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Kratom, All of Your Questions Answered

I work with a lot of people who have substance abuse issues. A few years ago I began hearing a lot about Kratom from my clients. After briefly educating myself I began to talk about this relatively new drug with my collogues only to find out that many of them, even those who worked in substance use and addiction where unfamiliar with it. While the drug has been around for quite some time, it has been gaining popularity in the United States as a recreational drug in the recent years. As with any “new” drug there is a lot of hype and misinformation about it. Hopefully, this post will clear some of that up.

Kratom: What is it? Kratom is a plant (known formally as Mitragyna speciosa) native to Southeast Asia that can produce on opiate like high when ingested. It can be administered in several fashions but most popular are pills and tea. It has gained popularity in the United States for recreational purposes likely due to drug users sharing their experiences online.

What are the effects? Kratom produces a euphoria that has been likened the euphoria and numbness people experience on Opiates. In lower doses, it has been reported that Kratom can have a stimulating effect. In higher doses a more sedative effect. The CDC reports that Kratom abuse can also lead to agitation, irritability,, tachycardia, nausea, drowsiness,  and hypertension. Here is a Washington Post article that goes into much great detail

How does it work?

Thorough research into the pharmacology is still in incredibly early stages. What is known is that the chemical Mitragynine in Kratom binds with opioid receptors in the brain similar to morphine, heroin and other opiates. It is hypothesized that this action is largely responsible for the pain alienating and overall numbing qualities. Kratom is also serotonergic meaning that it binds with serotonin receptors. Serotonin in a powerful neurotransmitter that plays a prominent role in many psychiatric issues like depression and anxiety. Here is a Scientific American article that explains this is more detail. 

Is it safe? 

The CDC calls Kratom use "an emerging public health threat," and found that abuse can lead to the following health risks:  hepatoxicity, psychosis, seizure, weight loss, insomnia, tachycardia, vomiting, poor concentration, hallucinations and death.  According to a DEA press release between 2014-2016 there were 15 Kratom related fatalities. However, proponents of the drug note that of the many reasons opiates can be dangerous (especially when used recreationally) is the risk of overdose. When people overdose on opiates they stop breathing or have difficulty breathing. In preliminary animal studies, the main psychoactive ingredient in Kratom, mitragynine, did not cause any repertory depression (difficulty breathing). This however does not mean that the drug is safe, or a “better” alternative to opiates. Keep in mind this is a preliminary study done on rats and not humans. Kratom, like many other illicit substances is not regulated by the federal government and could contain any number of other compounds that may cause harm or have not been properly researched. Additionally, despite some anecdotal evidence, Kratom, like most mind altering chemicals can be addictive. I have worked with a number of people who displayed all of the symptoms of addiction with Kratom.

Is it legal?  

As of this writing the DEA is open to hearing public comment on the issue of legality for Kratom. The DEA has noted that Kratom has a high potential for abuse and initially sought to classify it as a schedule I drug. However, after significant public backlash, the DEA decided to open up comment on the proposed temporary ban. The DEA also has noted that Kratom use can lead to psychosis, and psychological addiction. Though federal action is pending the following states have passed laws that make Kratom a controlled substance: Alabama, Arkansas, Indiana, Tennessee, Vermont, and Wisconsin. In addition several other states, cities, and districts have bills that have been introduced but not yet passed. For more information on the legality of Kratom see the AKAs website. Is it a safe alternative to synthetic or other traditional opiates?  

To recover from an addiction a person must stop or cut back on the substance and treat the underlying behaviors and issues that either led to the addiction in the first place or where caused by a long period of use. Substituting one drug for another is a not a sustainable treatment. Many of the people I have worked with have tried to stop taking other opiates by using Kratom only to relapse on opiates again after a short time. Obviously this does not happen in every case and the harm reduction model is an evidence backed approach to dealing with substance issues. However, as Kratom is not regulated and the potential effects and benefits have not been thoroughly researched it would be unethical to claim that it is safe or a helpful in a harm reduction treatment program. What should I do if I or a loved one has a problem with Kratom?

Most experts (and the DSM 5) identify a substance uses disorder as the use of substances that causes pathological behaviors. These behaviors can separated into roughly 4 categories. To meet criteria a person needs to display problems in at least two of the following categories. How many symptoms a person experiences will determine the severity of the disorder.

1. Impaired control: This can be summarized by using for longer time than anticipated, using larger quantities than anticipated, and spending excessive time craving, using, recovering from, thinking about, or obtaining the substance.

2. Social impairment: Continued use despite negative social consequences, such as causing substantial harm to romantic relationships, friendships, negatively effecting job or academic performance or abilities, harming functioning around the house such as hygiene and chores, or significantly harming familiar relationships such as neglect of children or failure to follow through on obligations.

3. Risky use: someone who repeatedly put themselves in physical or psychological harm to continue to use, such as driving while intoxicated or worsening depression.

4. Pharmacological indicators (tolerance and withdrawal): For many substances people developed a tolerance (they have to use more to achieve the desired effect) or suffer from withdrawal (negative physical and psychological symptoms as a result of using less or stopping completely.

If any of the above seems familiar to you I urge you to seek professional help. For severe cases a medical withdrawal and in-patient treatment withdrawal is advised. For less severe cases, intensive out-patient psychotherapy such as the one provided by The Center For Integrative Healing or individual out-patient psychotherapy can be incredibly helpful. Also, there are free self-help groups such as Alcoholics Anonymous or Narcotics Anonymous that have helped millions of people recover world-wide. If you or a loved one is struggling with Kratom use or addiction please do not hesitate to seek help. Many counselors and therapists (myself included) offer a free 15 minute phone consultation to help you decide what sort of treatment would be the best fit for your particular situation.

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