2020 Johns Hopkins Kratom User Survey
Johns Hopkins Medicine researchers released the findings of an anonymous online survey of more than 2,700 self-reported kratom consumers. Overall, the results suggest that kratom should be studied and regulated rather than banned and that the active compound in kratom has a lower rate of harm than prescription opioids in the treatment of pain, anxiety, depression and addiction.
The study “Kratom (Mitragyna Speciosa): User demographics, use patterns, and implications for the opioid epidemic” is published in the journal Drug and Alcohol Dependence.
The study results have significant implications, because in 2016, the U.S. Drug Enforcement Agency (DEA) proposed banning the commercial sale and use of kratom, and the U.S. Food and Drug Administration (FDA) advised categorizing it as a Schedule I drug, meaning it has no proven medical application and has a high risk of abuse.
These proposals were met with significant public outcry and supplemental industry pushback, and no action was taken.
The research team states that kratom is neither regulated nor approved by the FDA and that scientific studies have not been conducted to officially establish safety and benefits. In addition, they say that U.S. drug agencies should seek to research and regulate rather than ban kratom sales as it appears to have safe therapeutic potential and may potentially be used as an alternative to opioid abuse.
Albert Garcia-Romeu, Ph.D., instructor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, says the new survey findings “suggest that kratom doesn’t belong in the category of a Schedule I drug, because there seems to be relatively low rate of abuse potential, and there may be medical applications to explore, including as a possible treatment for pain and opioid use disorder.”
“There has been a bit of fearmongering,” he adds, “because kratom is opioidlike, and because of the toll of our current opioid epidemic.”
For the survey, the researchers recruited participants online and through social media, as well as through the American Kratom Association (AKA). Overall, users were mostly white, educated and middle-aged, and 97% were located in the United States.
Kratom was primarily taken orally in doses of 1-3 grams (49 % of respondents), with daily use (59 %) being most common. Kratom was used for pain (91% of respondents), anxiety (67 %), and depression (65 %), with high ratings of effectiveness.
Approximately 61% of users were women, and 90% were white. About 6% reported being multiracial, 1.5% reported being Native American or Hawaiian, 0.5% reported being Asian and 0.4% said they were African American. Participants were an average age of 40. About 84% of respondents reported having at least some college education.
Of the survey participants, 91% reported taking kratom to alleviate pain on average a couple times a day for back, shoulder and knee pain; 67% took kratom for anxiety and 65% for depression.
About 41% of survey respondents reported using kratom to treat opioid withdrawal, and of those people who took it for opioid withdrawal, 35% reported going more than a year without taking prescription opioids or heroin.
As part of the survey, the survey participants completed a Substance Use Disorder Symptom checklist to see whether their kratom use qualified as a substance use disorder according to the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition guidelines. Less than 3% of responses met the criteria for moderate or severe substance use disorder for abusing kratom.
Factors Supporting Why Kratom Should Be Legal and Regulated
“Both prescription and illicit opioids carry the risk of lethal overdose as evidenced by the more than 47,000 opioid overdose deaths in the U.S. in 2017,” says Garcia-Romeu. “Notably there’s been fewer than 100 kratom-related deaths reported in a comparable period, and most of these involved mixing with other drugs or in combination with preexisting health conditions.”
About a third of the participants reported having mild unpleasant side effects from kratom, such as constipation, upset stomach or lethargy, which mostly resolved within a day.
Only 1.9% reported that side effects were severe enough for them to seek medical treatment. These effects included feeling withdrawal symptoms such as anxiety, irritability, depression or insomnia when the kratom wore off.
When asked how troubled they felt regarding their kratom use, the mean rating was 3.2 on a scale from 0 to 100.
“Although our findings show kratom to be relatively safe according to these self-reports, unregulated medicinal supplements raise concerns with respect to contamination or higher doses of the active chemicals, which could increase negative side effects and harmful responses,” says Garcia-Romeu.
“This is why we advocate for the FDA to regulate kratom, which would require testing for impurities and maintaining safe levels of the active chemicals. Otherwise, unregulated products run the risk of unsafe additives and dosing problems, which could be like getting a shot of grain alcohol when you were trying to order a beer.”
Siesta Botanicals Testing
As with any organically-grown plant, kratom is susceptible to contaminants that may be present in the soil, water and air. However, contaminants and unsafe additives aren’t a problem with our kratom. All kratom from Siesta Botanicals is thoroughly tested for potential contaminants, including heavy metals and bacteria. In particular, a third party lab tests our kratom for lead, arsenic, cadmium, mercury, E.coli and salmonella.
In addition, before we even began selling kratom, the owners of Siesta Botanicals made the journey to Indonesia to personally inspect our facilities and farms to observe their growing, harvesting and storing practices. They were able to witness firsthand the quality of the product before purchasing anything to sell directly to the customer. As an added bonus, Daniel, one of the owners of Siesta Botanicals, is also certified in quality management for government contracting.
According to the American Kratom Association (AKA), when the FDA began focusing on the adverse events and deaths they had alleged to be linked to kratom, as well as on the contaminants and adulterants that were present in some kratom products, the AKA created the Good Manufacturing Practices (GMP) standards program that asked vendors to voluntarily adhere to the GMP standards for food and dietary ingredient products.
“This has been welcomed as a powerfully positive step by many elected officials, public health officials, and policy makers at all levels of government. It clearly demonstrates the kratom industry is both willing and capable of self-regulation and condemns the kratom manufacturers to fail to use GMPs or who deliberately adulterate their products for profit.” The American Kratom Association