STIGMATIZE OR CELEBRATE?: Thailand is reviewing the legal status of the herb kratom (Mitragyna speciosa) to help control meth addiction in that country, and U.S. researchers are studying its potential to wean addicts off of opiates with minimal withdrawal side effects. Image: Courtesy of Uomo vitruviano, via Wikimedia Commons
More In This Article
The leaves of the herb kratom (Mitragyna speciosa), a native of Southeast Asia in the coffee family, are used to relieve pain and improve mood as an opiate substitute and stimulant. The herb is also combined with cough syrup to make a popular beverage in Thailand called “4x100.” Because of its psychoactive properties, however, kratom is illegal in Thailand, Australia, Myanmar (Burma) and Malaysia. The U.S. Drug Enforcement Administration lists kratom as a “drug of concern” because of its abuse potential, stating it has no legitimate medical use. The state of Indiana has banned kratom consumption outright.
Now, looking to control its population’s growing dependence on methamphetamines, Thailand is attempting to legalize kratom, which it had originally banned 70 years ago.
At the same time, researchers are studying kratom’s ability to help wean addicts from much stronger drugs, such as heroin and cocaine. Studies show that a compound found in the plant could even serve as the basis for an alternative to methadone in treating addictions to opioids. The moves are just the latest step in kratom’s strange journey from home-brewed stimulant to illegal painkiller to, possibly, a withdrawal-free treatment for opioid abuse.
With kratom’s legal status under review in Thailand and U.S. researchers delving into the substance’s potential to help drug addicts, Scientific American spoke with Edward Boyer, a professor of emergency medicine and director of medical toxicology at the University of Massachusetts Medical School. Boyer has worked with Chris McCurdy, a University of Mississippi professor of medicinal chemistry and pharmacology, and others for the past several years to better understand whether kratom use should be stigmatized or celebrated.
[An edited transcript of the interview follows.]
How did you become interested in studying kratom?
A few years ago [the National Institutes of Health] wanted me to do a bit of consulting on emerging drugs that people might abuse. I came across kratom while searching online, but didn’t think much of it at first. When I mentioned it to the NIH, they suggested I speak with a researcher at the University of Mississippi who was doing work on kratom. [The researcher, McCurdy,] assured me that kratom was fascinating, and he started to go through the science behind it. I decided I needed to look into it further. Talk about chance favoring the prepared mind. I no sooner hung up the phone when a case of kratom abuse popped up at Massachusetts General Hospital.
How did this Mass General patient come to abuse kratom?
He was a [43-year-old] successful software engineer who had been self-medicating for chronic pain [as a result of thoracic outlet syndrome, a group of disorders that occurs when the blood vessels or nerves in the space between the collarbone and the first rib—the thoracic outlet—become compressed, causing pain in the shoulders and neck as well as numbness in the fingers]. He had started with pain pills, then switched to OxyContin, and then moved to Dilaudid, which is a high-potency opioid analgesic. He had gotten to the point where he was injecting himself with 10 milligrams of Dilaudid per day, which is a large dose. His wife found out and demanded that he quit.
He read about kratom online and started making a tea out of it. For the most part, this helped him avoid the opioid withdrawal he had been experiencing. After he started drinking the kratom tea, he also began to notice that he could work longer hours and that he was more attentive to his wife when they would speak. He began experimenting with ways to boost his alertness by adding modafinil [a U.S. Food and Drug Administration–approved stimulant] with his kratom tea. That’s when he started to seize and had to be brought to the hospital. I have no idea how that combination of drugs caused a seizure, but that’s how he ended up at Mass General Hospital. Nobody there had heard of kratom abuse at the time. [Boyer and several colleagues, including McCurdy, published a case study about this incident in the June 2008 issue of the journal Addiction.]
The patient was spending $15,000 annually on kratom, according to your study, which is quite a lot for tea. What happened when he left the hospital and stopped using it?
After his stay at Mass General, he went off kratom cold turkey. The fascinating thing is that his only withdrawal symptom was a runny noise. As for his opioid withdrawal, we learned that kratom blunts that process awfully, awfully well.
Where did your kratom research go from there?
I had a small grant from the NIH’s National Institute on Drug Abuse to look at individuals who self-treated chronic pain with opioid analgesics they purchased without prescription on the Internet. This was an extremely restricted population, but it nonetheless measures in the hundreds of thousands of people. About the time I started the study, the DEA and the state boards of pharmacy began shutting down online pharmacies, so sources of pain pills for these hundreds of thousands of people in the United States dried up instantaneously. A number of them switched to kratom.
How many people are using kratom in the U.S.?
I don’t know that there’s any epidemiology to inform that in an honest way. The typical drug abuse metrics don’t exist. But what I can tell you, based on my experience researching emerging drugs of abuse is that it is not difficult to get online.