?
M. Lončík: Absolutely! While kratom sales will be reasonably regulated in Czechia, in Slovakia, it was placed among the hardest drugs in Group 1 without any specialist input. This means the strictest possible penalties. This approach completely disregards the stance of the broader expert community. Someone who forgets kratom in their backpack and crosses the border risks criminal prosecution and many years in prison. It is absurd that, for instance, cocaine – a drug with incomparably greater risks – remains in Group 2 with milder penalties for possession.
However, you are a Czech-Slovak association. Are you trying to change this situation in Slovakia?
J. Düringer: So far, we have primarily focused on Czechia. However, as the act on psychoactive substances will soon come into effect, we will have room to open a discussion about kratom in Slovakia as well. Given that kratom is illegal in Slovakia, this task will be significantly more challenging. But we will not give up.
KRATOM VS. HHC
Tom Philipp, MD, Ph.D., MBA, Head of the Rheumatology and Rehabilitation Clinic, Third Faculty of Medicine, Charles University and Thomayer University Hospital, and Member of Parliament for KDU-ČSL
Frankly, as a doctor, I would not recommend using either of these substances, let alone regularly. However, I consider kratom to be significantly less dangerous socially, even though its dependency potential is undeniable. In small doses for adult users, its use may be acceptable, but unregulated use, particularly in combination with other substances, poses considerable risks. HHC (hexahydrocannabinol) is a synthetic cannabinoid with a strong potential to affect the psyche, increasing the risk of mental health issues, dangerous interactions with other substances, and strong dependency. It was rightly classified as a banned addictive substance because it is highly risky both socially and health-wise. However, prohibition alone is not enough. Education is key – within families and schools, particularly among the youth, who are especially vulnerable to these substances.
KRATOM VS. HHC
Assoc. Prof. Martin Kuchař, Ph.D., M.Sc., University of Chemistry and Technology, Prague
Kratom is a purely natural substance, the crushed leaves of the Mitragyna speciosa tree, traditionally used in Southeast Asia for its stimulant effects. Larger doses are used as an aid in pain management. Kratom contains around 40 alkaloids, most of which already have known pharmacological properties, and it is generally considered safe in small doses. Millions of people worldwide use kratom for various reasons, such as a mild stimulant, an antidepressant, or pain management. The latest WHO assessment states that kratom should not be classified as a banned addictive substance. Hexahydrocannabinol, or HHC, is a synthetically prepared substance, first synthesized in 1942 and rediscovered a few years ago. It has spread as a legal substitute for the natural substance THC. Although HHC occurs in small quantities in the cannabis plant, it is prepared purely synthetically. In recent years, new information about HHC's pharmacology and toxicology has placed it alongside THC as a relatively safe toxicological substance. However, risk assessments are still ongoing at the international level.
