Kratom research sorely needed for clinical, policy decisions

In response to advocacy groups and congressional leaders, the Drug Enforcement Administration (DEA) Wednesday halted its attempt to place kratom on the list of Schedule I drugs—substances such as heroin that have no currently accepted medical use and a high potential for abuse. The DEA in August announced it planned to schedule the plant and its products as an emergency decision.

Moving forward, there is now a public comment period that will last until Dec. 1, 2016. The agency is also expecting input from the Food and Drug Administration (FDA) on kratom.

According to András Váradi, postdoctoral research scientist at Columbia University, who has researched the plant’s pharmacology with grants from the National Institute on Drug Abuse (NIDA), there are alkaloids in kratom that when isolated have produced analgesic effects in mice. In the studies, withdrawal appeared to be milder, with less physical dependence among the mice compared to morphine.

“The alkaloids are very promising and could lead to future analgesics,” Váradi says.

He also says the analgesic effects in mice lasted six times longer than morphine and were three times more powerful. However, he cautions that such studies are limited in scope and don’t mean kratom will have the same effect on humans.

“More research on kratom is important because what we have now is a lot of anecdotal evidence that it works,” Váradi tells Behavioral Healthcare, Addiction Professional's sister publication. “And people say it works for all sorts of things such as pain and getting off opioids, but we don’t actually know that. There are no tests or clinical trials.”

Kratom use

Kratom is related to the coffee plant, and its active ingredients include mitragynine and a chemical that binds to some of the same receptors as opioid products. It’s often prepared as a beverage. Its euphoric effects and potential addictive properties are concerning to clinicians, especially considering most drug testing processes don’t screen for kratom.

According to a survey of 6,150 kratom users, supported by the American Kratom Association, individuals say they are using kratom for pain (51%); anxiety (14%); and treatment of opioid addiction (9%). Two-thirds believe that kratom does not create a “high.”

According to NPR, 15 people died of kratom overdoses in a two-year period, and 14 of them had other substances in their system as well. The plant and its products have been banned in several countries, and there are legislative proposals to ban it in Florida, New Jersey and a few other states.