Considering Kratom as an Alternative to Opioids for Cancer-Related Pain

Is this relative of the coffee plant a safer alternative to opioids or a dangerous, unregulated drug?
BY Andrew Smith
PUBLISHED May 29, 2019
Kratom is a far more obscure plant than cannabis, but it is similar to the better-known botanical in many ways, particularly when viewed as a potential therapy for the symptoms of cancer and the side effects of treatment.

Like cannabis, kratom originated in Asia and for many centuries has been used there for both medical and recreational purposes. Both plants contain so many active ingredients that researchers have struggled to identify all their effects in the body, and both are considered by some to be a safer way to treat pain than opioids.

The plants have even more in common: Each has passionate users who herald its medicinal powers, govern­ment regulators who claim the plant is medically useless and unregulated dealers whose products don’t always come as advertised. The most important parallel is probably this: Both plants have yet to undergo the sort of rigorous trials that would allow for definitive assertions about the risks and benefits of using them during cancer treatment.

“Kratom advocates are vocally enthusiastic about what they perceive as its ability to ease pain, boost mood and, especially, reduce opioid dependence. That noted, there isn’t much research to support any of those claims, and there’s growing evidence that kratom use poses significant dangers,” says Megan Rech, Pharm.D, a clinical pharma­cist in the emergency medicine department at Loyola University Medical Center in Chicago.

The kratom tree is related to the coffee plant, and, when users take just a couple of grams, kratom produces a mild buzz and a significant stimulant effect. In higher doses, however, kratom exerts a depressant effect: Muscles relax, and heartbeat and respiration slow.

This depressant effect, which tends to kick in when users consume 5 grams or so, is said by kratom enthusiasts to reduce anxiety and pain and improve sleep. Researchers have yet to verify these claims, but findings have shown that kratom bonds to opioid receptors in the body, so it could have similar effects.

The advocacy of passionate fans has led to an exponen­tial growth in kratom use. What was once a very obscure substance in the U.S. has, according to one researcher’s estimates, attracted up to 5 million active users.

The combination of opioidlike effects and surging popu­larity has concerned regulators in Washington. The Food and Drug Administration (FDA) banned kratom imports, and the Drug Enforcement Agency (DEA) announced in 2016 that it would temporarily add kratom to its list of schedule 1 drugs — those that are illegal because of high potential for abuse but no recognized medical uses.

Backlash from passionate users and a few members of Congress prevented the DEA from criminalizing kratom, however, so it is still legal to purchase without any sort of prescription, except in six states and a number of cities that have passed their own bans.

The FDA has since linked kratom use to 44 deaths, although nearly all the victims also had other drugs in their systems when they died. Regulators say this proves kratom is dangerous. Kratom advocates say it proves that the drug is a wildly safer alternative to opioids, which killed more than 47,000 Americans in 2017 alone.

“(Although) some may feel that kratom is less dangerous than opioids, it’s an unproven, unregulated and potentially dangerous way to treat opioid addiction. Until we know more, patients would likely be better off using treatments like methadone or buprenorphine/naloxone that we know to be safe and effective if used appropriately,” Rech says. “As for treating pain safely, I’d love to see more research on kratom, cannabidiol and any other substance that looks promising, because we clearly need safer alternatives to prescription opioids and new medication-assisted treatments for opioid dependence. But the research just isn’t there yet.”
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