The True Cost Of Kratom - Non-Evidence-Based Opioid Treatments

August 30, 2020

Opioid addiction is ravaging our country. In 2018, 67,367 people died from drug overdoses in the United States—an increase of 57% from 2010. Opioid overdose is now the leading cause of injury-related death in the US and has been declared a public health emergency.

Fortunately, there’s significantly increased focus on evidence-based opioid addiction treatment, including prescription opioid addiction. Evidence-based treatment utilizes a biopsychosocial approach, which includes medication-assisted treatment (MAT) and behavioral health therapy, like counseling, support groups, and psychotherapy. MAT refers to outpatient treatment with buprenorphine, methadone, and naltrexone, and it’s critical to prevent overdose and death, especially in early recovery.

The truth about Kratom and other non-evidence-based opioid addiction treatments

In addition to evidence-based treatment, there are lots of non-evidence-based treatments out there, like Kratom and Ibogaine. Kratom is a psychoactive plant indigenous to Southeastern Asia, and its leaves were traditionally used to combat fatigue and relieve pain. In recent years, Kratom has become more frequently used in the United States and Europe. Since it doesn’t grow naturally in these regions, commercial preparations are more common, like powders or liquids. It’s most commonly consumed by drinking in tea or other liquid preparations.

It’s thought that Kratom acts on the opioid receptors in the brain. In low doses, Kratom produces a mild stimulant effect and was traditionally used by day laborers in Malaysia (and other nearby countries) while working in hot, strenuous conditions. At higher doses, Kratom effects include pain reduction, mood changes, and sleepiness. In the US, the most commonly reported reason for Kratom use is to self-medicate chronic pain.

Kratom Effects And Legality

Kratom effects can include nausea, constipation, drowsiness, muscle pain, liver damage, depression, hallucinations, delusions, and difficulty breathing. It is possible to overdose on Kratom. Kratom withdrawal occurs within 12-48 hours of the last dose, and users describe the opioid withdrawal as moderate.

Though Kratom is illegal in many European countries due to addiction and dependence potential, it remains legal in most states within the US. The United States Food & Drug Administration (FDA) warns that Kratom “should not be used to treat medical conditions, nor should it be used as an alternative” for prescription opioid addiction. Similarly, the Drug Enforcement Agency (DEA) does not recognize “any legitimate medical use for Kratom.” 

It’s estimated that approximately 1-1.5% of Americans have used Kratom at least once. As medical providers decrease the number of opioid prescriptions available, some users have turned to Kratom.

In the United States, there is increasing interest in the use of Kratom as substitution therapy for opioid addiction, though there’s minimal evidence that this works. Due to significant lack of research, it’s difficult to know the full risks of its use, though studies conducted in rodents show that it is addictive and can cause toxicity, organ dysfunction, and Kratom withdrawal. 

Further, because Kratom is not regulated in the US, many samples are tainted with unknown substances, and there’s no way to know the true potency of any particular sample. The Centers for Disease Control and Prevention (CDC) has linked Kratom to hundreds of overdose deaths in only two years. Due to lack of evidence and its potential risks, Kratom is not prescribed by medical professionals in the United States, and insurance does not pay for it.

Bicycle Health’s Medical Director, Dr. Brian Clear, says that, “When Kratom is used by patients, it’s being used in potentially very unsafe ways because it hasn’t been scientifically studied. We don’t know the appropriate doses, nor the necessary supports to have the desired effects. We already have well-studied, effective treatments available, so we’re not in a position to recommend non-evidence-based treatments.”

Ibogaine treatment is another non-evidence-based treatment, and it’s derived from a tree in Western Africa. Ibogaine treatment is not used by medical professionals in the US, and it’s illegal in most countries because it is known to cause severe abnormal heart rhythms that can result in death.  

Focus on evidence-based opioid addiction treatment

Like Dr. Clear mentions, there are safe and effective treatments available for opioid addiction that have lots of evidence to support them, like buprenorphine and methadone. “We have decades of experience with opioid addiction and opioid withdrawal, and long-term treatment with once daily medication is well-demonstrated to be safe and effective,” Dr. Clear states. “It is stability that’s really important, and you don’t get that kind of stability from anything outside of a medical setting.”

Buprenorphine acts like a partial opioid in the brain, which is different from methadone, oxycodone, heroin, and fentanyl. Buprenorphine sits on the opioid receptors, thereby reducing cravings and preventing withdrawal symptoms. Because buprenorphine is a partial opioid, it has a ceiling effect—this means that after a certain dose, there is no additional opioid effect, which ultimately decreases the risk for overdose. Buprenorphine is often combined with naloxone (i.e. Suboxone).

Methadone is another evidence-based treatment for opioid addiction, including prescription opioid addiction, though it’s strictly regulated by the government and can only be provided through federally licensed outpatient treatment programs.

Medication-assisted treatment is critical to prevent overdose and death. Research shows that with MAT, 75% of patients will still be in recovery one year later. Here at Bicycle Health, we offer MAT with buprenorphine/naloxone (Suboxone) to help patients stop or cut down on their opioid use.

To learn more about the proven evidence behind Suboxone treatment, call us at (844)943-2514 or schedule an appointment here.

About the Author

Rebekah L. Rollston, MD, MPH

Dr. Rollston is a Family Medicine Physician at Cambridge Health Alliance, Affiliate Editor-in-Chief of the Harvard Primary Care Blog, and Founder of Doctors For A Healthy US, LLC. She earned her Medical Degree from East Tennessee State University Quillen College of Medicine and her Master of Public Health from The George Washington University. Her professional interests focus on social influencers of health & health disparities, addiction medicine, sexual & reproductive health, homelessness & supportive housing, and rural health.

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