Herbal drug kratom contains opioids, FDA says

February 6, 2018 by Dennis Thompson, Healthday Reporter
Kratom leaf

(HealthDay)—The popular botanical drug kratom essentially is an opioid, the U.S. Food and Drug Administration declared Tuesday.

Nearly all of kratom's major compounds bind to opioid receptors in the human brain, and two of the top five most prevalent compounds activate those receptors, FDA Commissioner Scott Gottlieb said in a statement.

In addition, there have been 44 reported deaths associated with the use of kratom, often in combination with other substances, Gottlieb said.

Kratom grows naturally in the Southeast Asian countries of Thailand, Malaysia, Indonesia and Papua New Guinea. It has been sold as a dietary supplement to help manage pain and boost energy.

"Kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids," Gottlieb said. "There is no evidence to indicate that kratom is safe or effective for any medical use."

Claims that kratom is harmless because it's just a plant are "shortsighted and dangerous," Gottlieb continued, noting that heroin also is derived from poppy plants.

Gottlieb urged people to seek help from a health care provider if they are using kratom to self-medicate for pain or to treat opioid withdrawal symptoms.

"There are safe and effective, FDA-approved medical therapies available for the treatment of opioid addiction," Gottlieb said. "Combined with psychosocial support, these treatments are effective."

Concerns over kratom have been growing in recent years. For example, calls to poison centers regarding kratom increased tenfold between 2010 and 2015, rising from 26 to 263, according to the U.S. Centers for Disease Control and Prevention.

More than one-third of the poison center calls reported use of kratom in combination with other substances, such as illicit drugs, prescription opioids or over-the-counter medications, the CDC said.

"Cases of mixing kratom, other opioids and other types of medication is extremely troubling because the activity of kratom at opioid receptors indicates there may be similar risks of combining kratom with certain drugs, just as there are with FDA-approved opioids," Gottlieb said.

To assess the potential risks of kratom, FDA researchers used 3-D computer technology to evaluate the chemical constituents of the plant and simulate how they would affect various receptors in the brain.

Computer analysis predicted that 22 of the 25 most prevalent compounds in kratom bind to mu-opioid receptors, which have been linked to pain relief and a feeling of euphoria, Gottlieb said. Those receptors also have been implicated in the addiction process.

"The computational model also predicted that some of the kratom compounds may bind to the receptors in the brain that may contribute to stress responses that impact neurologic and cardiovascular function," Gottlieb said. "The agency has previously warned of the serious side effects associated with kratom, including seizures and respiratory depression."

The analysis also revealed that kratom's compounds form a strong bind to opioid receptors, comparable to controlled opioid medications, Gottlieb said.

In a statement, the American Kratom Association said that the FDA analysis is "an unprecedented abuse of science to create a new computer program that is clearly garbage in/garbage out, avoiding the rules of the Controlled Substances Act and making unproven claims that have been proven to be untrue."

The FDA's claims also have been questioned by kratom researcher Scott Hemby, chair of the department of basic pharmaceutical sciences at High Point University in North Carolina.

Hemby has found that kratom's principal chemicals do bond to opioid receptors and cause opioid-like effects such as pain relief and a euphoric rush from a release of the neurotransmitter dopamine. At least one of the chemicals may also have some addictive properties.

However, Hemby told CNN that kratom acts much less effectively than prescription opioids or heroin, and that the total amount of these compounds in the plant as a whole is so low that it's unlikely to lead to abuse or addiction.

"Just because it binds, it doesn't mean it has the same efficacy" as an opioid, Hemby explained.

Hemby also questioned the FDA's use of computer analysis to arrive at its conclusion.

"They make a lot of hay of using a computer model, but it's really nice to validate the findings with actual science," Hemby told CNN. "When it comes to drugs for cancer, we wouldn't rely on a computer model to drive policy. People would find that unacceptable."

Explore further: FDA warns of injury, death with herbal supplement kratom

More information: To read the kratom statement, visit the U.S. Food and Drug Administration.

Related Stories

FDA warns of injury, death with herbal supplement kratom

November 14, 2017
Federal health authorities are warning about reports of injury, addiction and death with a herbal supplement that has been promoted as an alternative to opioid painkillers and other prescription drugs

DEA halts move to ban controversial herbal kratom

October 14, 2016
(HealthDay)—Bowing to public pressure, the U.S. Drug Enforcement Administration has halted a move to ban a plant called kratom, which experts say could help battle the nation's opioid epidemic.

States ban kratom supplement over abuse worries

May 20, 2016
A little-known plant-based substance often sold as an herbal supplement to address chronic pain is raising alarm bells in states concerned that it could be as addictive as heroin.

Researchers suggest kratom may have medical benefit as opioid alternative

November 28, 2016
A delayed U.S. Drug Enforcement Administration ban on kratom would stifle scientific understanding of the herb's active chemical components and documented pharmacologic properties if implemented, according to a special report ...

Findings suggest kratom's potential to treat opioid addiction

December 15, 2017
As the nation grapples for solutions to the opioid epidemic—now claiming more than 33,000 American lives each year—the potential of the psychoactive plant kratom to become a useful tool in the battle has been hotly debated.

New hope for addicts

January 28, 2013
It doesn't take a rocket scientist to quickly grasp what a University of Mississippi professor's research could mean to the millions of people addicted to hardcore narcotics such as heroin, cocaine, methamphetamine and morphine.

Recommended for you

Researchers publish study on new therapy to treat opioid use disorder

May 22, 2018
Better delivery of medications to treat opioid use disorder (OUD) is key to addressing the opioid crisis and helping the 2.6 million Americans affected by the disease.

Could nonprofit drug companies cut sky-high prices?

May 17, 2018
(HealthDay)—Generic prescription drugs should be cheap, but prices for some have soared in the United States in recent years. Now a group of U.S. hospitals thinks it has a solution: a nonprofit drug maker.

Fewer antibiotics for kids, but more ADHD drugs

May 15, 2018
(HealthDay)—American kids are taking fewer prescription medications these days—but certain drugs are being prescribed more than ever, a new government study finds.

Opioid makers' perks to docs tied to more prescriptions

May 14, 2018
Doctors who accept perks from companies that make opioid painkillers are more likely to prescribe the drugs for their patients, new research suggests.

Less is more when it comes to prescription opioids for hospital patients, study finds

May 14, 2018
In a pilot study published in JAMA Internal Medicine, Yale researchers significantly reduced doses of opioid painkillers given to hospital patients. By delivering the opioids with a shot under the skin or with a pill instead ...

Generic options provide limited savings for expensive drugs

May 7, 2018
Generic drug options did not reduce prices paid for the cancer therapy imatinib (Gleevec), according to a Health Affairs study released today in its May issue.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.