As the opioid epidemic continues to ravage the United States, patients and physicians are looking for less-addictive alternatives for pain control.
For a growing number of U.S. patients, top among the contenders is kratom, a plant-based product that shows a dose-dependent opioidlike effect. For physicians, toxicologists – and federal regulators, however – the absence of evidence-based studies on the herb’s effectiveness and safety is raising concerns.
“There is very little toxicity data regarding kratom – although there have been deaths in the United States, including Florida, attributable to its ingestion,” said , chief and professor at the University of Florida in Gainesville. “As far as I know, there have been no clinical trials evaluating the efficacy of kratom to treat pain and mood disorders. All that is known is based on self-report.”
, an addiction psychiatrist who has treated kratom users, said an inherent challenge is countering patients’ perceptions about the substance.
“Somehow, in the popular culture, kratom has a reputation as being a mild opioid. And we’re not sure about that,” said Dr. Levounis, a member of the American Academy of Addiction Psychiatry. “But the fact that people think it’s more natural and therefore it must be safer is very problematic.”
The uncertainty around kratom raises the stakes when it comes to treating patients. “From a medical perspective, one of the trickiest issues is we’re not sure that naloxone reverses the opioid effects,” said Dr. Levounis, also chair of psychiatry at Robert Wood Johnson Medical School, New Brunswick. “We do use naloxone, but it is not clear that it works as an antidote. This is probably the most problematic area about kratom.”
A member of the coffee family, kratom (Mitragyna speciosa) grows in Thailand, Malaysia, Indonesia, and Papua New Guinea, and has been used throughout southeast Asia for many years to manage pain and bolster energy, according to the National Center for Complementary and Integrative Health.