December 17th, 2018

Kratom Research Approved: A Victory of Knowledge Over Ignorance

Research GrantThree cheers for the Federal Government! A research grant has just been approved to explore the benefits and dangers of the newly controversial plant known as kratom.

Used for centuries in Southeast Asia to relieve pain, kratom has in recent years become available in the U.S. Media accounts focused initially on its reputation for medical as well as recreational use. As its use expanded, the DEA moved to ban it as illegal, but a coalition of supporters have so far succeeded in keeping it accessible. Recently, publicized accounts asserting its role in overdose deaths have led to an intensification of this struggle. Supporters of legal kratom argue that while it may have dangers, it could serve as a safer alternative to traditional Western opioid pharmaceuticals.

I see an analogy to cannabis, for which restrictions by the DEA have impeded both research efforts to understand its complexities and pharmaceutical development to exploit its potential therapeutic benefits. What encourages me is the contrast that this research grant demonstrates for kratom. Similar to cannabis containing multiple cannabinoids which interact with our internal opioid system, kratom contains multiple alkaloids, some of which activate opioid receptors in our bodies, which would explain its effectiveness in relieving pain.

I think that it makes sense to objectively explore both the benefits and risks of kratom before making policy decisions, rather than precipitously locking up a potentially beneficial substance. History tells us that what is rationalized as “temporary” can, in fact, become a permanent limbo, particularly when the DEA rather than a public health agency has the final decision-making power. The placement of “marijuana” into Schedule I in 1970, for example, was supposed to be a temporary step, “until studies currently underway” could be completed. Those studies never were in fact completed and 48 years later we remain sadly ignorant about the substance.

I have no doubt that kratom has addictive potential, having seen patients enter the Kolmac outpatient detoxification and outpatient rehabilitation program because of having problems with its use. My impression is that its addictive potential is roughly equivalent to tramadol. As has been pointed out repeatedly, however, most prescription opioids as well as cocaine are substantially more addictive but have not been relegated to Schedule I status.

With kratom added to a growing list of potentially useful substances that includes cannabis, ketamine, and psilocybin, perhaps even MDMA will be the next escapee from the prison of Schedule I. I like to think that our country may be shifting to a policy position that argues that we are all made safer by accurate information than by ignorance.

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