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

• Wired’s “Kratom: The Bitter Plant that Could Help Opioid Addicts if the FDA doesn’t Ban it” concluded that if kratom is removed from public sale, recovering addicts lose something “possibly quite good.”
• Rolling Stone’s Why Did the FDA Declare the Herbal Supplement an Opiate? heavily quotes Herman and an AKA-commissioned scientist, Jack Henningfield, who “sees potential in kratom to help people suffering from opioid addiction.”
• The Cut’s The Intriguing Therapeutic Potential of a Little-Known Plant From Southeast Asia quoted Henningfield saying most users report “extreme benefits” from kratom, without mentioning his financial conflict.
• CNN’s Can the kratom plant help fix the opioid crisis? quotes a kratom researcher stating there is “definite medical potential for this plant” in treating opioid withdrawal.

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.

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.

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.”