Kratom, an alternative to traditional pain management that America desperately needs.

100 million Americans live with chronic pain, many of them relying on opiate pain medication to manage their debilitating symptoms. At the same time, opiate abuse is now an epidemic of historic proportions in the US, and is killing almost 200 people a day. There is a very real need for a safe, effective alternative for managing pain, and thousands of people have found an alternative: an ancient plant known as Kratom from the jungles of Indonesia.

You won’t hear about Kratom from your doctor, because herbal medicine is not taught in medical school. It’s not approved by the FDA, which is unlikely to change in the immediate future, as the FDA is ardently fighting to schedule the plant as a controlled substance. On February 6, 2018 they released a statement labeling the plant an opiate, implying that it should be controlled in a similar manner as morphine, fentanyl, and heroin, due to its interaction with opiate receptors. Their stance ignores the fact that not all opiate agonists have the same effect on the body. Other medications that interact with opiate receptors include Dextromethorphan, a main ingredient in cough syrup, and Loperamide, a antidiarrheal medication. Both are approved by the FDA and sold over the counter. Kratom too is unique in its interaction with the brain’s receptors, and notably does not cause the deadly respiratory depression that leads to opiate induced deaths.

Why Kratom?

With almost 1 in 3 Americans living with chronic pain, it is more common than any other health condition. The impact of chronic pain goes far beyond the individual, deeply affecting family, friends, and society as a whole. The financial burden is astronomical. The total health care cost, including missed productivity, ranges from $560 to $635 billion. [1] This is significantly greater than the cost of heart disease, cancer or diabetes. Perhaps the greatest burden has nothing to do with economics, but the tremendous suffering endured by patients and families. Suicide rates are twice the national average in people who suffer from chronic pain. [2] In one study it was reported that up to 32% of people with chronic pain have thoughts of suicide, a staggering number when compared to the general public. [3] The overall burden of pain is colossal, but we have created a much larger and far more devastating predicament: the opiate epidemic.

Photo by Dr. Trey Hanson

I am an emergency room physician. I can tell you it is very difficult to safely and effectively treat chronic pain, in part because approved treatment options are few, but also the treatments available all have significant limitations.

  1. Acetaminophen (Tylenol), which is generally only effective for the most minor pains, is rarely the answer to managing severe pain. High doses can cause liver failure, and if overdoses not appropriately treated with an antidote, a slow and painful death can occur over a few days.
  2. NSAIDs, such as Ibuprofen and Naproxen, can be very effective for acute pain, but like Acetaminophen are often not sufficient for severe pain, and with prolonged use they are infamous for causing kidney damage, gastric ulcers, and GI bleeding.
  3. Opiates, such as Hydrocodone, Oxycodone, Morphine, and Fentanyl, have a strong affinity for opiate receptors in the brain, which when activated block pain and cause intense euphoria. With continued use the body adapts to anticipate the drugs presence and if abruptly stopped horrible withdrawal symptoms ensue. Although not life threatening, opiate withdrawals are agonizing, and reports of suicide during the withdrawal period are not uncommon. Opiates are extremely effective for severe, acute pain. They will always have a valuable role in medicine in the correct situation. Opiates control pain more effectively than other medications except those involved in general anesthesia. However, for the last 20 years they have been overprescribed, often given in situations where clearly the risks did not outweigh the benefits.

Another Option For Managing Chronic Pain

Kratom is a relative of the coffee plant and has been used for centuries for its analgesic, anti-inflammatory and anti-depressant properties. Its main alkaloids, Mitragynine and 7-OH Mitragynine, activate the same opiate receptors as prescribed opiate medications. This is at least part of the reason why it is so effective against pain. However, unlike traditional opiates, Kratom has over 25 active alkaloids, and at least one, Corynanthiedine, acts as opiate antagonist, possibly providing a natural safeguard against respiratory depression, which is the cause of death in opiate overdoses. The thousands of Americans who use it report significant pain relief. Kratom users are going back to work, staying out of hospitals and paying taxes.

Another beneficial and unique property of Kratom is its potential to ease the symptoms of depression and anxiety by activating serotonin receptors. Serotonin is a neurotransmitter that plays a major role in mood disorders, such as depression and anxiety. Research shows mood disorders contribute to chronic pain, which then worsen depression and cause a vicious cycle. These conditions are anatomically linked by sharing neuronal pathways within the brain, contributing to both perceived pain, anxiety and depression. It is estimated that up to 60% of people suffering from chronic pain also have some form of depression. [4]

It’s true that Kratom needs further research to understand its full potential and limitations, but this will take time. Unfortunately, there is no time to spare, considering the mounting death toll from opiate overdoses. It is critical that Kratom remains legal and available to the public. Making it illegal will jeopardize future research and a large percentage of current users will revert back to more dangerous opiates including heroin. This is no time to close the door on alternative therapies that show so much promise. If Kratom helps people stay off traditional opiates, then Kratom is saving lives.

References

1.Darrell J. Gaskin, Patrick Richard. The Economic Costs of Pain in the United States. The Journal of Pain, 2012; 13 (8): 715 DOI: 10.1016/j.jpain.2012.03.009

2. Pergolizzi J, Jr, Raffa R, Taylor R Jr, et al. The risk of suicide risk in chronic pain patients. Presented at: PAINWeek 2017. Las Vegas, NV; S

3.Edwards RR, Smith MT, Kudel I, Haythornthwaite J. Pain-related catastrophizing as a risk factor for suicidal ideation in chronic pain. Pain. 2006;126(1–3):272–279.September 5–9, 2017. Poster 48.

4.Using chronic pain to predict depressive morbidity in the general population. Ohayon MM, Schatzberg AF, Arch Gen Psychiatry. 2003 Jan; 60(1):39–47.