Kratom, Again

aaaaaaaaaaaaaaakratom

I blogged about this topic about a year ago, and thought I’d post a repeat, given recent events in another Southern state.

Parents of a 22-year old junior at the University of Georgia say their son killed himself after becoming inadvertently addicted to kratum

http://www.11alive.com/story/news/local/mornings/2015/06/03/family-fights-substance-they-say-led-to-sons-suicide/28396933/

https://www.yahoo.com/parenting/whats-kratom-parents-speak-out-after-drug-drives-119458538452.html

These parents are lobbying to make this drug illegal in Georgia, where its use is presently not against the law.

Kratom (also called ketum or kratum) is a tree in the genus Mitrogyna, which is related to the coffee tree, and found in Southeast Asia. Kratom leaves have been used for thousands of years by natives of the area to produce stimulant and opioid effects. Fresh leaves can be chewed, or broken up to make a drink, or steeped in hot water to make a tea. Dried leaves can be smoked by users, who say low doses of kratom cause a stimulant effect. Higher doses are said to cause sedation.

Kratom’s active ingredient is mitragynine, an opioid agonist. Mitragynine activates the mu opioid receptor in the human brain to cause an opioid-like effect. Like other opioids, this compound in the kratom tree relieves pain and causes euphoria. Some rat studies demonstrated more potent analgesia from mitragynine than morphine. It’s structurally different than other opioids, and unlikely to show as an opioid on drug testing.
Because of its opioid-like effects, kratom can be used recreationally for the high it produces.

If you google “buy kratom,” more than a million websites appear, offering to sell all sorts of varieties of kratom, and extolling its properties of, “Pain relief, Energy, Prolonged Sexual Intimacy, and Mood Support.” You can buy capsules, dried leaves, and plant extracts. Because of this recreational use, governmental agencies in the U.S. have been reluctant to fund studies on this drug.

Users and marketers of kratom say it’s an herbal pain medication that’s safe and effective.

Sadly, many people accept the idea that “herbal” and “natural” means “safe.” Not so at all. Some of the world’s most potent poisons are found in nature. Hemlock, belladonna, and cyanide leap to mind. And there’s no way to know what exactly you are buying on the internet. It may be kratom, ….or it may be nightshade.

Assuming a person does buy real kratom off the internet – is it harmful? Probably about as harmful as other opioids, though rat studies did show less respiratory depression than other opioids. That may be due to kratom’s activity at the kappa opioid receptor. This drug also has adrenergic and serotonergic activity, so it has a complicated method of action. The increased adrenergic effect of the drug may give users a feeling of energy, like the other stimulants cocaine and amphetamines. This property has led some people to say kratom could be a treatment for methamphetamine addiction.
Chronic and continued use of the kratom leaf can cause opioid dependence, with opioid-type physical withdrawal symptoms when stopped. However, at least one case report showed less physical withdrawal than expected when a heavy user suddenly stopped kratom after having a seizure. [1] There’s talk on internets sites of using kratom as a treatment for opioid addiction, but no scientific literature or human trials have been done.

Mitragynine from the kratom tree has intriguing possibilities for use in the medical world, but we won’t know unless scientific studies are done. Until then, it would be dangerous and irresponsible to recommend use of this product, especially if it’s bought off the internet with no way to know what you are buying.

I hope researchers will explore this drug to see if it has potential to help patients with opioid addiction. For now, there’s not enough evidence to be able to recommend kratom’s use for any purpose. And with recent publicized adverse events, there’s good reason to avoid kratom, given it’s potential to cause physical dependence and addiction.

Even if the compound mitragynine in kratom shows efficacy in clinical trials as a pain reliever or opioid addiction treatment, it shouldn’t be ingested in unprocessed plant form. We don’t have people in pain chew on an opium poppy seed pod, or heart patients chew on the foxglove plant to get their digitalis, and doctors won’t recommend use of kratom in the plant form. Let’s purify the drug in kratom, mitragynine, study it, and produce it as a medication in standardized doses with quality control, if it’s found to be effective.

1. http://www.scientificamerican.com/article/should-kratom-be-legal/

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2 responses to this post.

  1. Posted by Jessica Eaddy on June 8, 2015 at 2:16 pm

    Thanks for sharing this, as I’ve been hearing a lot more about it lately as well. Do we know if naloxone is effective in reversing kratom overdoses?

    Great to see you in Statesville!

    Jessica Eaddy, MSW

    Project Lazarus Training Coordinator

    Governor’s Institute on Substance Abuse

    1121 Situs Court, Suite 320

    Raleigh, NC 27606

    (919)256-7415

    jessica.eaddy@governorsinstitute.org

    Reply

    • Excellent question!
      I don’t know that anyone has tried it for kratom overdose, but I don’t think it would hurt to try. That’s the nice thing about naloxone – there’s no down side to using it, if the person has stopped breathing. so yes, I would definitely try it, if I had a patient with a kratom overdose.

      Reply

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