When it comes to addictive substances, most of what I write about on Sobrietyland has to do with my former Vicodin and Loperamide addictions. But there are so many other “new” or “natural alternative” drugs emerging on the scene! I get questions regarding Kratom with some frequency. Recently, one of my relatives has started touting the wonders of Kratom to me, not knowing of my drug addictive past. She has sent me invitations on Facebook to join her various and sundry Kratom Use Promotion Groups, all of which I have declined. They are often filled with hyperbole and bad science. So I decided to investigate and study for myself.
Kratom (botanical name Mitragyna speciosa) is a “relatively” new drug to the US and Europe, widely sold, unregulated, in head shops, often labeled as “incense” and hypocritically labeled “not for human consumption” (though everyone knows that’s exactly what it’s for). It has been popular for centuries in Southeast Asia as an anti-diarrheal medicine, a painkiller, and a recreational drug (numerous reports in the literature of this being a major health problem there). The kratom plant is in the same family as coffee, and the drug is derived from the leaves of the tree. The leaves are often crushed and chewed, eaten, smoked, or consumed using various other methods of ingestion. “The pharmacokinetics of M. speciosa in humans has not been well studied and various aspects such as the half-life, protein binding properties and other properties such as the elimination or metabolism is not known.” (Wikipedia) Users often compare it to coffee with a kick — or consider it as innocuous as a caffeine addiction or a light marijuana habit.
As I am sort-of, kind-of, ya-know, now in the business of substance abuse/addiction, I decided it was long-past time that I start researching this opiate alternative and see for myself. In doing so, I began to worry that my niece is being fed a ton of internet-based false information. Hey, when I first started using Loperamide, I looked at the internet discussion groups and thought it was a wonder drug too. It wasn’t.
[Full disclosure: way back in the day, before Loperamide, I had tried Kratom for my Vicodin withdrawals, entirely unimpressed with the results. It tasted like rotten sweatsocks and was too expensive in my opinion. But times have changed.]
The rise of opiate alternatives (like Kratom and Loperamide) are worrisome to me — and the medical community at large as well.
Okay, before people get all weird and crazy and defensive about the Kratom thing (as they are wont to do), here’s why I’m concerned.
If you overdose on a traditional opiate (Vicodin, Heroin, etc.) and present to the Emergency Department unconscious (or at the very least, unwilling to tell them what you’re on) there are certain tests that teams can administer to save your stupid ass from yourself. First, they run a fast tox screen to see what you’ve been taking. Traditional opiates light up like a Christmas tree, so your ED team can administer Narcan and other medications to ensure you don’t die from your overdose.
A bit about tox screens for a minute. Toxicology screens are tests used to determine if an individual has been exposed to certain legal or illegal drugs. They are designed to do this by keying in on particular metabolites of drugs. For instance, the metabolite for Vicodin is Hydromorphone. If that lights up on the tox screen, they know what you’ve been taking so they know how to treat it. If you’ve been using cocaine, Benzoylecgonine will be highlighted, and appropriate treatment can be started.
BUT if you use an alternative substance, like Loperamide — or like Kratom — that bind to opiate receptors, but don’t show up on a traditional tox screen, you’re screwed. Loperamide’s metabolite is N-Desmethyl-loperamide — that’s not on the list. Kratom’s metabolites, one of which is 5-desmethylmitragynine, isn’t on that list either. They are detectable in a lab setting however, but not in the standard set of ED tox screens. This can lead to misdiagnosis or improper treatment.
So what to do with the Kratom thing?
Like Loperamide, people use Kratom to ease symptoms of withdrawal from traditional opioids. Some just use it as a legal high. BUT…. do they stop?
And as with loperamide, there is a lot of misinformation out there regarding Kratom’s safety that I take issue with.
- Kratom is “herbal” and “natural” so it’s perfectly safe. FALSE. Oh please. A drug is a drug is a drug. Heroin, for instance, happens to be derived from Papaver Somniferum, a specific species of the Poppy flower. One could easily argue that it is also safe because it comes from nature. Bad assumption there.
- Kratom is not an opioid. FALSE. This is really just a game of semantics. Just because it doesn’t come from a poppy doesn’t mean it isn’t an opioid. If the drug’s metabolites bind with opiate receptors (in Kratom’s case, both mu and kappa), then yes, that would be an opioid. A non-traditional one, but one just the same.
- It is said that Kratom is not addictive. As a mind-altering substance, you’re damn skippy it IS addictive. Will everyone become addicted to it? No. Just like any other potential drug of abuse, if you have addictive tendencies, and you’re on a mind altering substance that makes you feel good, and you NEED to feel good, the odds are in your favor that addiction will follow. Just remember, the same argument could be made for opium — some will be addicted, some won’t. Do you really want to find out?
- Some say Kratom has no tolerance or withdrawal symptoms. FALSE. Just like any opiate, it has both tolerance and withdrawal, the severity of which is dependent on the dosage and length of time of usage. Just like Vicodin.
- Nobody ever overdoses or dies from Kratom. FALSE. Both deaths and overdoses have been reported in the medical literature (particularly seizures and coma), leading some states and regions to ban or regulate the drug.
Maybe I’m just being a party-pooper asshole who’s trying to ruin someone’s legal high, or trying to remove a poor chronic pain patient’s only means of effective pain relief, right? BUT I look at it this way: I feel it’s incumbent on me to blow a few of these misconceptions out of the water. If you want to use Kratom, you should know what you’re getting into.
It’s legal. It’s unregulated. But just like loperamide in high doses, or any other mind-altering substance, it can cause addiction and there’s a lot of crap information out there to help you justify your usage if that’s what you’re looking for. That’s the danger. Be clear with your doctor what you’re on. If you don’t want to do that, put a little index card in your wallet or purse that could tell medical staff what you’re using (and how much) in case of an emergency. And please, above all, don’t combine it with other psychotropic medications without consulting your doctor. Seriously.
If you’re gonna do it, I certainly don’t recommend it. But know the facts about what you’re getting into. An informed decision is better than one based on bullshit.
“An intelligent person can rationalize anything, a wise person doesn’t try.”― Jen Knox
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