Herbal Medicines for the Management of Opioid Addiction

Abstract

Striking increases in the abuse of opioids have expanded the need for pharmacotherapeutic interventions. The obstacles that confront effective treatment of opioid addiction - shortage of treatment professionals, stigma associated with treatment and the ability to maintain abstinence - have led to increased interest in alternative treatment strategies among both treatment providers and patients alike. Herbal products for opioid addiction and withdrawal, such as kratom and specific Chinese herbal medications such as WeiniCom, can complement existing treatments. Unfortunately, herbal treatments, while offering some advantages over existing evidence-based pharmacotherapies, have poorly described pharmacokinetics, a lack of supportive data derived from well controlled clinical trials, and severe toxicity, the cause for which remains poorly defined. Herbal products, therefore, require greater additional testing in rigorous clinical trials before they can expect widespread acceptance in the management of opioid addiction.

Pharmacologic and clinical assessment of kratom

“…13 Importantly, oral kratom doses of 807 and 920 mg/kg did not induce respiratory depression. 16 Mitragynine stimulates postsynaptic a-2 adrenergic receptors. 9,17 Dexmedetomidine is an a-2 adrenergic agonist used for sedation, and clonidine is an a-2 adrenergic agonist used to manage pain, anxiety, attention deficit disorder, and symptoms of withdrawal (e.g., from opiates, benzodiazepines, alcohol, tobacco).…”

Determination of Common Pharmaceutical Adulterants in Herbal Medicinal Products Used in the Treatment of Opioid Addiction

“…Moreover, the effectiveness of OAT is limited by difficulties at all levels of the therapeutic process, such as diagnosis, entry, and persistence of the patients on treatment; it also needs training health care professionals for the treatment and prevention of opioid abstinence syndrome during the therapy [1]. In this regard, there is an increased interest in alternative pharmacotherapy modalities for opioid addiction among health care providers and patients [8][9][10][11][12].…”

“…Unfortunately, herbal remedies used in the treatment of opioid addiction have poorly described pharmacokinetics and mechanism of action, high potential of drug interactions, and the lack of evidence-based efficacy data from well-controlled clinical trials. Severe toxicity and high risk with adulteration with synthetic chemical and pharmaceutical agents are the important limitations of the usage of herbal remedies in treatment [8]. In Iran, many unregistered herbal shops introduce herbal medicines as traditional formulations, but there are poor regulations for the safety of traditional herbal products.…”

A Mass Spectrometric Study of Kratom Compounds by Direct Infusion Electrospray Ionization Triple Quadrupole Mass Spectrometry

“…Mitragynine (MG) and its major metabolites 7-hydroxymitragynine (7-OH-MG) are two of the major components of the plant extract Kratom [1] [2]. Kratom is derived from the Mitragyna speciose Korth tree in Southeast Asia, and like oxycodone, it has rare paradoxical properties consisting of augmented focus, concentration and physical energy, with concurrent reduction in physical and emotional pain [3] [4].…”