Bobby DiBernardo credits herbal supplement kratom six years ago with dropping heroin, oxycodone and alcohol.
"That saved my life," he said. "I could have died of an overdose of heroin every day and Kratom gave me a new lease. It helped to relieve the withdrawal pain.
DiBernardo, 41, of Rochester, New York, mixes a teaspoon of the herbal powder once or twice a day into a glass of water and drinks it, though he says it tastes terrible.
It is just one in a million Americans – potentially over 15 million, according to the estimates of the American Kratom Association (AKA) ̵
As the supplement becomes more popular in the US, safety concerns have prompted food and Drug Administration to alert consumers to the use of kratom and to combat companies that make fraudulent health claims.
"We have issued numerous warnings about the serious risks of using Kratom, including warnings about the contamination of high salmonella kratom products that endanger people using kratom products and cause numerous illnesses and recalls," said acting FDA Commissioner Dr. Ned Sharpless in a statement issued in June 2019, when the agency issued a warning letter to two companies selling Kratom. "Despite our warnings, companies continue to sell this dangerous product and make deceptive medical statements that are not supported by scientific evidence or reliable scientific evidence."
Six states – Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin – and The District of Columbia has even taken the step to ban the supplement.
This is a move Kratom defies, including Lois Gilpin, 58, of Louisville, Kentucky.
Gilpin has mixed kratom powder in her orange juice About two or three times a day for four years and says it relieves the chronic pain in her left leg and back so well that she can now get up and enjoy her family again. "It's definitely not a panacea," Gilpin said. "But it works well enough that I can pick up my granddaughters from school and bring them to the park."
She was so impressed by Kratom that she volunteered to co-ordinate the social media efforts of AKA, a consumer protection organization in Virginia, which was founded in 2014.
Is Kratom really all that matters? Or is more careful?
How is Kratom used in the US?
An online 2016 survey of more than 8,000 Kratom users, primarily contacted via the AKA, found that most of the product used to relieve pain or treat mood swings, such as depression and anxiety. Others used kratom to combat the withdrawal symptoms of prescription opioid or illicit drug use.
Kratom, according to a study by Oliver Grundmann, a clinician, was most often consumed as a powder in the form of a drink or a tablet Associate Professor of Medical Chemistry at the University of Florida, published in the journal Drug and Alcohol Dependence.
Is there solid evidence that kratom is beneficial?
"So far, there are no truly rigorous clinical studies to undertake studies, such as those we are conducting on drugs that are required by the FDA before a drug is approved for the market," said Grundmann.
This strict "gold standard" is not required before dietary supplements can be sold. Instead, "first and foremost, we have the beneficial usages that have been reported in a traditional East Asian environment, and polls and user stories in the US and Europe," he said.
In his survey the most commonly reported benefits of Kratom were less pain, more energy and a better mood. The majority of respondents said they had taken up to five grams up to three times a day.
"I would say that we have a good deal of good anecdotes proving that kratom has advantages for the average user as long as we consider how much kratom is used and what products are used" said Grundmann.
However, there may be encouraging anecdotal reports on benefits, with some experts calling for more research.
Is kratom safe?
That depends on who you ask – and opinions are very different.
The FDA strongly warns against kratom use. "The FDA fears that kratom, which affects the same opioid brain receptors as morphine, has properties that expose consumers to the risks of addiction, abuse and dependence," the study said.
"There are no FDA-approved uses for kratom, and the agency has received reports on the safety of kratom," the FDA said , "The FDA actively evaluates all available scientific information on this topic and continues to warn consumers against using products containing the botanicals kratom or its psychoactive compounds mitragynine and 7-hydroxymitragynin."
The Drug Enforcement Administration went so far as to temporarily list Kratom as a Controlled Substance on List 1 – a classification that means it has no accepted medical use and a high potential for abuse – and the decision only after a public outcry and one withdraw targeted petitions from advocates.
The FDA has also expressed concerns that Kratom products may be contaminated with heavy metals or salmonella and that marketers make misleading health claims.
In 2018, for example, the additive was linked to a multi-stage Salmonella outbreak. Request for recall by the FDA. (A specific source of this contamination has not been identified, but may have occurred during growth or the manufacturing process.) An analysis of 30 different kratom products in April 2019 revealed traces of heavy metals, including lead.
In Summer The FDA issued a warning letter to two companies for the sale of "unapproved, misidentified kratom-containing medicines with unproven claims about their ability to treat or cure opiate dependency and withdrawal symptoms".
It is this illusion that this is a plant will be fine.
Dr. Paul Earley, a specialist in addiction medicine in Atlanta and president of the American Society of Addiction Medicine, said he treated patients who depend on Kratom, including a patient who was recovering from opioid abuse, when he switched to Kratom he thought it was safe. This patient later had to be hospitalized for kratom addiction.
"It's this illusion that it's a plant, so it'll be okay, it's milder than heroin – and yes, that's true – but it's not a safe remedy," Earley told NBC News.
"Kratom is physically dependent, and people who are particularly dependent should stay away from it because it tickles the same part of the brain that opioids do," he added. Two reports this year linked Kratom use to various Side effects, even death.
A study in the journal Clinical Toxicology found that more than 1,800 calls with kratom were made in US poison information centers between 2011 and 2017. The most common complaints were restlessness / irritability and rapid heartbeat followed by nausea, somnolence, vomiting, confusion and hypertension. However, there were also reports of serious complications including seizures, respiratory problems, coma, and eleven deaths. Nine deaths included other drugs such as cocaine, fentanyl and alcohol, but two were attributed to Kratom only.
Another report from the Centers for Disease Control and Testing examined more than 27,000 drug overdoses in a multi-state database between July 2016 and December 2017, and found that 91 Americans died of overdose with kratom. Most cases involved the consumption of several medicines, including fentanyl, heroin and benzodiazepines. In seven cases, however, kratom was the only compound detected at the post mortem inspection. However, the researchers found that "the presence of additional substances can not be excluded".
Critics claim that this type of report is difficult to conclude, as other factors could play a role.  AKA claims that there were no deaths directly attributable to Kratom products that are genuine and not used in combination with other medicines. "Kratom has been safely used for centuries in Southeast Asia, where there are no deaths associated with the consumption of kratom," said Mac Haddow, AKA Senior Fellow for Public Order. "In the US, there are no deaths associated with pure kratom use."
What is Kratom about?
While some health professionals are in favor of a kratom ban, others say that regulation is a better way.
DR. Peter Grinspoon, a family doctor and trainer at Harvard Medical School, said the Kratom ban would leave many chronic pain sufferers without an option they could rely on if they wanted to avoid prescription opioids or not get them from their doctor.
Grinspoon recommends that patients avoid kratom due to lack of regulation.
"When you buy kratom, you do not know what you are getting," he said. "Do you really get one gram of kratom, or do you get a gram of what is in the capsules in the powder they call kratom? Growth, production, packaging, distribution, or sale of kratom are not monitored."
Follow NBC HEALTH on Twitter and Facebook.