You’re right—I’m absolutely not suggesting people go out and take it willy-nilly. I’m saying we have anecdotal evidence that it could be effective in a clinical setting, because people (including myself)
are currently going out and taking it willy-nilly. Personally I would like it to remain available OTC but I’d be fine if it ended up scheduled for prescription only.
It’s my understanding that there are no records of deaths that were clearly caused by kratom alone—but there are a few dozen cases that the FDA has published where someone has died with kratom in their system, usually alongside other drugs such as opiates, alcohol, benzos, or steroids—but also (and here’s where I call “junk science”) from a fall and a gunshot wound. We currently don’t know to what extent it interacts with other drugs—it’s a bad idea to take it with anything else that affects your breathing, or an MAOI.
As for the “won’t kill you” claim: β-arrestin2 recruitment is responsible for the main deleterious side effects of traditional opiates, including respiratory depression, constipation, and tolerance buildup. These are reduced but not eliminated when taking kratom, similar to how morphine behaves in knockout mice lacking this protein. It could still certainly kill you, although the best estimate we have right now is “you’d have to take an awful lot of it”—probably via extracts, unless you want to eat a few pounds of leaves.
Mitragynine and 7-OH-mitra are metabolised by the liver, and yes, there are some reports of liver toxicity. I have heard of seizures in cases where someone was already detoxing and susceptible. I had not heard of kratom-induced psychosis—do you have a citation handy?