New research suggests that mindfulness can help reduce cravings for opioids.

The National Institute on Drug Abuse report that around 21–29% of people, whose doctors prescribe them opioids for the management of chronic pain, end up misusing these drugs. Furthermore, some 8–12% of people who take prescription opioids develop opioid use disorder.

Some of the criteria that specialists use to diagnose opioid use disorder — according to the Diagnostic and Statistical Manual of Mental Disorders — include:

• taking opioids for longer or in larger quantities than the doctor advised
• experiencing intense and hard to control cravings for opioids
• opioid use negatively affecting performance at work or school

Usually, when a person receives a diagnosis of an opioid use disorder, doctors prescribe methadone maintenance therapy.

In this form of therapy, doctors offer people controlled doses of methadone — also an opioid — to help reduce withdrawal symptoms and reduce cravings for opioid drugs.

“Methadone maintenance therapy has been an effective form of medication treatment for opioid use disorder,” notes Nina Cooperman, an associate professor and clinical psychologist in the Division of Addiction Psychiatry at Rutgers Robert Wood Johnson Medical School in New Brunswick, NJ.

“However, nearly half of individuals on [methadone maintenance therapy] continue to use opioids during treatment or relapse [within] 6 months,” she adds.

For this reason, Cooperman and colleagues were interested in finding out whether some alternative practices, specifically, mindfulness, could help boost the effectiveness of methadone maintenance therapy for people with opioid use disorder.

Mindfulness may be a useful therapy add-on

In a study — whose results now appear in the journal Drug and Alcohol Dependence — Cooperman and team tested a new approach to opioid use disorder treatment.

The researchers recruited 30 participants with this condition, as well as chronic pain, whom they randomly split into two groups.

Over 8 weeks, one group continued with their usual treatment of methadone and targeted counseling, while the other received an experimental, combination therapy that the researchers dubbed “Mindfulness-Oriented Recovery Enhancement” (MORE).

MORE combined methadone maintenance therapy with mindfulness practice, which teaches individuals to focus on the present and become more aware of thoughts and sensations as they occur.

The researchers found that, at the end of the 8-week study period, the participants who had received the MORE experimental intervention reported having 1.3 times better control over their opioid cravings compared with peers from the group that had their treatment as usual.

Participants in the MORE group also reported significantly lower pain and stress, as well as significantly higher positive emotions in comparison with the other participants.

Also, those who practiced mindfulness noticed that they were aware of more cravings for opioids. The investigators suggest this reaction may have actually helped these individuals gain more control over those cravings since mindfulness promotes awareness without judgment.

“[T]he therapeutic effects of MORE were evident above and beyond those provided by a structured program of [treatment as usual], consisting of approximately 6 hours of group and individual therapy per week — attesting to the potency of the MORE intervention,” the researchers conclude in their study paper.

“Thus, […] the present study provides suggestive evidence that MORE may be a useful adjunctive behavioral therapy for medication assisted treatment of [opioid use disorder] among individuals with chronic pain,” the authors suggest.

Kratom’s rise in popularity is concerning.

Kratom is an extract from the tropical tree Mitragyna speciosa, a relative of the coffee plant.

Historically, manual laborers in Southeast Asia have used the compound — either chewing the leaves or making them into tea — to soothe aches and pains and boost energy levels.

As it stands, kratom is not illegal in the United States, and people can easily purchase it online.

It is most commonly available in the form of a green powdered supplement. Although manufacturers market kratom extract as safe and natural, it is far from inert.

Scientists have carried out limited studies on its effects, but it appears to act as a stimulant at lower doses and has a sedative effect at higher doses. Over recent years, usage in the U.S. has increased sharply.

Who uses kratom?

Some people with mood disorders or chronic pain use kratom to self-medicate, whereas others use it recreationally. Some individuals with opioid use disorder use the drug because the active component of kratom — mitragynine — acts on opioid receptors.

Although there is no medical evidence to support this use, some people who are dealing with an opioid addiction consider kratom to be a godsend. Relative to opioid-replacement medications, such as buprenorphine, it is much cheaper and easier to obtain.

After witnessing firsthand an increase in patients experiencing either the toxic effects of kratom or symptoms of withdrawal, Prof. William Eggleston from the State University of New York at Binghamton decided to investigate.

Prof. Eggleston and his team took data from the National Poison Data System (NPDS) and a County Medical Examiner’s Office in New York State. They recently published a brief report in the journal Pharmacotherapy.

A startling increase

The researchers took data from between January 1, 2011, and July 31, 2018. In total, they identified 2,312 reports that mentioned kratom exposure.

The data describe a worrying trend: In the whole of 2011, there were 18 exposures, but, in just the first 7 months of 2018, there were 357 exposures.

More than half of the events (56.5%) involved taking kratom as a powder, capsule, or tablet, with 86.2% of users taking kratom orally.

Many of these events involved multiple substances, so the scientists focused their analysis on the 935 cases that only involved kratom. The most common adverse events were:

• agitation: 18.6%
• tachycardia: 16.9%
• drowsiness: 13.6%
• vomiting: 11.2%
• confusion: 8.1%
• seizure: 6.1%
• withdrawal: 6.1%
• hallucinations: 4.8%
• respiratory depression: 2.8%
• coma: 2.3%
• cardiac or respiratory arrest: 0.6%

Additionally, they identified four cases of neonatal abstinence syndrome, in which an infant experiences withdrawal from a drug due to exposure during gestation.

In four cases, the reports listed kratom as either a contributing factor or a cause of death. In two of these cases, the reports identified kratom alone; in the other two cases, additional compounds played a role.

Although kratom is less potent than other opioids, it can still have significant negative effects on the body.

“In larger doses, it can cause slowed breathing and sedation, meaning that patients can develop the same toxicity they would if using another opioid product. It is also reported to cause seizures and liver toxicity.”

Lead author Prof. William Eggleston

More work necessary

It is clear that kratom can produce negative effects, but that does not mean that the authorities should ban it entirely. As Prof. Eggleston explains, “Kratom may have a role in treating pain and opioid use disorder, but more research is needed on its safety and efficacy.”

Importantly, though, he hopes that regulations will become tighter. “Our results suggest it should not be available as an herbal supplement,” he says.

The authors note that reporting drug events to the NPDS is voluntary, so the findings are likely to significantly underestimate the true number of adverse events relating to kratom.

Although these findings add to our understanding, there are still questions around who uses kratom, why they use it, and how it interacts with other substances. Prof. Eggleston plans to follow up this work with a deeper dive into kratom and those who use the drug in the U.S.

As the opioid crisis continues, the number of people using kratom is likely to increase. Understanding kratom and its impact is more important than ever. The authors end the article with a call to action:

“[K]ratom’s rapid rise in popularity in the [U.S.] highlights the urgent need to expand access to evidence-based medication-assisted treatment for patients with [opioid use disorder] and to address the complex symptoms of chronic pain.”