News stories about kratom, an herbal ‘opioid alternative,’ wrongly prioritize propaganda over science

Mary Chris Jaklevic is a reporter-editor at HealthNewsReview.org. She tweets as @mcjaklevic.

Wouldn’t it be great if a safe and readily available plant could help curb opioid addiction?

There hasn’t been a lot of research on mitragyna speciosa, also known as kratom.

That’s the idea being promoted by a group called the American Kratom Association (AKA), which has been campaigning to block a federal ban of the Southeast Asian herb due to safety concerns.

The association — which won’t disclose its funding sources and has attempted to discredit government scientists as members of a “dark state” that’s out to protect prescription opioid makers — has been widely quoted in news stories.

It aggressively promotes the message that kratom is harmless and no more addictive than coffee, and could even be a solution to the opioid epidemic.

And it’s pushing an alarmist narrative that if access to kratom is restricted, users will be driven to a black market or to prescription opioids or heroin.

“If you ban kratom, people are going to die,” AKA Chairman Dave Herman recently told alternative medicine podcaster Robert Scott Bell. “You’re going to create a prohibition-style black market with adulterated product, people being forced back to opioids, people with guns out there running that industry.”

Wide coverage of unproven “potential”

There’s no reliable evidence that kratom can help addicts safely wean themselves off of heroin or prescription opioids, or that it offers any other therapeutic benefit, according to the FDA, which has issued a public health warning about its potential for addiction.

Nevertheless some new stories have echoed the AKA’s framing of the issue, that restricting kratom could be bad. Some examples:

Science versus PR spin

One person who’s bothered by this unquestioning news coverage is Adriane Fugh-Berman MD, a professor of pharmacology and physiology at Georgetown University and director of Pharmed Out, a project that raises awareness of pharmaceutical company marketing practices.

She said journalists should be pushing back on the AKA’s unsubstantiated claims.

“It’s casting it as if these are two equal sides, when one is the PR side and one is the science side,” she said.

Addiction specialist and HealthNewsReview.org contributor Michael Bierer, MD, MPH, said promoting kratom as a first-line treatment for opioid addition strikes him as irresponsible. He noted that well-tested and robust therapies are available, another point that has been missing in some news stories.

“I always worry that unregulated, un-standardized products are risky,” he said via email.

With Fugh-Berman’s help, we came up with five ways coverage about kratom could be better.

Don’t rely on positive anecdotes from kratom users. Many stories highlighted people who claim the herb helped them kick their addictions to heroin or prescription opioids, but that’s not evidence of a benefit.

Positive patient testimonials abound in kratom coverage.said it

Kratom “probably is effective for helping opioid cravings because it’s an opioid,” Fugh-Berman said. Users are “deluding themselves into thinking they are getting off opioids.”

While the AKA claims on its web site that “kratom is not an opiate,” the FDA said it studied the herb’s chemical structure and determined that kratom is in fact an opioid because compounds in the plant bind to a person’s opioid receptors.

Dig into the available evidence. Human clinical trials on kratom are lacking. But one of Fugh-Berman’s graduate students, PharmedOut intern Jane Kim, found studies and clinical reports that challenge the the AKA’s safey claims.

For example, a 2014 study of 293 kratom users, funded by the Malaysian government and the World Academy of Sciences, reported that all claimed to be dependent on kratom, and a majority reported “severe Kratom dependence problems.”

It said many habitual Kratom users were unable to quit due to withdrawal symptoms such as sleeping problems and pain.

Put death reports in perspective. The AKA says “zero deaths” have occurred from kratom, while the FDA said 44 deaths involving kratom that have been brought to its attention.

Why the discrepancy? The AKA’s Herman told Rolling Stone: “The FDA is saying people died and they found kratom in their system. It’s like if I drank a Coke and got hit by a truck.”

But it’s quite possible that kratom was a contributing factor in some deaths because people may have taken kratom with other substances not realizing its effects, Fugh-Berman said. Kratom’s effects and how it interacts with other substances haven’t been well-studied.

Also, some news stories also haven’t explained that reporting deaths and other adverse events isn’t mandated, so only a tiny fraction reach the FDA’s attention. An uptick in the number of reports is considered a signal that there might be a wider problem.

Ask who’s paying. We haven’t seen any news stories mention the AKA’s lack of transparency about its funding. That’s a problem because while the AKA claims it’s advocating for average kratom users, it’s unclear whose interests it’s representing.

We’ve reported on the importance of journalists scrutinizing the funding sources of advocacy groups, since many are supported by industry. Recently there’s been a push to mandate disclosure of pharmaceutical company payments to nonprofits.

The AKA raised $1.04 million in 2016, the last year for which IRS records are available.

In response to our emails, a spokeswoman for the AKA declined to identify its major donors or say what percentage of its revenue comes from industry. She said more than 80% of donors are “average American kratom users” and the remainder are related to the kratom industry.

The AKA has used social media to discredit FDA scientists.

Cast a wide net for sources. Some of the strongest coverage has incorporated the views of experts outside the orbit of federal regulators or kratom advocates, who haven’t been widely heard.

The Chicago Sun-Times sought out Dan Bigg, head of the Chicago Recovery Alliance, which does outreach work with drug users. Bigg noted effective drugs such as methadone and buprenorphone are available to treat opioid dependence.

Washington, D.C.’s WUSA9 tapped psychiatrist George Kolodner, MD, who said he was treating two people for kratom addiction and noted its legality in most states “makes it attractive to some people.”

The Washington Post quoted Bertha K. Madras, PhD, a professor of psychobiology at Harvard Medical School, who said benefit claims are not scientifically substantiated.  “I support the FDA on this,” Madras said. “I really believe they have taken a cautionary stance, which is to protect the American public.”

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Comments (10)

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James Perretta

March 12, 2018 at 9:01 pm

I see that research is limited in America but in other countries there is a lot more research on Kratom. And ass for seeing with my own eyes over 20 people I k ow have died from opiates. Sever more have overdosed several times. And hundreds of people I personally know have been able to knot go through debilitating withdrawals and stay away from supper addictive opiates thanks to Kratom. It would be very foolish to put a band on Kratom. It saves lives.. know one I know has ever had any problems from Kratom. I think the government doesn’t like it because they aren’t making money on. Big pharm wants a band or regulations because it means more opiates. I k ow for a fact if Kratom was baned today 100’s of personal aquantises and friends would use opiates such ass pills or heroin just to get through the day.

Amanda Beutel

March 13, 2018 at 3:29 am

I will say it has benefits to help ween off of opiates…HOWEVER…for people to say there is no danger involved and that its no more addictive than coffee…has mislead ALOT of people…it can also cause high blood pressure and irregular heartbeat…i speak from personal experience and this was only from taking it for about a month…point blank it needs to be regulated and studied more…im not at all pro fda..but my own struggles with opiate addiction and my experience with kratom…has its pros and cons…

zack karo

March 13, 2018 at 9:54 am

The author claimed the 2014 study of 293 kratom users said:

“many habitual Kratom users were unable to quit due to withdrawal symptoms such as sleeping problems and pain.”

This isn’t accurate. It says:

“A sizable proportion of the respondents in this study could usually not endure the first day of Kratom withdrawal symptoms as the symptoms disrupt their physical and psychological functioning.”

“a sizable portion”….“usually could not endure”. First, the exact number isn’t given, which seems rather unscientific. How much is a sizable portion? The language “usually could not endure” is also terribly ambiguous, but even so it does not say many were unable to quit. This is rather sad considering the author is a journalist whose job it is to share the objective truth without any bias. Instead the author cherrypicked and contorted the information to the point of near dishonesty.

“Although the withdrawal symptoms lasted only for a short period of a few days and gradually subsided, the pain that they experienced severely affected their work performance and mental occupation”

Now this makes sense in light of the fact that:

“About 90% (265/293) claimed that they have better social functioning when using Kratom. This was mainly because they were able to work long hours and to better socialise with their family members and friends”

and…

“Those who claimed that they use Kratom to enhance their work performances, actually use Kratom as an ‘energy boosting drink”

As well as…

“The Malay village community does usually not discriminate Kratom users because they regard the Kratom using practice as an inherent aspect of their ancestral tradition. They see the Kratom using habit as an integral part of their present culture, and, hence, Kratom users as ‘diligent’ and ‘hard working’, while e.g., cannabis users are ‘lazy’ (Saingam et al., 2013).”

Which leaves the authors of the study to possibly conclude this:

“It was claimed that most of the non-addicted psychoactive drug use in the world is based on drug instrumentalization rather than on the direct pharmacological reinforcing effects of the drug (Müller and Schumann, 2011a)….“From the reports of Kratom use in order to enhance work output and to recover from exhausting work, one may speculate that the easy availability of this ‘drug instrument’ and the lack of alternative instruments in rural Malaysia may foster systematic Kratom use and the transition to Kratom dependence.”

Furthermore, the study itself does not go into detail as to how it used the Leeds Dependence Questionnaire (LDQ) to determine dependence and severe dependence. Even so, the study says that:
“About 23% (68/293) of the regular users reported high craving for Kratom while 77% admitted low craving.”

Which is strange because an opiod is an addicting psychoactive drug. One would assume cravings would be a lot stronger. Instead, the study seems to say that much of the dependence is on the fact that the farmers in this Malay village have hard, demanding work in the sun, therefore, they depend on kratom in order to be able to work hard and earn very little money to support their families.

Of course the author would leave out the fact the study said this:
“When probed, most respondents reported being previously dependent on cannabis, heroin, and methamphetamine. Respondents claimed that they use Kratom juice to treat and reduce their dependence on illicit drugs. In fact now they used Kratom as a substitute for the illicit drugs. None of the respondents were tested positive for using illicit drugs during the interview which may suggest a certain efficacy as a substitute drug….”

Also, it should be noted that not a single person died in the study mentioned.

Mary Chris Jaklevic

March 13, 2018 at 12:31 pm

Zack,

My paraphrasing is consistent with the findings of the study, which concludes that “regular Kratom use is associated with drug dependency, development of withdrawal symptoms, and craving. These symptoms become more severe with prolonged use and suggest a stronger control of the drug.”

Regarding physiological symptoms of withdrawal, the study states: “About 76% (222/293) of the Kratom users experienced body aches, including severe muscle pain and cramps, after abstaining abruptly from Kratom use. About 65% (190/293) experienced mild withdrawal effects while 35% (103/293) experienced moderate to severe withdrawal effects after Kratom cessation. Kratom withdrawal symptoms were experienced for 1–3 days in 64% (187/293) of the regular users. In 36% (106/293) they lasted for more than 3 days.”

It further states: “Psychological withdrawal symptoms commonly reported by the respondents in this study include nervousness, sadness, restlessness, anger, tension, and depressed mood. About 73% (151/293) of the respondents encountered at least five different psychological withdrawal symptoms during the first day of Kratom cessation. None of the respondents had any suicidal ideation after using Kratom for prolonged periods.”

The remainder of your comments goes beyond the scope of my point, which is that journalists need to comb through the available evidence, particularly research in which the funding sources are clear and not potentially swayed by commercial interests.

Sam Wilson

March 13, 2018 at 3:41 pm

There is no evidence that kratom is deadly. The fda claims 44 deaths from kratom. All of these people had other drugs in their system. The fda wants people to use methadone and suboxanne. Both of which are very deadly. We the American public aren’t stupid. We know the war on kratom is about money, not public safety

Gabriella Bell

March 13, 2018 at 3:50 pm

This article is terribly one sided. Data from the available studies was cherrypicked to promote a narrative of kratom being addictive and unsafe. The author didn’t bother to contact any of the scientists that have researched kratom and found it to be beneficial. Instead, she indirectly promotes methadone and suboxone. Both highly addictive with a vast death toll which doesn’t seem to be mentioned. Unsurprisingly, the recommended treatments coincides with the FDA. She also mentions the FDA’s “research” which was a computer simulated model that predicted kratom “can” or “may” act exactly like an opioid causing respiratory depression and other dangerous effects. No mention of the studies that completely contradict those statements or the fact the FDA’s findings are not based on real science. I understand reporting the FDA’s concerns, but this is far from unbiased journalism. It is extremely disappointing reading articles like this.

Kevin Lomangino

March 13, 2018 at 4:53 pm

The comments on this post are becoming repetitive. Most are from kratom users and advocates who claim that the post does not accurately reflect the science showing benefits of kratom for opioid withdrawal. As noted, there is no good-quality evidence of such a benefit. Commenters also take issue with the FDA’s statistics on deaths related to kratom and the Malaysian study showing adverse effects among kratom users trying to quit. They also communicate their own anecdotal experiences using kratom or those of others. These issues are all dealt with in the post or in our replies to the comments. Additional comments will have to address new issues related to media messages about kratom or they will not be approved.

Kevin Lomangino
Managing Editor

Andrew Turner

March 15, 2018 at 9:01 am

Eventually some in the media were going to address that much of the official Kratom Advocacy is funded primarily by vendors, as a proponent for Kratom staying legal from both the harm reduction and well being stands I wish more would read the article closer to grasp that many points made here are discussing things we should be discussing ourselves. Grassroots movements and astroturf organizations run by professional fundraisers cross paths in most every advocacy movement. That being said the grassroots consumers of Kratom have tried for well over a year to ask the FDA to sit down with us without the paid “advocates” largely representing vendor interests. Many, Maybe most consumers support stronger regulation and over sight of Kratom but that message has largely been blocked by some of the paid “advocates” to control the narrative for vendor interests. I do applaud the author for addressing that. I will have to agree somewhat that far more research is out there but it’s fairly simple for anyone interested to find it and it definitly points to the fact that oversight of the plant is sorely needed. The only major issue I take with the article is the idea that a black market wouldn’t happen if it was banned. Every substance our government has ever banned has created a far more dangerous black market. I’ll include this article written in the UK that presents a very common sense underatanding of that.( https://iea.org.uk/blog/prohibitions-create-black-markets-and-cause-violent-crime ) This may be one of the few things I fully disagree with about the article and believe that notion should be far more explored. The FDA, the DEA and Congress have it in their power to make changes as needed to create far more oversight without banning/scheduling Kratom and removing access of so many that have few options. At the same time the Kratom Community and it’s “advocates” need to work far more on public education of both the perceived benefits and risks that the research and reports have identified. The Kratom industry as well as Congress should be seeking far more openly funded research be done by academics to explore if the benefits greatly out number the risks and vice versa. There is far too many unanswered questions but at this point the Kratom organizations as well as the FDA have both grossly muddied the water with misinformation while pointing at the other for doing the same. Ita fairly clear that most Kratom consumers are trapped in the middle and will lash out due to fear of a ban while not fully understanding the risks they are accepting and likely pushing on others.

At this point the call should be for the FDA, Congressional representation and the consumers trapped in the middle to hold a public forum, find some commin sense approach to increasing safety, oversight and properly public funded research. It just largely looks like neither side is willing to truly sit down with the other with consumers just trapped in the middle and used as pawns in a larger match of chess.

I appreciate the authors points, I both agree and disagree with some of them but I can openly admit my bias. I’m a Kratom consumer that knows I face both benefits and risks. Hopefully we will finally get a more open dialog going on that isn’t directed by “advocates” but by those that just want safer access to a plant that has improved many in interesting ways.

Adriane Fugh-Berman

March 16, 2018 at 11:33 pm

Claims that “there is no evidence that kratom is deadly” and that all kratom-associated deaths involved other drugs are wrong. Some deaths involved kratom alone. Some people killed by kratom were also taking an antihistamine, an anticonvulsant, or another drug unlikely to have caused death. Some people combined kratom with other opioids, which certainly could have contributed to deaths because of additive effects. That still doesn’t exonerate kratom, because kratom contains opioids that contributed to a fatal overdose. Sure, kratom helps opioid withdrawal symptoms – it’s an opioid. And because it’s a natural product, it will contain varying amounts of opioids. Pharmaceutical products for opioid use disorder are standardized, and have known benefits and harms. Medication-assisted treatment, under a health care professional’s care, is a far safer choice than DIY kratom regimens.

Kristina Monroe

April 7, 2018 at 5:34 am

“There is no evidence to indicate that kratom is safe or effective for any medical use.” (Copied from article) But there was no paragraph that said there is no evidence that Kratom is not safe and not effective for medical use.
In regards to private donors who choose to contribute to further the research of Kratom, isn’t that their choice? Is it not ok to remain anonymous? Might donors feel there could be some recourse for such donations? Who knows? Research with findings of negative properties of Kratom are government agencies or government funded studies. I’m not singling out this article to express my opinion. I appreciate the opportunity since I have yet to find articles with the same principles that offer comment sections for some strange,uh hem, reason. Thanks for having the courage