Thoughts on Kratom

[MCHAD]

Anyone seeing patients using this in their practices?https://www.nbcnews.com/storyline/americas-heroin-epidemic/fda-declares-popular-alt-medicine-kratom-be-deadly-opioid-n845311

i haven’t had patients ask me about this but have seen it advertised for sale on local Facebook groups.    

[d-wade]

Have a friend that swears this stuff cured his addiction, but that's purely an anecdote. The FDA is calling it an opiate, which I'm not so sure alone is great reasoning for blocking its usage - buphrenorphine is an opiate too, we don't have issues prescribing that for addiction. I suppose more safety, and efficacy trials should be performed, but some of the FDA blow-back feels manufactured, and I question if there are any conflicts of interest or lobbying going on. I'll reserve my opinion until I see more studies I suppose.

[ventana]

Seeing people addicted to it.  More popular in the south. 

 

Yup dangerous. 

 

Yes opioid like

 

yes. Detox from it is just like opioids. 

[mgriffiths]

Had a patient with a history of norco abuse/addiction who started taking Kratom "to help" with her addiction (this was before she became my patient).  She didn't understand how she had lost 100lbs in 14 months and after I started a GI workup she failed a urine drug screen.  She went to inpatient rehab, but continued using Kratom.  It seemed that everything was clean, except her Kratom use, but she continued losing weight.  She went from ~230lbs in March 2016 to 88lbs September 2017 - quite scary, especially as I inherited her June 2017 and she lost 60lbs from June-September 2017 alone.  She was essentially skin and bones.  Finally after months of telling her to stop the Kratom I threatened to discharge her as a patient unless she stopped the Kratom and magically she gained 10lbs in 1 month, and before finally being discharged for marijuana in her system, she had gained back to around 130lbs.  NOT MY ONLY PATIENT WITH THIS STORY.

My thoughts on Kratom - should not be sold as a supplement, and should be researched further to see if it has potential uses as a medication to help with addiction or other problems.

[d-wade]

https://www.forbes.com/sites/davidkroll/2018/02/09/fda-weaponizes-opioid-label-against-kratom-consumers/#2e98bfdd4536

Good article by David Kroll on this. 

[sas5814]

I just had my first experience with a patient using kratom and it wasn't good but it was a tough patient on a good day. Patient with depression and anxiety(chronic/severe with panic attacks) on a mish mosh of meds that I can't rationalize decided to add kratom to the mix. 3 antidepressants, 2 benzo anxiolytics, 2 schedule II stimulants, and she decided to add kratom to the mix because "it help with my depression and anxiety so much." It helped so much that when I told her her urine was clear (here for dysuria) she got agitated and asked me if she had cancer and had I ever seen something like this before and what did they turn out to be (insert additional near paranoid ramblings that wouldn't stop).

I have never seen this patient before so this might be a typical day for her (or a good day...dunno) and there were so many chemicals in play it boggles the mind but I am 100% certain this person and other patients like her shouldn't have access to kratom.

[mgriffiths]

21 minutes ago, sas5814 said:

3 antidepressants, 2 benzo anxiolytics, 2 schedule II stimulants

I will never understand providers who prescribe this type of combination of medications...and then to add Kratom on top...good grief.

[EMEDPA]

kratom is nasty stuff. Brian Kloss DO, PA does a great em lecture on why it is evil. 

[d-wade]

Lots of anecdotes in this thread, no great evidence. Kratom is an opioid like substance that partially acts on the opioid receptors, while suboxone, or methadone are opioids themselves, albeit the prior with naloxone to prevent overdose. The argument seems to be that because kratom has a partial effect on the opioid receptors, it is dangerous... which is a fallacy if you accept that suboxone itself is safe, which also agonizes the opioid receptors. Overdosing on Kratom alone as far as I can tell is very rare/difficult, and overdoses that do produce death, almost always involve something like fentanyl and alcohol in conjunction. The same of which can/does happen with suboxone, to my knowledge.
As far as the argument that Kratom is addictive, well I'd say that's true as it partially interacts with opioid receptors and when you come off, they don't like being unoccupied. Suboxone has the same effect, is an opioid itself, and is highly addictive. So much so that the most recent evidence shows that we have much better outcomes when people simply stay on suboxone indefinitely. Treating substance abuse disorder similarly to hypertension. I have a friend (once again, unfortunately an anecdote in the absence of studies), who is doing great on kratom, and a functional member of society/professional. Hasn't used in 5 years, and is even tapering the kratom.

Obviously safety trials, and dosing needs to be established for kratom, before the medical community can recognize it, as we are evidence based. My fear is that kratom will suffer from the fact that is a useful herbal medicine, and cannot be properly patented, and monetized... unlike suboxone... a life-saving drug, that is also a major cash cow. The blowback to me, feels manufactured and sensationalized as a reflection of that propaganda. Propaganda, because the evidence of the dangers is based on loose evidence, from those who wouldn't accept so much loose evidence for other facets of medicine.

Edited June 7, 2019 by d-wade

[LT_Oneal_PAC]

4 minutes ago, d-wade said:

Lots of anecdotes in this thread, no great evidence. Kratom is an opioid like substance that partially acts on the opioid receptors, while suboxone, or methadone are opioids themselves, albeit the prior with naloxone to prevent overdose. The argument seems to be that because kratom has a partial effect on the opioid receptors, it is dangerous... which is a fallacy if you accept that suboxone itself is safe, which also agonizes the opioid receptors. Overdosing on Kratom alone as far as I can tell is very rare/difficult, and overdoses that do produce death, almost always involve something like fentanyl and alcohol in conjunction. The same of which can/does happen with suboxone, to my knowledge.
As far as the argument that Kratom is addictive, well I'd say that's true as it partially interacts with opioid receptors and when you come off, they don't like being unoccupied. Suboxone has the same effect, is an opioid itself, and is highly addictive. So much so that the most recent evidence shows that we have much better outcomes when people simply stay on suboxone indefinitely. Treating substance abuse disorder similarly to hypertension. I have a friend (once again, unfortunately an anecdote in the absence of studies), who is doing great on kratom, and a functional member of society/professional. Hasn't used in 5 years, and is even tapering the kratom.

Obviously safety trials, and dosing needs to be established for kratom, before the medical community can recognize it, as we are evidence based. My fear is that kratom will suffer from the fact that is a useful herbal medicine, and cannot be properly patented, and monetized... unlike suboxone... a life-saving drug, that is also a major cash cow. The blowback to me, feels manufactured and sensationalized as a reflection of that propaganda. Propaganda, because the evidence of the dangers is based on loose evidence, from those who wouldn't accept so much loose evidence for other facets of medicine.

One thing just to add, ask pregnant females about the use of kratom. I’ve seen IV drug users kick it using kratom, then gave birth to a kratom addicted child that subsequently withdrew. 

[d-wade]

52 minutes ago, LT_Oneal_PAC said:

One thing just to add, ask pregnant females about the use of kratom. I’ve seen IV drug users kick it using kratom, then gave birth to a kratom addicted child that subsequently withdrew. 

That would certainly suggest a physiological addiction process, which seems highly likely. A good follow up would be a comparison of withdrawal profiles, particularly long term relapse success.

[Reality Check 2]

Kratom is a particular problem in the Pacific Northwest where marijuana is legal and meth is a big problem.

Until or unless this is a regulated product - I can't comment on it. 

So much is mixed - alcohol, benzos, meth, pot of varying strengths, oxy, suboxone, methadone, spice, bath salts.

Kratom is advertised on pot shop billboards. They continue to stress the falsehood that "natural means safe".

Frankly, I am tired of it and wish it wasn't available legally. It is killing people in my neck of the woods.

 

[mgriffiths]

On 6/7/2019 at 12:30 PM, d-wade said:

Overdosing on Kratom alone as far as I can tell is very rare/difficult, and overdoses that do produce death, almost always involve something like fentanyl and alcohol in conjunction.

For me this is generally the grind...similar to the state of MI (and others I believe) who have made gabapentin a schedule V controlled substance.  Not because gabapentin itself is super dangerous when used appropriately, but in MI became the most common substance to be found in patients with opioid overdoses (other than the opioids...duh).  Of course, I don't understand why Lyrica has been controlled for many years, and gabapentin only this year...

 

So, how frequently is kratom being found in overdose cases, and does it contribute to the risk of overdose?