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Sunday, January 3, 2016

Kratom -- Addictive Stimulent or Opioid Dependency Aid?

Kratom is a leaf that stems from the mitragyna speciosa tree (evergreen) native to Thailand. In Thailand, kratom leaves are typically chewed fresh, cutting out the fibrous central vein. This leaf can also be dried, crushed into powder and then steeped in tea or simply mixed in with a drink like orange juice.

First described in an 1839 publication by Dutch botanist Pieter Willem Korthals, kratom is used as a traditional medicine to reduce pain, as an anti-diarrheal, and as way of reducing opiate dependence.

Yes, I said kratom has been used to reduce opioid dependence. Some have even considered it an alternative to methadone.

Here is how the substance works:

"The leaves of kratom contain mitragynine and several related alkaloids.  Of all the compounds present in the leaf, mitragynine appears to be the most active and the one most likely responsible for kratom’s pleasing effects. Used as an opiate substitute, kratom contains no opiates of any kind, but it does bind to the same receptor sites in the brain. It binds to the mu-opioid receptor, as do both enkephalins and morphine.

"Additionally mitragynine binds to kappa-opioid receptors, which are associated with pain relief and sedation. Mitragynine is adrenergic, which produces a stimulating effect, and it also binds with serotonin receptors, producing an anti-depressant effect as well. Due to this multiplicity of activities in the brain, kratom produces an overall pleasing feeling.

(Chris Kilham. "Kratom: The latest legal plant-based high."
Fox News Health. December 04, 2013.)

For many addicted to opiates, kratom seems like a perfect solution.

But, not so fast. The substance can be addictive itself.

Dariya Pankova, 23, a Brooklyn native who received kratom treatment in Delray Beach, Florida, said ...

“It’s preying on the weak and the broken, It’s a mind-altering substance, so people like me who are addicts and alcoholics, they think just because it’s legal, it’s fine. It’s a huge epidemic down here, and it’s causing a lot of relapses.”

Kratom's growing popularity and easy availability are raising concerns among substance abuse experts and government officials who say it is being furtively marketed as a way out of addiction, even though it is itself addictive.

Worse, some of those experts say, kratom can lead some addicts back to heroin, which is cheaper and stronger.

In fact, Ms. Pankova said she and many friends wound up spending $60 a day on kratom drinks before moving back to less expensive heroin.

(Alan Schwarz. "Kratom, an Addict’s Alternative, Is Found to Be Addictive Itself."
The New York Times. January 02, 2016.) 

Dr. Edward W. Boyer, a professor of emergency medicine at the University of Massachusetts Medical School and a co-author of several scientific articles on kratom, warned: “Recreationally or to self-treat opioid dependence, beware -- potentially you’re at just as much risk” (as with an opiate).

Nevertheless, kratom is now available around the country. The DEA claims that kratom is an addictive stimulant, but even though the agency says that it is dangerous, it is not even controlled under the Controlled Substances Act. Alan Schwarz reported because kratom is categorized as a botanic dietary supplement, the Food and Drug Administration cannot restrict its sale unless it is proved unsafe or producers claim that it treats a medical condition. (Some packages are coyly labeled “not for human consumption” to avoid tripping such alarms.)

The Drug Enforcement Administration has listed kratom as a “drug of concern." Indiana, Tennessee, Vermont and Wyoming have banned it on their own; several other states, including Florida and New Jersey, have set aside similar bills until more is known about kratom’s health risks.

In Thailand, kratom has been banned since 1943, but the country is considering legalizing it as a safer alternative for meth addicts. The substance is smuggled into the United States from Thailand, as well as from several other Southeast Asian countries. It is now available here at special bars, head shops, gas-station convenience stores, and on the Internet.

Trading Addictions?

I found several nearby "smoke shop" listings for kratom online including Darkwings LLC in Wheelersburg,  Darkwings LLC in Ashland, Granny's in Ironton, Counterculture in Southpoint, and Waterbeds N Stuff in Chillicothe. I don't know how many of these places are presently open for business. And, I have no idea about how many people use kratom in our area.

Should kratom be stigmatized or celebrated? I think the answer depends upon the person who is struggling with self-treatment for opioid dependency. While it may hold some promise, small amounts of the substance may be ineffective while large amounts may be dangerously addictive. Chances are very little medical monitoring of treatment adds to the risk.

And, the cost? It can be astronomical.

Scientific American spoke with Edward Boyer, a professor of emergency medicine and director of medical toxicology at the University of Massachusetts Medical School. Boyer has worked with Chris McCurdy, a University of Mississippi professor of medicinal chemistry and pharmacology, and others for the past several years to better understand kratom use.

Boyer told of one 43-year-old, successful software engineer who was using kratom for opioid addiction. That patient was spending $15,000 annually on kratom. The guy eventually ended up in the hospital due to kratom abuse. Still, when asked what happened when he left the hospital and stopped using kratom, Boyer said ...

"After his stay at Mass General, he went off kratom cold turkey. The fascinating thing is that his only withdrawal symptom was a runny noise. As for his opioid withdrawal, we learned that kratom blunts that process awfully, awfully well."

Click here to read the entire Scientific American article titled "Should Kratom Use Be Legal?": http://www.scientificamerican.com/article/should-kratom-be-legal/.

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