Conference Coverage

For some SUD patients, kratom may be a self-treatment tool



– New research suggests that some patients with substance use disorder are turning to the herbal supplement kratom in an effort to reduce their use of heroin and prescription pain killers.

“Some, but not all, heroin users are utilizing kratom as an opioidlike drug with less risks, primarily as a drug substitute or to help abstain from IV heroin and prescription opiate use,” lead author Kirsten Elin Smith, a PhD student at the University of Louisville and an associate at the University of Kentucky’s Center on Drug and Alcohol Research, said in an interview. “Kratom appears as less risky due to the fact that it is not readily injectable.”

Kirsten Elin Smith of the University of Kentucky

Kirsten Elin Smith

Ms. Smith presented findings from a survey of polysubstance users at the annual meeting of the College on Problems of Drug Dependence. Her survey focused on the use of kratom within the past 12 months.

Kratom, a plant-based herbal product that’s available over the counter, produces an opioidlike effect. When the Food and Drug Administration declared in February 2018 that scientific evidence shows that kratom indeed is an opioid, the agency also warned that the drug could lead to abuse, addiction, and death. Several U.S. states and the District of Columbia have banned it, as have some cities and counties. In addition, the Drug Enforcement Administration has put kratom on its list of Drugs and Chemicals of Concern.

Nevertheless, some substance users view kratom as helpful and are open to using it, Ms. Smith and her colleagues reported in Drug and Alcohol Dependence.

“There seem to be three categories of substance-using individuals with some relationship to kratom: Those who use kratom inconsistently and as needed when there isn’t an alternative, those who tried it once and just didn’t find much benefit in it, and didn’t try it again, and those who have been using it regularly/daily as a long-term replacement for opioids, including IV heroin use,” Ms. Smith said.

For the new research, Ms. Smith and her colleagues surveyed 478 polysubstance users at five residential recovery centers in Kentucky. The average age of subjects was 35, 58% were male, 85% were white, and 48% were employed. About 85% of the participants were referred to programs by correctional facilities. Twenty-one percent reported ever using kratom, and 10% reported use within the last 12 months.

What do the findings mean? Along with anecdotal reports now being documented, they suggest the use of kratom by heroin users as a “possible harm-reduction” aid, Ms. Smith said at the meeting.

“These men and women are not necessarily getting kratom on a Friday night and saying, ‘This is going to be a great time.’ ” In the interview, she added that “this shows that substance-using individuals are, above all else, pragmatic.”

“It is unlikely that the majority of these users are consuming kratom primarily for achieving recreational ‘highs,’ ” Ms. Smith and her colleagues wrote in the article.

She added during her presentation that kratom is inexpensive and primarily legal. “If it were going to catch on as a serious drug of abuse, we would have expected to have a kratom epidemic already – but we do not.”

As for the big picture, Ms. Smith said in the interview that “it seems that some people want to make bold statements that kratom is a panacea or a public health menace. I suspect that it’s neither.”

Going forward, Ms. Smith said, she and a colleague plan to document the lives of regular kratom users in an effort to understand the progression from heroin and other drugs to kratom. They also want to know what the users would do if kratom is banned.

“These will be case studies in Kentucky, New Mexico, and possibly somewhere in the Northeast,” she said. “Since data will be collected locally, I think it would be helpful to try and obtain samples of kratom that the individuals report using so it can be analyzed. There may be variation between kratom purchased online vs. local vendors, which needs to be documented as well.”

Ms. Smith reported funding from the University of Louisville Graduate Student Research Fund, and another author was supported by the National Institute on Drug Abuse. The authors reported no relevant disclosures.

SOURCE: Smith KE et al. CPDD 2018. Drug and Alcohol Depend. 2017 Nov 1. 180:340-8.

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