A pair of salmonella cases linked to a Southeast Asian supplement are Alaska’s first amid a nationwide outbreak of similar infections, state health officials said Tuesday.

The Alaska Department of Health and Social Services released an Alaska overview of illnesses stemming from the use of kratom, which grows naturally in countries including Indonesia, Malaysia, Papua New Guinea and Thailand. Leaves from the plant, which has psychotropic effects and us used as a stimulant and opioid substitute, can be chewed, smoked, or used in capsules and teas.

Salmonella, a disease typically associated with eating uncooked eggs, typically has effects including abdominal cramps, diarrhea and fever. According to DHSS, roughly 1.2 million cases of salmonella and 450 deaths resulting from them occur nationwide each year.

The federal Food and Drug Administration closed a year-long investigation of contaminated kratom products in June, which led to a Las Vegas-based pharmaceutical firm voluntarily recalling more than two dozen items. Although that outbreak left nearly 200 people sick in a total of 41 states, DHSS officials say kratom is federally unregulated because its packaging “does not claim that the products are edible or therapeutic.” Six other states have banned the use of kratom.

“Neither the Municipality of Anchorage Food Safety and Sanitation Program nor the Alaska Department of Environmental Conservation (DEC) have regulatory authority over kratom or the retailers that sell it (e.g., smoke shops),” state officials wrote. “The U.S. Drug Enforcement Administration and FDA are assessing the abuse potential of kratom to determine if it should be placed on the federal controlled substance list.”

Both of the Alaskan salmonella patients, who were sickened in March and April, were hospitalized but made full recoveries. The first patient, a man, had used powdered kratom he had bought online, while the woman in the second case acquired her dose of kratom in Alaska.

“She bought kratom powder reportedly in unmarked plastic containers at a local store in Anchorage, and regularly consumed smoothies that contained the powder,” state officials wrote. “Neither source of the kratom had labelling information on the source of the product.”

Dr. Jay Butler, the state’s chief medical officer, said Tuesday that although kratom has numerous potential uses, the lack of official testing means few of those have been borne out. He likened the drug’s emergence in disease reports to that of synthetic marijuana, which made major headlines in Alaska in 2015 – and more recently due to mass overdoses that sickened nearly 100 people in New Haven, Conn.

“One of the concerns that are raised around kratom are that there’s a lot of claims that are made, including that it can be used to treat opioid withdrawal or it can be used to maintain recovery,” Butler said. “We really don’t have information on that, and that’s one of the challenges with it being completely unregulated.”

Another delay in the investigation, Butler said, was that several strains of salmonella were discovered as a result of the national investigation.

“We just don’t know what’s in the capsule,” Butler said. “The discovery of multiple strains of salmonella within one product definitely raises concerns about the supply chain.”

Kratom is one avenue of potential salmonella infection monitored by the state, according to Butler, ranging from raw turkey to Honey Smacks cereal.

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