Kratom and Opioids: What’s All The Talk About?

Opioids are molecules that bind to opioid receptors in the brain, peripheral nervous system, and the gut. There are three different kinds of receptors known as mu, delta, and kappa. Different type of opioids binds to different receptors and produce different effects on the nervous system.

Opioids are known to reduce pain thresholds and create emotional detachment from that pain. Beyond pain, they can cause sedation, euphoria, respiratory depression and constipation.

You can take opioids as a medication whether by prescription or take a natural herb such as kratom. Kratom is used for treating opioid addiction.

You also have opioid-like molecules that are produced in the brain. These are small proteins known as Enkephalins. They have a similar effect and are released when you are under stress to help you pull through a difficult time particularly during extreme physical activity.

They produce euphoria as well. Under normal conditions, pain is a good thing because it warns us that something is wrong and necessary for our survival.

However, when pain becomes chronic (long-term), it requires prompt medical attention. Pain can become a debilitating thing that you just can’t live with. Some examples of opiates are methadone, buprenorphine, morphine, hydrocodone, oxycodone, heroin and now kratom (just recently added to the list). Some opiates are natural, and others are semi-synthetic and some fully synthetic.

Kratom is an all-natural opioid plant. It grows in Southeast Asia, and the plant is called Mitragyna speciosa or commonly known as kratom. For hundreds of years, local farmers chewed the leaves to energize themselves. In medicine, it has been used to manage diarrhea, coughing, and pain. Recreationally it is used to get high.

According to media, it is passed off as an opioid addiction solution. However, the Food and Drug Administration (FDA) feels that it should be treated no differently from any other addictive opioids. Kratom is growing in popularity, but there may be some associated risks with it.

Various products made from kratom appear to be cropping up in health food stores and drug paraphernalia stores in Europe and the U.S. This natural herb comes in several forms from beverages such as tea and capsules.

Kratom effects can take place within 15 minutes and last anywhere from 2 to 5 hours.

Ten grams of kratom (low dose) can produce some euphoria, increased energy, and increased social interactions.

Higher doses (20-50 gm) of kratom bring about pain relief, pleasure, and sedation.

Currently, kratom is banned or a controlled drug in 16 countries and is banned in several states in the U.S. due to harmful effects. There is some speculation that kratom has healing powers; however, the FDA believes it may cause harm to anyone using it.

With the current opioid epidemic, the FDA doesn’t feel that it can handle another addictive drug without some serious evidence that it can help with opiate withdrawal and pain.

Some of the reported side effects include psychosis, addiction, nausea, itching, dry mouth, sweating, loss of appetite, weight loss, insomnia, anorexia, emotional changes, muscle aches, irritability, runny nose, awkward motor movements, and constipation. There have been a few reports of liver damage as well.

General Self-Medication Issues

There can always be potential risks when individuals try to self-medicate. Of course, this may depend on the educational background of the person.

These potential risks include incorrect self-diagnosis, not getting help when needed, unexpected severe side effects (allergic), drug interactions, improper mode of administration, inadequate dosage, choose the wrong treatment and they might have another underlying problem (disease) that gets hidden or becomes worse due to self-medication.

Needless to say, a number of patients violate their prescription medications anyway. Look how many individuals have a prescription opioid addiction. That’s not saying much for the medical community. Of course, some of these patients are non-compliant and perhaps not well informed. Patient education would go a long way here.

Medical professionals and counselors believe that the greatest success for drug withdrawal comes when taking advantage of mental support along with other prescription drugs in terms of withdrawal issues.

But, you need to consider that these traditional therapies are often expensive and time-consuming. Not to mention that treatment centers have waiting lists which may not be convenient for most people.

For individuals who have not had success with in-house therapies or they are afraid of them, kratom seems to be the choice of self-help.

Patient Studies, Patients Comments, Kratom Consumer Comments

Below is a composite of the scant information about kratom coming from a single patient history, patient comments to their doctors and a survey of kratom users by the DEA. This by no means gives you anything definitive about the efficacy or safety of kratom so take it as you will.

In late 2017, one patient by the name of Eric Mayhew Jr. said that he wanted to break his 10-year long addiction to opioids that had been prescribed to him for a knee injury. He decided to stay away from in-house therapies (medical intervention) and used kratom to help him get past opioid addiction. He had tried other methods without success for a two-year period. For Mayhew, kratom did the job.

He said that “What kratom does is kills your brain’s desire when you are addicted to opiates, and you want opiates. It dulls your pain, and you start to get your wits back again.” Mayhew is now taking a kratom recommended dose of 2-4 capsules daily. He reports that he has not experienced any side effects but that he still needs some willpower to avoid going back on prescription opioids.

He says that you need the proper frame of mind in that you have to want things to work. In essence, nothing will work unless you have some understanding of that. So far, he hasn’t relapsed.

Some professionals believe that we need to do everything we can to make sure that those suffering from various addictions have access to FDA-approved medications and proper therapy options. Buying unregulated medicines/supplements over the internet should not be the way to go.

Back in late 2016, the DEA said that it wanted to classify the main psychoactive component in kratom as a Schedule I drug saying that there is an “imminent hazard to public safety”.

However, after a public outcry, the DEA decided to allow the public to make comments and conduct an FDA investigation. They received over 23,000 public comments about kratom and are reviewing them to determine what to do with this botanical. Which probably means ban it or regulate it.

The problem is that we need human studies to determine the efficacy and safety of kratom for opioid withdrawal. One study was done in 2008 by Edward W. Boyer, MD, director of academic development in the Department of Emergency Medicine of Brigham and Women Hospital in Boston on a 43-year-old man.

This patient abruptly stopped using an opioid prescription by taking kratom. The patient reported spending $15,000 a year on kratom that he got online. He administered kratom as a tea 4 times daily to ease his opioid withdrawal.

The patient reported that this herb reduced his pain considerably as well as withdrawal symptoms. He said it didn’t make him drowsy or cause any side effects that he could tell.

Another study in mid-2017 found that this herb had few side effects except when taken in high doses or frequently. Kratom helps merely to inhibit cravings and elevate their mood to prevent going back on prescription opioids.

As you can see, kratom is in need of clinical trials. The problem is big pharma and the medical community. So far, what little research has been done is in rodents. Only a few patients have been observed and interviewed. This ‘Screams Clinical Trials’.

Part of the problem is that medical professionals and counselors believe that the greatest success comes when taking advantage of mental support along with other prescription drugs in terms of opiate withdrawal symptoms.

But, you need to consider that these traditional therapies are often expensive and time-consuming. Apparently, treatment centers have waiting lists which may not be convenient for most people as well.

People who use kratom are reporting that it definitely helps stop cravings to go back on prescription opioids while elevating their mood. They actually feel right about things. They also say they are motivated to do things, so they are not lazy which opioid prescriptions tend to do.

They are able to return to their normal routines. The medical community needs to turn on their ears and get rid of their bias. If you’re not aware, pharmaceuticals are more of a problem than street drugs or natural herbs.

Christopher McCurdy, Professor College of Pharmacy, University of Florida comments “It is probably addictive, but its addictive equivalent is something like coffee, which isn’t surprising because the leaf is in the coffee family.

We firmly believe that it will be very good for treating opioid withdrawal and may be a possible solution to the opioid epidemic we are facing as a country.” But again, clinical trials are required. We must have scientific information on this herbs safety and efficacy.

As people are buying this from the internet from overseas, they have no real idea what they are getting. There are no standards for this unregulated herb, and it is anybody’s guess what’s in the bottle.

McCurdy and colleagues were involved with a study back in 2016 that analyzed several kratom products. What they found was that the opioid levels were higher than that found in the raw leaves. You’re not really sure what you’re getting. That’s scary!

So far, kratom appears to be the most commonly used herb for self-detox from prescription opioids. However, some people migrate to Imodium, marijuana and OTC pain relievers. But, most kratom users indicate it is best for pain and anxiety.

FDA Declares Kratom as an Opioid

On Feb. 7, 2018, the FDA declared that the natural herb kratom is an opioid. Most of the major molecules in kratom where found to bind to opioid receptors in the human brain and that 2 of the 5 most common molecules actually activate opioid receptors.

The FDA also reported that there were 44 deaths linked to the use of kratom at that time, however other drugs were often used in conjunction with kratom.

According to Gottlieb of the FDA, “Kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids.” Gottlieb goes on to say, “There is no evidence to indicate that kratom is safe or effective for any medical use.” Gottlieb believes that the claims that kratom is harmless because it is a botanical are dangerous and shortsighted and points out that heroin also comes from a plant.

He urges people who are taking kratom to seek medical attention and goes on further to say that there are better ways to get off opioids. There are therapies already available approved by the FDA, and along with psychosocial support, these therapies are effective.

According to the U.S. Centers for Disease Control and Prevention (CDC, Atlanta, GA), there has been some concern in recent times about kratom. They report that poison center calls have increased 10x during the five-year span between 2010-2015 from 26 to 263 calls. Generally, kratom had been used with other drugs whether OTC, prescription opiates or illegal drugs.

Computer Analysis

No experimentation was done on animals/humans but rather the researchers used 3D computer technologies to simulate how kratom opioids would affect receptors in the brain.

The analysis predicted that 22 out of 25 prevalent molecules bound to the mu-opioid receptors. There are 3 known opioid receptors which include mu, delta, and kappa. The mu receptor is believed to be linked to pain relief and a high sensation (euphoria).

The mu receptor is also thought to be involved with the process of addiction. This model predicted that some of the molecules might contribute to stress responses that affect the brain and cardiovascular function.

This means the possibility of seizures and respiratory depression which allows CO2 to build up in the body and generate acidosis. This only occurs at high dosages.

The American kratom Association was not happy about this analysis and stated that it is “an unprecedented abuse of science to create a new computer program that is clearly garbage in/garbage out, avoiding rules of the Controlled Substances Act and making unproven claims that have been proven to be untrue”.

Scott Hemby, chair of the department of basic pharmaceutical sciences at High Point University in North Carolina, questions the FDA’s claims in terms of their 3D computer analysis.

Hemby reported that the main molecules in kratom do bind to opioid receptors and generate opioid-like effects such as a euphoric rush and pain relief by way of dopamine release.

He also says that one of the molecules in kratom may have addictive properties.

But, this botanical is less effective than prescription opioids. The amount of these molecules in the plant is very low such that it is unlikely to cause abuse or addiction.

Hemby goes on to say, “Just because it binds, it doesn’t mean it has the same efficacy” as an opioid. We need real data coming from actual science. As Hembly puts it, “When it comes to drugs for cancer, we wouldn’t rely on a computer model to drive policy. People would find that unacceptable.”

As to whether this natural supplement is effective against opioid withdrawal and safe to use is up for grabs. There have been no clinical trials done on kratom as of yet, and it doesn’t look like any are planned for 5-10 years.

2016 – Notice of Intent: Temporary Placement of Mitragynine

In 2016, the DEA published a 21-page notice saying that kratom doesn’t have “an approved medical use” and “is misused to self-treat chronic pain. The DEA did not cite any studies to support their claim that kratom was being misused to treat pain. Many of the kratom users were very upset with the DEA (U.S. Drug Enforcement Administration) and their plans to make the possession and sale of kratom illegal are very soon.

So, the best one can do take a look at kratom consumers and see what they have to say about it. Pain News Network and the American Kratom Association conducted an online survey of more than 6,000 kratom users.

What they found was that 9 out of 10 users thought the herb was “very effective” for treatment of anxiety, depression, insomnia, pain, alcoholism and opioid addiction. They also reported that less than 1% indicated that kratom did nothing.

Given that this was an online survey of self-selected users, this does not constitute a scientific study on the efficacy and safety of kratom but nevertheless important.

Summary

Kratom has been classified as a category I drug as an opioid by the DEA. The federal government defines these substances as drugs that have no currently accepted medical use and have a high potential for abuse (addiction).

The FDA says that it should be treated as any other addictive opioid including heroin. It has been banned or controlled in 17 countries, and a few states in the U.S. Whether the DEA will place a ban in the U.S. is still up for grabs.

So far, there is no reliable information available for kratom in terms of its efficacy or safety. No clinical trials have been done as of yet, and the 3D model produced by the FDA is not acceptable.

Nevertheless, a survey conducted by the DEA on self-selected kratom users indicates that these users are extremely satisfied with this herb’s ability to stop cravings for prescription opioids and keep anxiety at bay. The verdict isn’t in yet so only time will tell.

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