Note: this post refers back to an earlier post on the topic.
Since I conducted my wee kratom study in 2018, how much proper scientific research on the herb do you think has been done? I mean, given its potential as a harm-reduction measure for opioid and alcohol dependency, wouldn’t you expect half the labs in America to be well-stocked with green powder and instruments for measuring its effectiveness? Wouldn’t you expect to see long lines of volunteers waiting outside the doors of these labs–volunteers with monkeys on their backs hoping for a chance to see if kratom can finally peel those pesky monkeys off? Wouldn’t you expect to see scientists racing to publish whether the green powder actually works or is just an unusually effective placebo?
But, no, in the seven years that have passed since my wee study, almost nothing has been published on the topic of whether kratom can help people with alcohol use disorders. Or opioid dependency, even though that use is well-attested in Southeast Asia, where kratom grows naturally. Or much of anything else having to do with kratom. In fact, a 2024 article in the journal Addiction Medicine begins by saying, “Use of kratom has outpaced systematic study of its effects, with most studies reliant on retrospective self-report.” In other words, people are consuming much more kratom today than they did in 2018, but science has lagged behind, doing essentially what my wee study did, though with way more people answering way more scholarly interview questions.
And what conclusions has this handful of timid, derivative studies reached? Get ready to yawn again: they agree that kratom shows great potential as a harm-reduction measure for substance use disorders but that there’s not enough research yet to justify clinical use.
A person could be forgiven for wondering why scientists don’t do more of that research, instead of observing over and over that it doesn’t exist–though, to be fair, the study I just quoted did a tiny bit, which I’ll get to in a minute. But first, what the heck is this “clinical use” that can’t start until they get off their asses? Turns out, “clinical use” is the kind of experiment I was just talking about: giving kratom to people who might actually benefit from it and then checking to see whether they do benefit, and, of course no responsible scientist would immediately do that with a brand new drug, even one for a worldwide killer like alcohol dependency! First they’d demonstrate that it’s safe and efficacious for hard-drinking rodents; then they’d try it on dipsomaniac dogs, rabbits, or monkeys; and only then would they test it on humans struggling with alcohol use disorders.[1]
But kratom isn’t a brand new drug; it’s an old, familiar plant that has been used for hundreds of years, first in Southeast Asia and now all over the world. There’s no need to give kratom leaf to guinea pigs to prove its safety because thousands, possibly millions, of human guinea pigs have already consumed it without dying or even suffering much in the way of adverse effects![2] Moreover, kratom has the potential to help with a very urgent problem: the opioid and alcohol dependencies currently killing hundreds of thousands of Americans and (in the case of alcohol) millions worldwide–and without leaving worse problems in their place! So should postponing “clinical use” really be a top priority right now?
As if logic and basic humanity weren’t enough reason to move immediately to clinical trials of kratom, the law is no longer the impediment it once was because, at the end of 2022, Congress passed the FDA Modernization Act 2.0, repealing an earlier law requiring all drugs to be tested on two animal species (one small and rodent-like, one larger and cuter) before being tested on human beings.
So, since December 2022, there has been nothing, not even a legal technicality, preventing clinical trials of kratom for alcohol use disorders, which means that the past couple of years should have witnessed a veritable stampede to the labs of alcohol researchers as they rushed to test the discoveries made by pioneers like the ones who answered my little questionnaire and posted their discoveries to social media and blogged about their experiences. But there hasn’t been.
I do have to acknowledge that, if you use a search engine such as Google Scholar, you’ll certainly notice a few articles popping up in response to the combined search terms “kratom” and “alcohol.” But most of them are just articles about people’s stated reasons for using kratom, including to cope with alcohol cravings, not articles investigating how kratom does those things. Or even how well, except subjectively. They mostly just ask people “Why do you use kratom?” and enough people answer “to deal with an alcohol problem” to put the word “alcohol” into the summary.
Some researchers on the general side do go a teeny-tiny bit further, though still not very far, asking, for example, whether people who use kratom “instrumentally” consume more kratom than people who use kratom “recreationally,” which is the kind of question researchers like because it’s binary, hence, clear-cut and easy to quantify. Also because all the surveying and all of the data-collating can be done by an app. But the truth is that the line between instrumental and recreational use isn’t clear at all. I might use kratom overall to help me stop drinking (instrumental), but is every dose purely instrumental? When I raise my dose, am I really thinking “Four grams are no longer sufficient to quell my alcohol cravings” (instrumental), or am I thinking “It’s been a rough day, and I’d enjoy a buzz, for once” (recreational)? Or am I thinking both things, along with a little “and my back hurts” (instrumental) plus a soupçon of “fuck it, I don’t know why; I just want another gram” (neither instrumental nor recreational). So I have trouble seeing this research as terribly useful.
There was one article I found somewhat useful, however: the one I quoted at the beginning of this post, which measured the effects on ten regular kratom users of their normal morning dose. It found only minor physiological changes after dosing: a decrease in pupil diameter and withdrawal symptoms plus mild euphoria for about eighty minutes to two hours. There was no appreciable change in psychomotor performance. While these results aren’t news to anyone who uses kratom, they’re valuable in objectively confirming that there’s no physical or mental impairment associated with regular, judicious use of the herb. In other words, when people claim they can work just fine while taking kratom regularly, that they feel good but not high, there are now data to support the claim—not much data, to be sure, but a start.
Most of the other research just summarizes what’s already known and urges further study, which might have looked bold and inspiring in 2018 but now seems timid and frivolous, as though researchers want to be known as someone who recognized kratom’s value ahead of the curve but are worried it might later get banned and demonized and make them look like child-poisoners an ruin their careers. So they call for further research to hedge their bets, giving themselves the scientific cachet of pioneers without actually pioneering anything.
But let’s give those poor researchers the benefit of the doubt. Let’s be kind and realize that it has only been since 2022 that clinical trials of kratom have been 100 percent lawful. It takes a while for scientists to design useful experiments and find the necessary staff and line up the funding and take care of the other logistical considerations I know nothing about because I’m not a scientist, though I did work in an NIH lab as an undergraduate researcher, so I know there are a lot of them. Let’s grant all of those things and conclude thereby that it’s simply too early to expect the amount of research and the kinds of research I had hoped to find when I sat down to write this follow-up. Surely, then, that research is on its way! It’s being conducted right now, or it’s in the pipeline, and we’ll be reading all about it in a year or two or three at the most! Right?
You’re thinking I don’t have a crystal ball so I can’t answer that question, but I can, as long as the NIH research database hasn’t been shut down yet. So go make yourself a sandwich while I look. Make it two sandwiches and dessert; the database is a little clunky.
[An hour passes.]
Yes, the giant list of all studies currently funded by the NIH is still online and keyword-searchable, including 1,256 projects sponsored by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). It’s up for now, anyway, though the Senate will soon confirm the new NIH director, Jay Bhattacharya, whose views on alcohol research are unknown, as alcohol research doesn’t involve vaccines, the primary focus of his confirmation hearing. Apparently, however, he’s a big fan of “scientific dissent,” so I’ll be brainstorming ways to make the lack of kratom research look a big pharma conspiracy. Which it very well may be, now that I think about it, although not the kind with a cute name ending in “-gate.”
Sorry, so hard not to get distracted by politics these days.
Anyway, pleased as I am to see the NIH database still standing and the research it listed still underway (for now), I’m sorry to report that I saw zero evidence of any NIAAA-funded studies into the efficacy of kratom as a harm-reduction measure for alcohol dependency. And, if you’ve read some of my less-sexy blog posts (don’t feel bad, no one else reads them either), then you know that NIAAA is the world’s leading funder of research into alcohol use disorders, so, chances are, this vital research simply isn’t being done.
I did notice one hopeful thing, however: four major studies investigating the role of opioid receptor systems in alcohol use disorders and in treatment for alcohol use disorders. Now don’t get too excited: it is not news that opioid receptors play a role in alcohol dependency; that has been known for many decades. But some of this new research specifically aims to see if medication targeting opioid receptors might be useful in treating AUDs, so perhaps, eventually, one of these researchers will stumble over kratom, which targets these very receptors. (At the moment, the only medication specifically named is naltrexone—again, not news, but I suppose a bit more study of that drug would not go amiss.)
So maybe I’ll write to the opioid pathway researchers and suggest they look at kratom. Sounds ridiculous, I know—why would Real Scientists read an email from the likes of me? But I write to most of the scholars I cite, and a surprising number respond, not because they’re dazzled by my writing, but because I make a point of reading theirs and struggling to understand it. It’s the same phenomenon as going to a country where you don’t speak the language but trying anyway; you’re going to make a hash of it, but people tend to appreciate the effort.
So stay tuned for another follow-up on kratom as harm reduction for alcohol use disorders—and let’s hope it’s not another seven years before there’s something to report!
Image by Deep Dream Generator from a base photo taken by me (the photo accompanying the original article).
[1] To be fair, I did notice one scholarly article mentioning brand names of kratom used in its research, thus allowing the average person to easily track some down. So, clearly, not all researchers endorse the “let’s not let anyone try kratom until all the monkey data are in” position.
[2] Two points need making here. First, kratom has shown up on some coroners’ toxicology reports, almost always as one of many drugs in a dead person’s system, including some lethal ones that are far more likely causes of death. Caffeine also shows up on a lot of coroner’s reports, but that doesn’t mean that caffeine is fatal, just that people sometimes drink coffee before taking a fatal drug or drug-and-alcohol overdose. Same with kratom.
Second, though kratom was traditionally consumed much like coca, as a fresh leaf chewed for pain-relief or endurance, and is now mainly sold in dried-leaf form, some vendors sell extremely potent extracts, which people can manage to OD on, if they really try, though their numbers remain extremely small. Nonetheless, in all of my writing, I caution people to stay away from extracts, and that admonition is crucial for people with a history of substance use disorders (including alcohol dependency). It’s not just the increased chance of an OD, which usually just means half a day of feeling lousy; it’s the increased chance of developing skyrocketing tolerance leading to an addiction that’s hard to shake. Seriously, folks, stick to plain dried leaf, which has everything you need and is less likely to bite you in the ass!