Could kratom help treat opioid addiction?

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By Saskia de Melker and Melanie Saltzman

MIKE TAIBBI: If you haven’t heard of kratom — sometimes called kray-tom — you will. It’s a coffee-like plant native to Southeast Asia whose leaves can be ground up into capsules or to used make tea or mix with juice or other liquids.  For centuries kratom has been used as a replacement for opium or to wean users off it.

In the US, kratom is currently very easy to buy on the Internet, in specialty bars as tea or some other liquid mixture, or in pill form in shops like Grateful J’s in Delray Beach, Florida, which also sells tobacco and smoking paraphernalia.

SALES PERSON: We got this last week. And we’re already almost gone. We get new stock once a week. It sells.

MIKE TAIBBI: So it comes and it goes.

SALES PERSON: It comes and it goes.

MIKE TAIBBI: A small packet of capsules or crushed kratom leaf sells here for between 20 and 30 dollars. While many use it medicinally, others also say they simply enjoy its slight euphoric effect, similar to drinking a cup of coffee or having a beer.

University of Florida Medicinal Chemistry Professor Christopher McCurdy has been collecting samples and studying kratom for more than a decade.

CHRISTOPHER MCCURDY: I receive emails at least on every other day basis from users or other researchers that are interested in this material, saying, you know, “this stuff’s been incredible for my patients,” or “it’s been incredible for me personally. Looking back at what we’ve found in the laboratory with the animals, we think it has profound potential.

MIKE TAIBBI: Whether people say they use it to curb an addiction, to self-medicate for pain, or just to feel good, the sale of kratom and kratom products is now largely unregulated and widely available without a doctor’s prescription

Florida State Representative Kristen Jacobs has fought to have kratom banned in her state as it is now in 6 other states and 15 countries.

REP. KRISTEN JACOBS: The problem is, because it’s completely unregulated you don’t know when you buy one of those cute, decorated packages, or you buy it in a juice, or in a tea, you don’t know how much of it has been mixed in. You don’t even know if there’s any kratom in it at all, it could be some other substances.

MIKE TAIBBI: You’re convinced it’s every bit as dangerous as other opioids?

REP. KRISTEN JACOBS: Yes, I am.

MIKE TAIBBI: The Drug Enforcement Administration may agree with her. Last August, the DEA announced it was ready to list kratom as a Schedule 1 drug meaning it has a“ high potential for abuse” and has “no currently accepted medical use”, listed under federal law alongside heroin, LSD, ecstasy, and marijuana.

REP. KRISTEN JACOBS: I do think that this is a bad drug, and it needs to be regulated…it needs to be, in my opinion, to be scheduled as a Schedule 1 drug.

MIKE TAIBBI: But there’s another side to the kratom story.  In laboratory experiments on mice, McCurdy and his colleagues say they have shown how kratom can wean users off opioids. They took mice, like these, addicted to morphine and then deprived them of the drug…thrusting them into withdrawal. Then, they replaced their morphine with kratom.

CHRISTOPHER MCCURDY: We would look at low doses, medium doses, high doses.  We even went to doses that were off the chart for what a human would use…and this is a mouse!  And we didn’t ever see any toxicity with the plant material itself.

MIKE TAIBBI: And none of them died?

CHRISTOPHER MCCURDY: None of them died.  And we never saw any seizure, we never saw any side effect essentially.

MIKE TAIBBI: Those side effects include respiratory distress… breathing slowing and sometimes stopping… that causes most fatal overdoses from opioids

CHRISTOPHER MCCURDY: We haven’t published the withdrawal studies on the mice, but what we’ve seen is a clear medical potential for this to treat opiate addiction and withdrawal.

MIKE TAIBBI: No question in your mind?

CHRISTOPHER MCCURDY: No question in my mind. None at all.

MIKE TAIBBI: Because of widespread protests and appeals from 51 members of the House of Representatives and 9 Senators to reconsider, last October, the DEA walked back its plan to immediately list kratom on its Schedule 1 roster…and opened a public comment period.

After 23-thousand public comments submitted to the DEA and 140-thousand petition signatures to keep it legal, kratom’s fate now remains up in the air.

Gina Rivera was one of the people who submitted a pro-kratom comment. Several years ago, she began taking prescription painkillers to manage chronic back pain.

GINA RIVERA: I got in a car wreck seven days after my 21st birthday.

MIKE TAIBBI: After three surgeries, she was prescribed opioids and became addicted…even through the birth of her child.

GINA RIVERA: When I got pregnant with my daughter, I was taking,four 30mg oxycodone a day, and then two 10mg methadones a day. So 20 milligrams of methadone, 120 milligrams of oxycodone.

MIKE TAIBBI: Every day?

GINA RIVERA: Every day, if not more than that. Sometimes I would take more if I was in more pain.

It’s probably about 12:30, which means  I’m going to take a green kratom.

MIKE TAIBBI: Rivera says it was a doctor who cast her a lifeline.

GINA RIVERA: He leans in close to me and, after tears running down my face, he says ‘have you heard of kratom?’ And I said ‘no I haven’t.’ And he looks at me and he goes, ‘well, I can’t tell you about it, I might lose my job… so I urge you to go search the internet, seek help on the internet and search up kratom.’

MIKE TAIBBI: She did… and since then she has mixed kratom into her morning juice.

GINA RIVERA: I use it every day, because I use it in place of medications that I would already be on anyway. I would be on opiates if it weren’t for kratom.

MIKE TAIBBI: A Florida realtor we’ll call ‘Steve,’ who agreed to speak to us if we didn’t use his real name, is another kratom believer. He says he drinks kratom tea everyday and says it helped him kick his addiction to the opioid painkiller Percocet.

STEVE:  I knew I was losing my marriage. I knew I was losing my career, and when it got to the point where I was possibly going to lose my kids, I realized that I just had to stop. I can’t tell you like the research behind kratom. I can just tell you how I feel: that I have energy. I’m in great shape. I work out. I’ve developed another career that is going very well.

SCOTT HEMBY:  Mitragyna speciosa is just the latin name for the plant.

MIKE TAIBBI: Scott Hemby, a professor of pharmaceutical science at North Carolina’s High Point University, is now partnering in kratom research with Chris McCurdy.  In his lab, Hemby is looking more closely at kratom’s two psychoactive compounds to determine the extent to which kratom is addictive.

One of those compounds is called 7-hydroxy. And Hemby’s initial results show that lab rats will continue to take 7-hydroxy again and again when they’re presented with it.

SCOTT HEMBY: It may have addictive properties like morphine does.

MIKE TAIBBI: And that’s a red flag — the potential addictive or abusive use…

SCOTT HEMBY: What we find is that it has the potential to be abused, that’s correct.

MIKE TAIBBI: Despite kratom’s potential to be “addictive,” Hemby says he appreciates the anecdotes by users who praise kratom… and believes research on kratom must be allowed to continue.

SCOTT HEMBY: In terms of pain relief management, in terms of addiction medicine.  The potential there is huge… and I think it would be, we would not be serving the public interest if we completely pushed these off the shelf for investigation in the future.

MIKE TAIBBI: The DEA does cite 15 deaths in the U-S since 2014 as kratom-related, but 14 of those people had other drugs in their system at the time of death.

Addiction treatment specialists like Ryan Johnston of Fort Lauderdale’s Cornerstone Recovery Center oppose the use of kratom for those struggling with substance abuse, because they’re substituting one drug for another.

RYAN JOHNSTON:  It’s a minor mood-altering substance. So our clients are not permitted to use it.  What we find, is that it leads them back to the behaviors of what surrounds them when they’re using, let’s say, opiates, and oftentimes leads them then further down back to their drug of choice.

SALESPERSON: So right now we only have the red horn capsules.

MIKE TAIBBI: Without any regulations for kratom, what exactly is in these capsules is a mystery.

CHRIS MCCURDY: Right now, it’s a ‘buyer beware’ marketplace for any of the supplements that are out there.

MIKE TAIBBI: That is one of the “Kratom Concerns” listed by epidemiologist Jim Hall, a member of the Food and Drug Administration’s advisory committee on drug safety and risk management. His unpublished 2015 background paper for the Florida legislature also cited respiratory depression, delusions, and aggression as negative side effects.

JIM HALL: If it’s to be used medically, as many users claim they are self-medicating with it, self-medicating with their opiate withdrawal syndrome, that then proceed as we do with any other medical product in this country: apply for a new drug application and work through rigorous clinical trials and supervision of the food and drug administration.

MIKE TAIBBI: But you know that that takes five to 10 years minimally?

JIM HALL: It can, yes.

MIKE TAIBBI: In the meantime, 30-thousand people are dying a year from opiate overdoses.

JIM HALL: But I don’t know if this will save their lives.

MIKE TAIBBI: Right

JIM HALL: The vital question is what is a safe and effective potential product as a medicine or even as just a food supplement.

MIKE TAIBBI: Hall’s paper echoes the FDA’s negative warnings on kratom. But the FDA has not yet conducted a full analysis of the drug to back up those claims.

The FDA and DEA declined our interview requests.  In a written statement to NewsHour Weekend, the DEA did say it “still considers kratom to be harmful and dangerous” and that kratom “has not undergone the scientific rigor to prove that it’s both safe and effective.”

The DEA, the FDA and the Centers for Disease Control and Prevention, have approved other drugs with addiction potential — like methadone and a medication called suboxone — for opioid addiction and withdrawal.

Both “Steve” and Gina Rivera tried each of them for a long period, and say they didn’t work for them the way kratom did.

STEVE:  When I started drinking kratom as a way to not go and use opiates or painkillers.  I got to the point I haven’t used drugs in a year.

MIKE TAIBBI: Now Rivera fears losing access to kratom.

GINA RIVERA: That would pretty much tear my life apart right now.

MIKE TAIBBI: For now, kratom is in limbo. The DEA has vexing choices ranging from classifying it as an illegal drug which could restrict its sale and research, to leaving it essentially unregulated, a potentially dangerous drug that proponents call a life-saver.

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