Banning a Promising Cure for Opioid Addiction Is a Bad Idea
Forty-five years after the drug war was declared by President Richard Nixon, the United States leads the world in both recreational drug usage and incarceration rates. Heroin abuse rates continue to soar. Drug-related violence in our nation’s cities and cartel wars in Latin America exact horrific tolls.
And then there is the ever-present bully on the block, prescription drug abuse. More than two million Americans have become hooked on the pharmaceuticals that doctors prescribe to ease their pain. Opioids—both legal and illicit—killed a mind-boggling 28,647 people in 2014.
But not to worry: The Drug Enforcement Administration is on the case. “To avoid an imminent hazard to public safety,” the agency said in a press release, it will be adding kratom, a medicinal herb that has been used safely in Southeast Asia for centuries, to its list of Schedule 1 substances, placing the popular botanical in a class with killers like heroin and cocaine at the end of September.
Why ban the mild-mannered tree leaf? Well, because the DEA claims it’s an opioid with “no currently accepted medical use.” Wrong on both counts.
Pharmacologists label kratom as an alkaloid, not an opioid. True, kratom stimulates certain opioid receptors in the brain. But then, so does drinking a glass of wine, or running a marathon.
Kratom is less habit-forming than classic opioids like heroin and the pharmaceutical oxycodone, and its impact on the brain is weaker and more selective. Nevertheless, the herb’s ability to bind loosely with certain opioid receptors makes it a godsend for addicts who want to kick their habits. Kratom is currently helping wean thousands of Americans off illegal drugs and prescription pain relievers, without creating any dangerous long term dependency.
The powdered leaves are readily available from scores of herb sellers on the Internet. Since the ban was announced in late August, websites and social media have exploded with accounts from people who credit the plant with saving them from lives of addiction and chronic pain.
Take, for example, Virginia native Susan Ash. She was using Suboxone to help cope with severe joint pain resulting from Lyme disease. “My life was ruled by the clock—all I could think was, ‘when do I take my next dose,’” Ash says. Then someone suggested she try kratom to help kick her addiction to the prescription pain killer. “In two weeks time, I went from being a bed-bound invalid to a productive member of society again.
She founded the American Kratom Society in 2014 to help keep this herbal lifeline legal. Ash says that tens of thousands of people use kratom not just to help with chronic pain, but also to alleviate depression and to provide relief from PTSD. She strongly disputes that users like herself are simply exchanging one addictive drug for another.
“I have never had a craving for kratom,” Ash says. “You can’t compare it to even the mildest opiate. It simply won’t get you high.”
What it might do, users say, is slightly tweak your mood. The leaves of the Mitragyna speciosa tree, a biological relative of coffee, have been chewed for centuries in Southeast Asia by farmers to increase their stamina. Kratom is gently euphoric and also relaxing—think coffee without the jitters and sleeplessness. It is hard to take toxic levels of the herb, since larger doses induce nausea and vomiting.
But does it provide medical benefits? Dr. Walter Prozialeck, chair of the Department of Pharmacology at Midwestern University in Downers Grove, Illinois, who conducted a survey of the scant medical literature on kratom, says the herb did indeed help to relieve pain in animal studies.
While no clinical trials have yet been done with humans, addicts in Thailand and Malaysia have used kratom for decades to detox from heroin and alcohol. It was so successful in getting people off opium that Thailand banned kratom in 1943 to stem the loss of the opium taxes that funded the government.
Nobody knows how many are using kratom here in the US. “There are so many testimonials out there [from kratom users] on the Internet that I personally found quite compelling,” Dr. Prozialeck says. “This merits further study.”
But study has proven difficult. Dr. Edward Boyer, director of toxicology at the University of Massachusetts Medical School, says that when he tried to conduct research on kratom, potential partners told him, “we don’t fund drugs of abuse.” Drug companies have shown sporadic interest in isolating the active constituents in kratom since the 1960s, he says, but no pharmaceuticals have yet been developed from them.
Given the current opioid crisis, Boyer hopes researchers will dive deeper into the plant’s pharmacology. “Wouldn’t it be great to have an analgesic that will relieve your pain and not kill you?” Boyer notes that kratom is free from the potentially deadly side effects like respiratory failure that have bedeviled prescription opioids.
However, drug companies have shown little interest in a plant remedy that cannot be patented. While some of kratom’s active ingredients have indeed been patented by researchers who hope one day to market them to pharmaceutical firms, Boyer said that these compounds have failed to exhibit as powerful pain-killing effects as the whole plant. “There is something in there that we don’t yet understand,” he added.
And if the DEA’s ban goes into effect, we may never understand kratom’s remarkable potential. That’s because the federal action would have a chilling effect on research, according to Boyer.
The DEA claims that kratom is addictive. Since you can get hooked on most anything— even coffee or chocolate, as Dr. Boyer pointed out, this claim is both relatively meaningless and also hard to dispute. Users report that withdrawal symptoms from kratom are comparable to giving up coffee—a few days of irritability, perhaps a headache.
In issuing its scheduling notice, the DEA said that the Centers for Disease Control received 660 complaints about kratom (including reports of constipation and vomiting) between 2010 to 2015, out of 3 million calls annually reporting adverse reactions to assorted other foods and drugs. To put this number in perspective, the National Poison Data System registers more than 3,700 calls about caffeine annually, every year leading to multiple overdoses that result in death.
“This hardly constitutes a public health emergency,” says Susan Ash. “They definitely get more calls about energy drinks.”
In banning kratom, the DEA dispensed with the usual public comment period. Advocates, however, refuse to be silenced. They plan to challenge the DEA’s action in court and are marching on the White House on September 13. A petition urging President Barack Obama to reverse the ban has surpassed the 100,000 signature mark which, by law, requires a personal response from the president.
“There is a cheap plant out there that’s helping people getting off opioids,” Ash says, “and now so many are going to be forced back into active addiction, or made a prey to black market drug dealers.”
What if, instead of turning tens of thousands of law-abiding Americans into either addicts or felons, the DEA listened to those who have used kratom successfully to kick their addictions and manage chronic pain? Instead of banning the herb, why not draft some sensible regulation to establish dosage and labelling requirements and to protect consumers from adulterated product?
And while they are at it, America’s drug agency should sponsor some long overdue scientific research into a substance that may be the best thing going to combat our runaway epidemic of opioid addiction.
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