12 Feb Johns Hopkins: Kratom Shows Therapeutic Potential & Reduced Harm Over Opioids

Kratom, a herbal supplement that is often sold online and in smoke shops across the US, is being reported by Johns Hopkins Medicine researchers to have a lower rate of harm than prescription opioids for treating pain, anxiety, depression, and addiction. In a report published in the Drug and Alcohol Dependence journal, the researchers stated that self-reported surveys may not always be reliable but kratom’s potential benefits could make it a possible alternative to opioid use.

The American Kratom Association (AKA) estimates that between 10 to 16 million people in the US regularly use kratom. The tropical plant, grown mainly in Southeast Asia, contains the chemical mitragynine, which acts on brain opiate receptors and affects mood. In Asia, people use it in small doses as an energy and mood booster and in larger doses for pain or recreationally.

However, kratom products are unregulated and non-standardized, and reports have linked its use to hallucinations, seizures, and liver damage when combined with alcohol or other drugs. The US Drug Enforcement Agency (DEA) proposed banning kratom sales and use in 2016, and the FDA has advised categorizing it as a Schedule I drug, meaning it has no proven medical application and a high risk of abuse.

In the current survey, 2,798 people completed an online survey about their use of kratom, and 91% reported using it to alleviate pain, 67% for anxiety, and 65% for depression. Of those who used it for opioid withdrawal, 35% reported going over a year without taking prescription opioids or heroin.

According to the Substance Use Disorder Symptom checklist, fewer than 3% of responses met the criteria for moderate or severe substance use disorder for abusing kratom, and about 13% met some criteria for kratom-related substance use disorder, which is comparable to about 8-12% of people prescribed opioid medications who became dependent.

Kratom-related deaths have been reported to be fewer than 100 and most of these involved mixing with other drugs or in combination with preexisting health conditions, according to the National Institute for Drug Abuse. In comparison, opioid overdoses resulted in more than 47,000 deaths in the US in 2017. A third of survey participants reported mild unpleasant side effects such as constipation, upset stomach, or lethargy, which mostly resolved within a day.

In conclusion, while more studies need to be done to formally establish the safety and benefits of kratom, the findings suggest that kratom should not be categorized as a Schedule I drug because of its relatively low rate of abuse potential and medical applications to explore, including as a possible treatment for pain and opioid use disorder.