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Kratom For Opiate Withdrawal & Chronic Pain

Effects and Benefits Of Using Kratom

The side effects of drugs have urged patients as well as researchers to seek safer alternatives.  It is estimated that more than 30% of patients in the US are using or have used herbal remedies at some point.  Chronic pain patients are no exception to this since the long term use of opioid analgesics for chronic pain has caused increased cases of opiate tolerance and addiction.  Therefore, it is just a matter of time before patients need a larger dose of analgesics to maintain the same level of pain reduction.  Some of the 40 million American patients with chronic pain resorted to kratom, a medicinal herb, available through internet vendors or smoke shops.  Kratom is used for self-management of pain and to avert the opioid withdrawal symptoms.

 

Kratom is derived from Mitragyna speciosa, a Southeast Asian herb that belongs to the family Rubiaceae.  Other members of this family include gardenia and coffee plants.  Mitragyna was used for a long time in Southeast Asia.  It was traditionally used to treat cough, hypertention, diarrhea, malaria, fever, hypoglycemia and by laborers in order to work hard.  It was later banned in 4 countries: Australia, Myanmar, Malaysia and Thailand due to its abuse.  However, in Thailand and the surrounding areas, “kratom cocktail” made of kratom decoction, antitussive syrup, coke and coffee or codeine is served with ice to this day.  Kratom has been recently introduced to the western world through the internet through claims about its contradictory dual nature.  The notable increased use of kratom in the Western world in the past decade has prompted further research on its therapeutic uses and constituents.   Kratom is now available in many forms such as leaves, capsules, compressed tablets, gum and tea powder.  It is usually smoked or brewed into tea.

 

The resulting effect depends on the administered doses.  In low to moderate doses (1-5 g), kratom leaves produce stimulant effects, increasing alertness and energy.  In moderate to high doses (5-15 g), kratom is reported to causes opioid-like analgesia.  However, very high doses of kratom (more than 15 g) cause sedating and euphoric effects and can cause its misuse by addicts.

 

It was found that kratom is made up of more than 20 alkaloids.  The exact composition depends on the geography where the plant was grown.  The most important alkaloids that cause the opioid-like analgesic activity are mitragynine and 7-hydroxymitragynine since they bind with the opioid receptors.  Mitragynine is the most abundant alkaloid in kratom.   7-hydroxymitragynine is a minor component that is more potent and can penetrate blood brain barrier more than mitragynine.   It is believed that 7-hydroxymitragynine is 13-fold more potent than morphine.  Mitragynine was first isolated 87 years ago and scientists are still not able to totally synthesize it in the laboratory.  All the mitragynine used by individuals or researchers is extracted from the leaves of the Mitragyna speciosa plant.

 

The striking increased prevalence of kratom use in the west is indicated by the number of forums and groups dedicated to kratom such as (The Kratom Forum, Kratom Online, Kratom Science) which include tips about using kratom, suggested suppliers and personal stories of using kratom.  Most cases of kratom use are not reported since kratom has minimal acute toxicity.   One reported case included an individual who used kratom to avert withdrawal symptoms of daily 10mg subcutaneous hydromorphone.  The patient described pain relief and improved alertness compared to opiates.  Upon sudden cessation of kratom, he described kratom abstinence symptoms to be rather longer but less intense than that of opiates.

 

In a study of the experiences of kratom users as reported to erowid.org, it was found that positive, negative and neutral experiences were reported.  Positive experiences reported included euphoria in (30%) of the participants, relaxation (24%) and fewer participants expressed increase in energy and sociability.  The participants described their experiences with words like “pleasant thoughts”, “mental calm”, “desire to work” and “an exceedingly clear mind”.  The negative experiences reported included nausea and stomach pain in (16%) of the sample, alternating chills and sweating (9.3%), unpleasant dizziness (6.8%) and fewer individuals reported itching (3.1%).  Some neutral experiences reported included numbness of the mouth and throat right after the ingestion of kratom in any form other than capsules (3.8%)and visual alterations (3.8%) were also reported.  (10.6%) of individuals reported to have successfully used kratom to wean off harmful or addictive substances.  (9.9%) Also described the kratom withdrawal symptoms to be milder than those of opiates.   The results suggest that individuals with a history of substance use problems should be very cautious when using kratom due to its dependence potential.  Also the sedative effects and visual alterations caused by kratom indicate that it shouldn’t be used when driving or doing another activity that requires alertness and coordination for safety.

 

Kratom has limited side effects compared to opioids.  It doesn’t appear to cause the emesis associated with using opioids.  Also, respiratory depression has not been reported after the administration of kratom in humans.  This makes kratom a safer alternative to opioids that can cause respiratory and central nervous system depression and affect the immune system making patients vulnerable to infections.  The fact that kratom is orally ingested or smoked eliminates the risk of blood borne infections that can be transmitted through sharing needles in case of opioid drug addiction.  It is also associated with increased alertness unlike the sedative effects caused by opioid analgesics.

 

The long-term use of kratom has been associated with effects such as anorexia, weight loss, constipation, mouth dryness and facial hyperpigmentation.  Anorexia and weight loss are due to mytraginine inhibitory effects on gastric acid production in the stomach.  Upon sudden cessation of kratom use, withdrawal symptoms similar to those of mild opioid abstinence were observed.  The most common symptom observed was rhinorrhea, but muscle pain, poor concentration, lethargy, aggression, insomnia and joint pain were also documented and persisted for 10 days from the last administered dose.

 

Mitragynine has produced interesting results and promising potential in animal experiments.   In mice and rats that have received large oral doses of mitragynine, respiratory depression was never reported.  In an experiment involving zebrafish, mitragynine was found to alleviate the morphine-withdrawal symptoms expressed in their swimming behavior and the level of cortisol in their bodies.  In mice, mitragynine combined with morphine was found to reduce morphine tolerance that usually results from long-term administration as well as augment its analgesic effect.
In spite of its great benefits, the restricted use of kratom remains essential.  The US Drug Enforcement Administration (DEA) indicated that kratom can be abused.  The use of kratom by patients on their own and its availability online and in smoke shops as a legal drug that can be obtained without a prescription is raising concerns.  There are no regulations regarding its production and patients use it on their own.  It is still considered to be a new drug for healthcare workers and researchers alike and we still need to know more about the outcomes of long-term administration.  Further research and controlled-clinical trials are needed to further investigate the benefits of kratom, the possible drug interactions, the effects of possible adulteration and the side effects.  We still need relentless research to find out how addictive kratom can be, how it is metabolized and eliminated from the body.

 

The severity of withdrawal symptoms in the treatment of opioid addiction and the high rates of relapse are some of the major challenges we face nowadays when it comes to opioid addicts.  There are also a limited number of treatment centers and specialists who can deliver the needed interventions.  The immense need for better alternative therapeutic modalities for chronic pain make kratom an ideal candidate for scientific research in an attempt to further support chronic pain patients in the future.

 

References:

 

  1. Boyer, E. W., Babu, K. M., Adkins, J. E., & Halpern, J. (2008, June). Self-treatment of opioid withdrawal using kratom (Mitragynia speciosa Korth). Retrieved from https://www.researchgate.net/publication/5370024_Self-treatment_of_opioid_withdrawal_using_kratom_Mitragynia_speciosa_Korth

DOI: 10.1111/j.1360-0443.2008.02209.x

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  2. Rosenbaum, C. D., Carreiro, S. P., & Babu, K. M. (2012). Here Today, Gone Tomorrow…and Back Again? A Review of Herbal Marijuana Alternatives (K2, Spice), Synthetic Cathinones (Bath Salts), Kratom, Salvia divinorum, Methoxetamine, and Piperazines. Journal of Medical Toxicology, 8(1), 15-32. doi:10.1007/s13181-011-0202-2
  3. Fakurazi, S., Shamima Abdul Rahman, S., Mohamad Taufik Hidayat, M. T., Ithnin, H., Moklas, M. A., & Arulselvan, P. (2013). The Combination of Mitragynine and Morphine Prevents the Development of Morphine Tolerance in Mice. Molecules, 18(1), 666-681. doi:10.3390/molecules18010666

 

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