Could Kratom Play a Role in the Treatment of Pain and Addiction?
According to the Center for Disease Control in 2017 opioids killed more than 47,000 people and 36 percent of those deaths were due to prescription opioids. The over prescribing of opioids in the United States within recent years has sparked an epidemic of addiction, overdose and death. The current opioids that are being used today clearly pose a great risk of abuse and misuse. It is clear that new therapies must be looked at and developed in order to more effectively manage pain, addiction and withdrawal.
Kratom is a tropical tree indigenous to Thailand and Southeast Asia. It has been used medicinally for hundreds of years by people native to the area. Kratom is an opioid and at low doses produces a stimulating effect while at higher doses it starts to act more like a depressant. Historically it has been used for managing morphine withdrawals, pain, anxiety, and depression. During the 20th century the increasing cost of opium forced many people in Thailand to begin using kratom as a substitute to help with withdrawal symptoms. In 1943 due to its wide popularity the Thai government made it illegal to grow kratom trees. After 76 years of prohibition in 2019 the Thai government announced that they no longer consider kratom a narcotic and that they plan to legalize it in areas that have used it traditionally for centuries.
Kratom is an opioid, the active chemicals found in its leaves (mitragynine and 7-α-hydroxymitragynine) stimulate opioid receptors in the brain. The major benefit of kratom is that it works extremely well at treating pain and causes little to no respiratory depression compared to other opioids. Kratom is a unique plant and could potentially serve as an effective treatment for pain and opioid withdrawal symptoms.
Many drugs including opioids are viewed as inherently bad or dangerous. This is because the ones we are aware of have a lot of problems. Medicinal chemistry and pharmacology are still in a relatively primitive state and there is still much to be learned. Many of the opioids used today are simply derivatives of morphine which has been used for hundreds of years. There are better options for the treatment of chronic pain. As science progresses we will discover less addictive treatments for pain and the alkaloids within kratom are potentially a large step in that direction.
There have been deaths associated with kratom but this does not mean it is dangerous or unsafe to use as a medicine. Almost any drug can cause death if used inappropriately. Caffeine, aspirin, and acetaminophen (Tylenol) kill thousands of people each year in the United States. Providing information and education to patients about medication is one of the major roles doctors and pharmacists play in preventing tragic instances of overdose and death.
Kratom comes in capsules and powder form, patients can mix the powder in water, shakes, tea or foods like yogurt and applesauce. Patients who are considering using kratom should first consult their doctor or pharmacist. Kratom is a medicine which is not yet fully understood in regards to its mechanism of action, therapeutic window, and how it interacts with others drugs and disease states.
One of the biggest concerns with kratom is the risk of interactions with other prescription and street drugs. These interactions can potentially lead to serious adverse reactions and death. The few deaths associated with kratom have mostly involved the use of other prescription and street drugs. One case described a patient who was using kratom along with Modafinil (provigil) and experienced a seizure. For patients with a history of seizures it is advised to avoid use until more definitive tests come out detailing kratom’s effect on the body and CYP450 enzymes.
Some of the most common side effects of kratom include agitation, tachycardia, drowsiness, vomiting and confusion. Just like any other substance there is a slight potential for abuse and misuse but patients also face this risk when taking prescription opioids. If you are considering using kratom you should first speak with your doctor or pharmacist to become better informed.
People have benefited from the use of kratom for hundreds of years and there is great anecdotal evidence showing that patients suffering from chronic pain or opioid use disorder could benefit greatly from this medicine. More studies on kratom need to take place in order to better inform patients about appropriate dosing, interactions, toxicities, and side effects. Kratom is a legal product which patients can buy regardless of any doctor or pharmacist’s recommendation so it is important that healthcare providers best inform their patients of the potential risks and benefits of this unique medicinal plant.
