A Few Words on The Kratom Kraze

kratpapa

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?

kratLike 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.

They say….

  1. 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.
  2. 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.
  3. 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?
  4. 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.
  5. 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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REFERENCES:

The pharmacology and toxicology of kratom: from traditional herb to drug of abuse

28 October, 2015, International Journal of Legal Medicine. Marcus L. Warner, Nellie C. Kaufman, Oliver Grundmann

An accidental poisoning with mitragynine

Forensic Science International, Volume 245, December 2014, Pages e29–e32, Ritva Karinena, Jan Toralf Fosena, Sidsel Rogdea, Vigdis Vindenesa

New Drugs of Abuse

Pharmacotherapy, article first published online: 4 DEC 2014 DOI: 10.1002/phar.1522 Megan A. Rech, Elisabeth Donahey, Jacqueline M. Cappiello Dziedzic, Laura Oh, and Elizabeth Greenhalgh

Seizure and coma following Kratom (Mitragynina speciosa Korth) exposure

J Med Toxicology, 2010 Dec;6(4):424-6. doi: 10.1007/s13181-010-0079-5. Nelsen JL1, Lapoint J, Hodgman MJ, Aldous KM.

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About madmargaret

Nursing student, Mac nerd, medical 'genius', recovering addict, singer, ex-actor, and all-around swell egg. Really!
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16 Responses to A Few Words on The Kratom Kraze

  1. Lance Lawson says:

    Yup Kratom is not unlike Tramadol (which has been found in African Peach tree bark). If a substance chemically moderates opiate withdrawl it is binding to opiate receptors. Opiate receptors send out signals of withdrawl when the induced stimuli is halted and the natural endorphin count has not yet returned to normal. That’s the long and short of it. Opium is a herb as well, The Poppy is a flower nothing synthetic about opium. I used Tramadol for a year for a chronic pain condition and suffered no major ill effects in term of withdrawl although it wasn’t something I’d stand online to go through again. Kratom is IMO chemically between Opium and Tramadol and brings with it the same risks of tolerance, and addictive potential.

    • madmargaret says:

      Thanks for your reply! As an emerging drug of abuse, Kratom really needs to be studied properly. Appreciate your thoughts — thanks!

  2. I tried it a couple times. The last time, I had the worst headache I’ve ever experienced. Literally felt like my head was exploding. I will never try it again; it’s just awful, dangerous stuff.

  3. This article upsets me. Most of your sources aren’t linked to specific cases but are rather vague statements, and one of them involves a person who was abusing many other drugs along side kratom.

    Kratom is a million fold safer then loperamide, and much safer then traditional opiate and opiod narcotics. When consumed in ground leaf form, and not a sketchy extract, kratom has an extremely good safety profile. The reason for this is that it doesn’t have the respiratory depression that traditional opiates do. Nalexone has never been used on a kratom overdose because it’s not needed. Kratom does not produce a nod.

    Look at the heroin epedemic in the states right now. People are overdosing every single day because of fentanyl cut heroin or just because heroin is a very dangerous substance. That’s how i found kratom. I was an IV heroin and fentanyl addict, as well as high dose loperamide abuse to string me along when i couldn’t get my drugs of choice.

    I overdosed on heroin. I luckily came back around and survived. I began abusing high dose loperamide to avoid the sickness, and began waking up gasping for air drenched im cold sweat, pale as a ghost, severe weakness, you know the story because you’ve been there. Loperamide was causing me cardiac problems. This scared me to death because i couldn’t go cold turkey, the withdrawals were just too severe. Ans i didn’t want to go back to heroin and fentanyl and play russian roulette again, i felt trapped.

    I then learned about kratom. I began using it and immediately dropped the high dose loperamide in favor of kratom. The withdrawals were still bad but the severe constipation induced by loperamide went away, and i wad passing stool multiple times a day again. I got my strength back, my heart rate went back to normal, i stopped terrifyingly waking up gasping for air.

    I tapered my kratom dose down to about 10 grams a day (of plain kratom, no extracts), and then stayed on that dose because went i would try to quit, i would relapse on heroin.

    It’s been a god send maintenance drug for me, with none of the side effects of traditional opiates. No constipation, no nodding, no vomitting, no near overdosing (it’s practically impossible to overdose on because of the lack of respiratory depression!), no itching and scratching, no red face from histamine release, no compulsively redosing like i did with heroin, no lack of appetite. I go about my day feeling like a normal person again.

    I have read ALOT of anecdoctal reports from other kratom users, and the general cobsensus from everyone is the same. Kratom is minimally recreational, and extremely safe compared to traditional opiates. It doesn’t share the month long severe withdrawals and side effects of the current maintenance drugs like methadone and suboxone. It is a plant from the earth, unaltered that has the ability to recover people from dangerous opiate addiction with a safety profile that is uncanny compared to traditional opiates. The withdrawals are mild compared to traditional opiates and opiate maintenance drugs.

    We currently have a heroin epedemic in the US, and i guarentee you that if most of these addicts found out about kratom, it would help them get clean and lead a much risky life style.

    I agree we need to study the alkaloids and mechanisms of actions in the plant so we can better understand it, but i would hate to see it just flat out bannef amd then ignored while the big pharmacy company continue to push deadly, easy to overdose on opiates, and then when they cut these people off, they end up on heroin.

    If kratom is banned i will probably end up relapsing on heroin and OD’ing and dying at some point. So would a lot of other people.

    Unlike loperamide, kratom has a long history of use in humans. It was only banned in thailand because it helped people get over opium addiction, and the government found this to be a threat to the opium trade they were taxing and making large profits from.

    Very few if any deaths, both in asia and now in north america, can be linked directly to kratom. Of those few reports, most of them seem to have involved people abusing other drugs or with other risk factors. Show me one medical journal where kratom was the only substance that contributed to an overdose.

    I can show you thousands where heroin, fentanyl, oxycodone, hydromorphone etc. were the single contributing factor to the death of a yound adult.

    I will be extremely saddened if kratom is made illegal. It may cause the nail in my coffin.

    • madmargaret says:

      Thanks for your thoughtful reply.

      While I understand your frustration, I must disagree with you regarding the relative safety of Kratom. Consider that Thailand, where the plant is grown, has banned the substance due to the number of addicts it has created. While you may think it’s perfectly safe (and many do), the reliance on skewed anecdotal reports on internet forums is precisely why further scientific study needs to be done — and mirrors the reason why loperamide has become such a serious problem that it is being referred to in the literature as a public health crisis. Of course forums are going to report Kratom to be safe and effective; that’s what they need to believe. A contrarian position would threaten the accessibility of the one drug people hope is a safe alternative.

      Many people DO use Kratom in “safe” quantities; many do not. Ignoring that danger is foolhardy.

      I just left a fascinating toxicology presentation on emerging drugs of abuse, one of which is Kratom. Multiple reports coming in from poison control centers regarding overdoses. It’s not just an isolated case of one or two. The rise of opioid dependence has caused a concurrent rise in the abuse of alternative substances; the risk is real.

      Regarding my sources, I assure you I have read them in their entirety. The links go to abstracts which are simply summaries of the submitted case studies. I requested the full copies and read them. And while i understand where you’re coming from on this, please don’t assume that just because it’s a plant from the earth that it is safe. I talked about that kind of thinking in the original article as false assumption (consider people who use opium which is a direct, unadulterated product of the poppy flower, Papaver Somniferum — not safe either).

      I am glad that you are getting some relief from Kratom. But I must do my due diligence by saying, I strongly recommend though that you seek medical treatment for your opioid addiction; remaining on Kratom for life is no life at all. Neither is returning to heroin. That’s not an option — please don’t think it is! There IS a life without opiates or opioid maintenance drugs, and I sincerely hope you can find that.

      Again, I thank you for your thoughtful comments and wish you all the best in your future.

      MM

  4. Hi, Margaret….
    It took me a good week, but I read your entire blog. Pretty good stuff.
    I’ve yet to comment on account of not having the motivation. You know what that feels like.
    July 30th was the last day I took loperamide. I tapered myself down from 144 pills daily to 1 pill. I was able to do that in a little over 5 months. I was at that high dose for almost a year. I won’t write my experience on here, because it’s really long and I’m doing good just to have the desire to want to reach out. But….I wanted to ask you a question. I’m almost at my five month mark of being lope free. I’ve been experiencing a fast heart beat, usually after eating. I went to the Dr on Friday and he hooked me up to the EKG. 101 bears per minute. 130/80 BP. He sent me to the cardiologist. They did another EKG. 100 bPM 118/69 BP. I had a normal sinus rhythm, just fast. They set me up for a 24 heart monitor, lab work and a stress test in the beginning of January. I’ve always had a faster pulse. Even in high school when I ran track and was healthy. I feel like my anxiety comes after I notice my heart rate pounding. I’m not taking any prescriptions at the moment. Just ibuprofen when needed. So, do you remember experiencing this? It could be PAWS, which I deal with. I appreciate your point of view. ~b~

  5. P.S. I read your blog back in October.

  6. roeschandco says:

    You know how cocaine is made, right? The coca leaves alone give a very light boost of performance enhance. But once they are shredded, and splashed down with fuel …you can find recipes online…my point is that what if the same process is applied to Kratom leaves? Would it create a stronger substance? Everyone should just stick with Marijuana. It’s still not proven to be addictive, does increase appetite; but I’m mostly impressed with what this plant is proven to do….cure brain cancer. Nature created this plant for a purpose. And to protect it, any insects, or animals who decided to feed on it would become confused and forget to find it’s way back notifying colonies, or cattle. Kratom may ease opiate and opioid withdrawals, but loperamide is an opioid and the best otc drug to combat dope sickness. I weened off oxycodone and down from 10 pills seven months ago to 3 daily. Post Accute Withdrawal Syndrome is a bitch. There are addicts like me who take two years to get clean while some kick it in 3 days. Best of luck to all of you..including myself.

  7. cpeterson55 says:

    I am a big fan of kratom as a long time former percocet user…. i was addicted for over 3 years and they wreacked HAVOK on my entire life. Kratom helped me 100% get off percocet and I still continue to use it today for a nice productivity boost. I have gone from being addicted to percocet, to landing a new job i with kratoms help, to now running my own business and I use kratom every single day. So Its tough to see the harsher criticisms of it when I have had nothing but a positive life changing benefit from it.

    [redacted; not for sales or promotion of products]

    • madmargaret says:

      Kratom is very helpful for some people, but for others, particularly people with addiction issues, it can set them up for more problems. When I touch base with ER doctors who tell me they have patients in kratom overdose (which some regular people say can’t happen), I perk up and listen. I am glad it’s helping you, however, just stay safe. 🙂 Best wishes, MM

  8. I never did opiates but I do use kratom.

    It is indeed very addictive, especially to a person like me with a history of dependency. Do you hear a lot of people saying it’s not? That’s crazy that somebody would think it’s NOT.

    You will have withdrawal when you stop using it. However it’s not as bad as I once thought it would be. There is a slight physical addiction for me but it is mostly neurological. A mental obsession.

    I quit drinking and doing hard drugs a long time ago. I was very sober and loved my life (I still do!). But I was on path to have a heart attack or stroke due to the stress I put my mind through. Even after 15+ years of “sobriety” I could not stop stressing out. Kratom helps me relax mentally while still be very much in the game of life. Yes it’s a drug of sorts but I will take this existence over having a mental breakdown in my 40s any day.

    This is a great blog you have by the way. Thank you!

    • Quadronnn says:

      No matter how much Kratom might have improved your life, you’re not going to convince the author of this blog. I don’t know whether her vehement crusade against all psychoactive substances is the result of embracing the anti-scientific and religious doctrine of Alcoholics Anonymous or if her dogmatic attitude was the reason behind her joining AA. In either case, anything positive someone might have to say about drugs of any kind is just going to go from one ear to another without passing the brain in between.

      Addiction can be a real ordeal, I know that from experience, but it is not necessarily something to be avoided at all costs. No matter what people want to tell you, you yourself are the sole expert on how it affects your life. You shouldn’t think there’s anything wrong in using drugs, regardless it being out of addiction or not, just because some people think sobriety in itself is something to strive for. Mad Margaret is likely to tell you, without knowing anything about you, that the way you live your life is “wrong”, but it really isn’t. Not if you know your way is the right one for you.

      • madmargaret says:

        Quadronnn, while I appreciate the time you took to reply, your criticisms are decidedly unfair and unfounded. It’s obvious you haven’t read my addiction articles carefully (nor thoroughly) as my work is very well-researched and decidedly scientific. I actually know the people on the front lines of addiction — and I’ve seen the damage it can cause first hand to myself and many, many others.

        Also, I do NOT maintain that any 12-step approach is right for anyone; in fact, I’ve been rather critical of the program. It’s not for everyone by any means.

        Addiction is a very real and deadly disease. To encourage people to live ignorantly addicted is unconscionable. Even the hardest drug addicts will encourage harm reduction or at least the opportunity for each person to make an INFORMED decision based on facts. People have the right to know what the dangers are regarding what they are deciding to put in their bodies.

        The addiction articles on this blog serve as a voice in the wilderness for those who are lost in an addiction (ex: loperamide) and seek information. If you feel that your drug use (or whatever) is not causing you nor others a problem, I encourage you to read elsewhere as the contents of this blog will likely continue to cause you further exasperation.

        Best of luck
        MM

    • madmargaret says:

      Zippy, I am glad that Kratom is working for you. Many people do swear by it, but there are dangers. My intent with the Kratom article is to warn people that it’s not an innocuous drug which many blogs report it to be, particularly if it’s being mixed with other substances. Thanks for your input! — M

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