Nonopioid Alternatives for Addiction Recovery Part II: Kratom
All right, friends, now for Part II of my discussion on opioid abuse disorders (OUDs). As this is the second part in a series, I recommend putting this post on hold while you read Part I, if you haven’t already.
Now, here’s a little statistical recap for you:
In 2017, 20.3 million American adults battled substance abuse disorders (SUDs)—a 600,000 person increase from the previous year.
In 2018, an estimated 2 million Americans had an opioid-specific dependence and a total of 47,600 Americans died from opioid overdoses.
In 2017, 91 Americans died each day from opioid overdoses.
In 2018, over 130 people died each day from opioid-related drug overdoses—a significant and unfortunate increase from the previous year.
There have been more than 300,000 opioid-related deaths in the United States in the past decade.
I said it in the last post and I’m going to say it again: What in the actual f*ck is happening in our society? Those are some scary facts, and each year the numbers seem to be rising as more and more people turn to substance use. Things need to change in order to quell the opioid epidemic. While there are undoubtedly larger underlying issues at hand (i.e. the state of mental health in the US), I can only cover one issue at a time, and that issue happens to be inextricably linked to our society’s dangerous ties to Big Pharma. I believe one step to right this wrong is to make available less harmful addiction treatment options—i.e. CBD and kratom. As I've said before, baby steps are still steps.
Big Pharma is a major negative factor in this discussion about kratom’s harm reduction potential. Now don’t get me wrong, pharmaceuticals are necessary in many cases. Prescription drugs like antibiotics, insulin, vaccines, and even some opioids in controlled environments, are necessary and have saved many lives—it's not my intention to discredit their benefits to contemporary societies. But the opioid prescription rate is entirely too high and addiction recovery programs still use opioids (methadone and buprenorphine) to treat OUDs—lots of eye rolling going on over here. These facts are outrageous. Clearly the excessive opioid prescription rate is a contributing factor to the current opioid epidemic, and you’d think recovery programs would be using more nonopioid medications for treating OUDs considering the proven dangerous side effects of using opioids, not to mention their highly addictive properties. But nope, methadone, a dangerous synthetic opioid, is still commonly used to treat OUDs and that’s a really big problem. Let me remind you of methadone’s potential adverse effects: difficulty breathing or shallow breathing; feeling lightheaded or faint; hives or a rash; swelling of the face, lips, tongue, or throat; chest pain; fast or pounding heartbeat; hallucinations or confusion. Seems like an effective “harm reduction” medication, eh? Well, as demonstrated in Part I, researchers indeed have given us one nonopioid harm reduction option: CBD—a plant with no adverse effects. Now let’s take a look at another potential nonopioid option.
In addition to methadone, buprenorphine is another opioid commonly used to treat opioid addiction. Both synthetic medications “work on the same opioid receptors as heroin and other opioids.” Well, I’ve got news for you—kratom, a botanical substance, also works on the same opioid receptors, but it’s a partial agonist at the mu-opioid receptors (the same receptors on which pharmaceutical opioids work) and acts with a much lower potency than prescription opioids. In other words, it’s not a full opioid agonist like heroin, methadone, buprenorphine, oxycodone, morphine, etc. Kratom is another nonopioid alternative (although many people mistakenly classify it as an opioid) that could potentially help opioid addiction recovery symptoms. In fact, I personally know people who have been successful in their addiction recovery because of kratom. So, what is kratom, you ask? According to the American Kratom Association (AKA): Mitragyna speciose, more commonly known as kratom, comes from “a tropical evergreen tree in the coffee family native to Southeast Asia whose leaves have been used for centuries as an herbal supplement in traditional medicines. Kratom is not a drug. Kratom is not an opiate. Kratom is not a synthetic substance. Naturally occurring Kratom is a safe herbal supplement that behaves as a partial mu-opioid receptor agonist … Kratom contains no opiates, but it does bind to the same receptor sites in the brain. Chocolate, coffee, exercise and even human breast milk hit these receptor sites in a similar fashion.”
Before we get to discussing the potential benefits of kratom, I need to bring to light the controversy surrounding the use of kratom as an herbal medicinal supplement. Chances are, if you do your own research, you’re going to find a lot of negative reports, so let’s clear some things up. There are tons of reports on the dangers of using kratom, especially here in the US as use of the plant has expanded from its native countries. According to a Drug and Alcohol Dependence review of kratom, written by Marc T. Swogger and Zach Walsh, US government and press sources have created a sort of drug hysteria around kratom use due to a lack of scientific data. The CDC claims that kratom may cause psychosis or death, but much of the reported apparent risks of kratom are biased, and again, the claim lacks scientific data. The fact of the matter is, kratom’s apparent risks are understudied and “Case studies present a relatively low level of evidence due to overrepresentation of extreme events, unknown validity and generalizability, and other potential biases” (134). Meaning, there may be some extreme events, and those are the ones being publicized, likely with misrepresented and biased data, which heightens the drug hysteria surrounding kratom’s potential as an alternative medication. Overrepresented extreme events detract from the benefits of the plant, benefits seen in Thailand and Malaysia for centuries. This is not to say cautions are unwarranted, because caution is always necessary when using any kind of substance, whether botanic or synthetic. It’s just to say that more scientific evidence is needed to determine if there are indeed severe risks associated with long-term use of kratom. But the government is essentially trying to prohibit that.
Swogger and Walsh state, “dangers of drug hysterias include the tendency toward the adoption of blunt and reactive strategies that risk inhibiting scientific study and thus deprive the public of useful medicine” (emphasis added, 135). And they’re exactly right. If Southeast Asian countries have reaped the benefits of the plant for centuries, then why wouldn’t the US government conduct more studies to determine its potential benefits instead of overrepresenting and skewing only a very few extreme events? Why indeed are they inhibiting scientific study? Some sites and articles claim kratom is a threat to public health, but if you check out the kratom subreddit, which was created in 2009 and has almost 85,000 members, you’ll see hundreds of thousands of testimonies praising kratom for its ability to help people abstain from drugs and alcohol. In fact, One World Herald (OWH) recently published two separate articles discussing the results of US surveys showing an increase in kratom use by NYC residents to curb habitual alcohol use and withdrawal symptoms from opioids and other drugs. While reddit and online news publications may not be scientific authorities, anecdotal evidence is important and should not be ignored. Scientific studies presenting empirical data are even more important than anecdotal evidence, though, and some have, in fact, been published over the last several years.
Swogger and Walsh’s review of kratom studies has brought to light “The need for evidence-based policy to manage the growing adoption of kratom in North America and Europe [which] makes this a critical time for evaluating risks and benefits” (135). Instead of the press publishing theoretical and biased information, likely as a clickbait tactic—insert another eye roll here—the plant needs to be seriously studied by researchers to determine its use as a potential nonopioid harm reduction tool, to develop evidence-based policy. Especially since “informal use [of kratom] as a supplement has increased in the U.S. over the past decade to an estimated 5 million users,” according to a 2019 study published in the Journal of Psychoactive Drugs (Smith et al.). The same study states, “there is no reliable information on the extent of its uptake by people with a history of SUD,” which is likely due to the fact that many people are wary of disclosing illicit opioid use to medical professionals (312). Again, take a look at that subreddit and keep in mind the longstanding use of kratom in Southeast Asia, specifically for battling symptoms of opioid withdrawal. Chances are, a very large percent of the reported 5 million kratom users have a history of SUD. Also, Smith et al. discuss the findings of a 2015 study which reported that the main reason for long-term kratom use is to abstain from using a variety of substances, meaning people are using kratom as a harm reduction tool to successfully stay away from more dangerous pharmaceutical and/or illicit opioids and other addictive substances. Smith et al. also highlight some very disturbing statistics about opioid prescribing rates: “In 2012, the annual opioid prescribing rate peaked at 81.3 per 100 persons, and although it has since declined, it remains high with a prescribing rate of 58.5 per 100 persons as of 2017” (emphasis added, 312). This is the exact freaking problem I’ve highlighted several times throughout these posts. I mean, come on. This is a major problem! Yeah, it’s great that the prescribing rate has dropped, and for all I know it may have dropped even more since 2017 (not likely considering the opioid substitutions used in treatment programs), but the damage has been done and the current standing of the opioid epidemic is testament to the dangers of Big Pharma. The government needs to wake up and start taking these potential nonopioid alternatives seriously—public health is more important than money. But, I won't even go there.
In response to an FDA claim that kratom has caused 44 deaths globally, Jane Babin, Ph.D. (molecular biology), Esq., conducted an independent analysis in 2018 for the AKA, which states:
"A review of the available FDA data reveals the overwhelming majority of the cited deaths fails to provide a cohesive or reasonable scientific basis to conclude any of the deaths was caused by kratom, nor does the information released conclusively support any conclusion that kratom was associated to the cited death other than coincidentally. Only one case report released by the FDA suggests that the only substance detected in the decedent’s blood was kratom, but that report provides no substantive detail other than the decedent’s age and ethnicity, and provides no data on any underlying health condition that may have caused the death."
Again, we see evidence of “exaggerated claims, discredited research, and distorted data that fails to meet the evidentiary standard for placing kratom as a Schedule I controlled substance.” Yup, that’s right. The Drug Enforcement Administration (DEA) has been trying to classify kratom as a Schedule I substance—the same classification as heroin—based on exaggerated claims and distorted data. And it seems these 44 alleged kratom-related deaths globally is their sole justification. Like, GLOBALLY. Not even restricted to one country or even one continent. And worse, out of those 44 deaths, only one decedent had only kratom in his/her system, so who knows what other drugs the other decedents had in their system. Or, who knows what underlying medical issues the decedents might have had. Talk about exaggerated claims causing drug hysteria, eh? Now, take a look at this adverse events chart:
“This analysis is drawn from the FDA Adverse Events Reporting System (FAERS: https://fis.fda.gov/sense/app/d10be6bb-494e-4cd2-82e4-0135608ddc13) Public Dashboard." American Kratom Association.
As previously stated, the 44 kratom-related deaths (“Mytragynine/herbal” per chart) have been regarded as exaggerated claims, but the above chart demonstrates the minuteness of the statistic in comparison to other pharmaceutical pain management therapies. The ibuprofen statistic is surprising and really puts things in perspective—for me, anyway. But I digress. According to the NIDA, “Drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017” (emphasis added). These deaths include that vile opioid substitution: methadone. To be clear, I’m not in any way trying to dismiss death from any drug overdose, because clearly any drug-related death—or untimely death by any means—is tragic. But if the alleged kratom-related deaths were indeed true, 44 deaths globally over a nine-year period is a significantly smaller statistic than the confirmed 17,029 deaths localized to just the US in one year. Can’t argue with the facts.
Despite the myriad negative reports surrounding kratom potential as an alternative medication, you can see there are indeed some substantial empirical data supporting its use in treating addiction. But many factors could further limit research on kratom’s potential for harm reduction, including the US government continuing down the path of a potential prohibition or the DEA continuing its pursuit of classifying kratom as a Schedule I drug. According to the DEA, “Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use,” a classification that makes it is much harder to get approval for research on substances in that schedule. If kratom is placed within Schedule I, research will be further inhibited—if not prohibited—thus depriving the public of potentially useful medicine, just as Swogger and Walsh stated. It would mean the government is ignoring all anecdotal and empirical evidence highlighting kratom's potential medical benefits. Also, Smith et al. sharply point out that “the high rates of non-prescribed buprenorphine use … indicates that some people using heroin or prescription opioids may procure harm-reduction medications illicitly and independently of formal medical channels. In other words, denied access to kratom, people with a history of illicit drug use may still procure prohibited drugs” (emphasis added, 316-7). So basically, prohibiting the sale and use of kratom in the US will likely drive people with a history of SUDs to procure dangerous, illicit drugs, whether illicit opioids or other substances. Tell me, which seems like a safer alternative? Illicit opioid use or kratom use? The latter of which has been a pretty successful option thus far, according to anecdotal evidence. Instead of government agencies continuing this unwarranted witch hunt, it seems more logical to encourage scientific studies and to potentially regulate the quality of kratom for safety purposes. This would provide people battling SUDs more nonopioid medication options for addiction recovery.
Smith et al. make another great point worth noting: “Since short-falls remain in the availability of scientifically-informed OUD interventions in the U.S. … decrease in accessible harm-reduction avenues for people with OUD is concerning” (317). Concerning indeed. This speaks to my early point about outdated treatment programming principles (see Part I: CBD). Kristen E. Smith, the article’s main author is a Ph.D. Fellow at the NIDA. You know, the same government agency I harshly criticized in Part I. Well, she also seems to be criticizing similar government agencies. Not necessarily the NIDA, and certainly not in the same way I am, but she and her colleagues are certainly drawing attention to the potential consequences that will result from government agencies (i.e. DEA, FDA, and CDC) ignoring scientific advancements and prohibiting the availability of nonopioid harm reduction medications, such as kratom. Though she and her colleagues do not mention CBD in their article, the same could be said for CBD as a potential harm reduction avenue. Their study could also help draw much needed attention to the potential dangers of using opioid substitutions in opioid addiction recovery programs.
So, I’ll leave you with this: do your research and don’t believe everything you read. If you’re looking for more authoritative sources, head to your local library and jump on their journal databases. Use keyword searches such as, ((kratom AND addiction)) or ((CBD AND addiction))—you’ll be pleasantly surprised by what you find. Also, the American Kratom Association is a great advocacy group and their website has plenty of resources for you to comb through. Check out the Netflix documentary A Leaf of Faith. Listen to some podcasts. Don’t jump on your local news outlet website because you’ll get a lot of biased and skewed reports. Don’t put blind faith in government agencies because, as I’ve demonstrated, their websites and policies advocate full agonist opioids as harm reduction tools for opioid addiction. I know, it sounds really freaking absurd when put like that, but it's the truth.
As always, GV Alternatives is here to help. We’re here to answer any questions you might have on this topic, and if we don’t have an answer for you, rest assured we will find the answer and it will be reliable. Promise.