Statement on the media campaign of the Czech Police on kratom

The Czech government decided last week that kratom will not be banned and that the functioning of the newly introduced very strict regulation and its impacts on public health and safety will be monitored. At the same time, the government is considering introducing an excise tax, which could generate funds for much-needed prevention in the area of ​​addiction policies in general. This sensible decision of the government, which we welcome, thus corresponds to the effort to base drug policy on data and real experience from practice, and it is good that Prime Minister Andrej Babiš has heard the call of experts in this regard. In this situation, it is therefore problematic that the Czech Police is simultaneously initiating an intensive media campaign that is one-sidedly focused incorrectly on the risks of death. This may create a distorted picture of the situation in the public sphere, given that nowhere in the world has it been confirmed that a crushed kratom leaf containing the substance mytragine alone causes a fatal overdose resulting in death, unless it is combined with other substances, most often other opioids, such as fentanyl, and of course alcohol.

Communication The police work with tragic cases of death and present them in a way that can lead to simplified and, in our opinion, probably not fully substantiated, or distorted conclusions. We do not want to underestimate the problems with addictive behavior, even in the case of kratom overuse, and therefore it is necessary to draw attention to the real risks of consumption. In some of the cases of deaths associated with kratom use that we have monitored, it was always a combination of multiple substances, not isolated use of kratom. If this context is not emphasized enough, the impression of a direct and unambiguous causal connection is created, which may not correspond to reality and creates a kind of political undue pressure on government decision-making. Such an approach is problematic from a public health perspective because it distracts attention from the real nature of the risks, which are often associated with combinations of substances, dosage or a specific form of the product, especially on the illegal market, and this is what regulation is trying to prevent.

A particularly ethically sensitive aspect of the entire campaign is the use of personal tragedies and testimonies of survivors, including highly emotional videos, if it is proven, as we rather assume, that these are not deaths related to this plant, but rather the combination of a number of substances that then create a given toxic mix leading to death. Although it is completely legitimate to draw attention to the risks, working with specific human destinies, where it may not be completely accurate information for survivors, thus shifts communication to a level that mobilizes emotions in an unethical way rather than supporting informed government decision-making. The public debate on the regulation of psychoactive substances should be based on data, context and a clear explanation of the risks, so as to avoid the exact opposite – damage to health and the creation of an even greater public health risk.

It is also important to place the issue in the broader context of addiction policy and addiction-related mortality. In the Czech Republic, we have long recorded significantly higher numbers of deaths related to single-time alcohol use resulting in death – i.e. single-time overdose with alcohol (approximately 500 people per year thousands of people per year) and drugs (also hundreds of people per year). At the same time, kratom also acts on the market as a substitute for a whole range of substances, as confirmed by experience from clinical practice, where it often appears, for example, as a substitute for alcohol. This does not reduce the risks associated with kratom, but it shows that focusing on only one substance without a broader perspective can lead to unbalanced public discussion and ineffective political decisions.

From the perspective of public health protection, it is crucial to understand the relative risks and focus on the areas where the greatest burden arises. At the same time, it is necessary to reflect on the possible impacts of restrictive approaches and choose measures that have already proven effective. If there were a complete ban, some users would probably already move to the illegal market, where quality control or product composition is not ensured. Such an environment significantly increases the risk of admixtures of unknown or highly dangerous substances and can lead to higher health damage. A regulated market allows the state to have control over the market and act effectively in the field of prevention and risk reduction. Another risk is the replacement of kratom with significantly stronger and much more dangerous substances, similar to this scenario that occurred with HHC, which our think tank has been warning about for several years.

Another important factor is the nature of the products available on the market. Serious health complications are often associated with concentrated extracts or alkaloid derivatives that are significantly stronger than the traditional form of kratom and do not comply with applicable regulations. This is where the attention of the regulatory authorities should be directed, because this is a segment of the grey economy with high risk and here there may indeed be a so far unexplored risk of overdose resulting in death. In this situation, we consider it essential that the Czech Police focus its capacities primarily on consistent enforcement of existing regulation, i.e. on the control of illegal products, compliance with sales rules and protection of minors.

Public communication by state institutions, including the police, should be accurate for us, set in the real context of such a serious health policy. Unilateral or emotionally-driven campaigns despite government decisions can undermine public trust and complicate rational policy setting and the trust of the state in its efforts to preventively inform the population about the risks.

Finally, we must reiterate that rational regulation and an effective approach to psychoactive substances are based on a combination of regulation, prevention and risk reduction, including market substitution with less risky substances and regulation. according to known risks. It is therefore crucial to systematically collect data, evaluate the impacts of the measures taken and adjust policy based on real findings. This process requires time, a stable environment and coordinated action by institutions, not conflicting signals to the public.