By Pat Anson, PNN Editor
The herbal supplement kratom is an effective treatment for pain, helps users reduce their use of opioids and has a low risk of adverse effects, according to a new study by researchers at Johns Hopkins University School of Medicine.
The study is based on an online survey of nearly 2,800 kratom users and was funded by the National Institute on Drug Abuse (NIDA). The findings are notable, because they debunk many of the claims made by other federal agencies that kratom has a high potential for abuse and should be banned because of its opioid-like qualities. Kratom is currently illegal in six states, and several cities and counties have enacted local ordinances banning sales.
Banning kratom would be a mistake, according to the researchers, who say kratom actually helps reduce opioid abuse. About 40% of those who participated in the survey said they took kratom to treat opioid withdrawal. Of those, 35% reported going more than a year without taking prescription opioids or heroin.
“There is a high likelihood that banning kratom or its constituents would compel individuals who are presently using kratom for pain relief or opioid use reduction to return to using prescription or illicit opioids with a known risk of dependence and possible lethal overdose,” Garcia-Romeu and his colleagues reported in the journal Drug and Alcohol Dependence.
Over 91% of those surveyed said they would endorse kratom for pain relief, and about two-thirds would recommend it as a treatment for anxiety and depression.
Kratom ‘Relatively Safe’
Survey participants also completed a checklist to assess whether they had a substance use disorder. Only 2% met the criteria for moderate or severe abuse of kratom, while about 13% met some criteria for a kratom use disorder. That is comparable to about 8% to 12% of people prescribed opioid medication who became dependent, according to NIDA.
“Both prescription and illicit opioids carry the risk of lethal overdose as evidenced by the more than 47,000 opioid overdose deaths in the U.S. in 2017,” says Garcia-Romeu. “Notably there’s been fewer than 100 kratom-related deaths reported in a comparable period, and most of these involved mixing with other drugs or in combination with preexisting health conditions.”
About a third of the survey participants reported having mild unpleasant side effects from kratom, such as constipation, upset stomach or lethargy, which usually resolved within a day. About 10% reported having withdrawal symptoms once the kratom wore off, with less than 2% saying their withdrawal was severe enough to seek medical treatment.
“Although our findings show kratom to be relatively safe according to these self-reports, unregulated medicinal supplements raise concerns with respect to contamination or higher doses of the active chemicals, which could increase negative side effects and harmful responses,” said Garcia-Romeu. “This is why we advocate for the FDA to regulate kratom, which would require testing for impurities and maintaining safe levels of the active chemicals.”
The Johns Hopkins findings are similar to those from a 2016 PNN survey of over 6,000 kratom consumers, in which 98% said kratom was very effective or somewhat effective in treating their medical condition. Over two-thirds rejected the idea of having the FDA regulate kratom, fearing it would lead to higher prices or because it would require a prescription.
While there are inherent problems with online surveys of self-selected kratom users, there is a notable lack of clinical studies that definitively prove whether kratom is effective or harmful — forcing researchers and regulators to rely mostly on anecdotal evidence.
In 2016, the DEA tried unsuccessfully to list kratom as a Schedule I controlled substance, claiming it was an “imminent hazard to public safety.” The CDC has linked kratom to dozens of fatal overdoses -- although multiple substances were involved in nearly all of those deaths.
The FDA says kratom is addictive and not approved for any medical condition. The agency has also released studies showing salmonella bacteria and heavy metals contaminating a relatively small number of kratom products.
Garcia-Romeu cautions consumers not mix kratom with other drugs or medications, and to talk with their doctor before taking any supplement.
“Kratom doesn’t belong in the category of a Schedule I drug, because there seems to be relatively low rate of abuse potential, and there may be medical applications to explore, including as a possible treatment for pain and opioid use disorder,” he said.
