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The Dark Side of Kratom

Given the magnitude of the opioid epidemic plaguing the country, it’s understandable that many would prefer to turn to alternatives for treating their chronic pain, or even withdrawal from opioids. One of those alternatives, the herbal supplement kratom, has become extremely popular in recent years. Our family practice doctors in Delray Beach, however, have reservations about the safety of this popular substance.

Some background

Kratom, a tree native to Southeast Asia, produces leaves that can be made into a tea or pill, or chewed by users. Relatively new to the United States, it has been used for centuries in Asian countries as a way to reduce fatigue and ease various aches and pains. In this country, it is sold in drinks or as supplements, and is touted to treat such common conditions as chronic pain, anxiety, depression, and opioid withdrawal. The American Kratom Association (AKA), a non-profit organization that promotes the regulation and safe use of kratom, reports that as many as five millions Americans have used the herb in the last few years.

Testimonials from users include such claims as, “Kratom gave me my life back after being addicted to pain pills;” “It has helped me enormously with chronic back pain;” and, “It got me off a 20-plus-year addiction to narcotics and opioids.”

The downside

A new study, however, highlighted the dangers associated with ingestion of kratom. Research published this month in the journal Clinical Toxicology found that the number of phone calls to U.S. poison control centers regarding adverse effects from kratom have soared, from 13 calls in 2011 to 682 in 2017. Reported effects of kratom overdose included rapid heartbeat, agitation, high blood pressure, seizures, coma, kidney failure, and 11 deaths during the study period. Two of those deaths were attributed to kratom alone, while the other nine occurred in people who combined kratom with other drugs.

“Kratom use has been associated with a variety of serious medical outcomes, from seizures and coma in adults to severe withdrawal syndrome in newborns,” said Henry Spiller, co-author of the study, in a statement. Spiller is also director of the Central Ohio Poison Center at Nationwide Children’s Hospital.

The U.S. Food and Drug Administration (FDA) agrees. In a statement released last fall, FDA commissioner Scott Gottlieb wrote:

“Over the last year, the FDA has issued numerous warnings about the serious risks associated with the use of kratom, including novel risks due to the variability in how kratom products are formulated, sold and used both recreationally and by those who are seeking to self-medicate for pain or to treat opioid withdrawal symptoms. These include warnings about the contamination of kratom products with extremely high rates of salmonella that put people using kratom products at risk, and resulted in numerous illnesses and recalls and the agency’s first-ever mandatory recall order after a rigorous investigation. As part of our efforts to assess kratom for contamination in the products tested, we also found disturbingly high levels of heavy metals in kratom products.”

And some users have reported becoming addicted to the supplement. One former user told The Washington Post, that “kratom was fun—it was like ‘having morphine and cocaine at the same time’—until he got addicted. Withdrawal, he said, was like ‘getting ripped apart by fishhooks.’ ”

Supporters’ arguments

Advocates for the unregulated availability of kratom attribute such negative reports to a profit motive on the part of drug companies, overly restrictive U.S. drug policies, and poor research, among other objections. They say it has been used successfully for thousands of years in Southeast Asia without a problem. They also claim the reports of side effects are overblown, and that even such usually benign substances as wine, coffee, and sugar can have negative consequences for some people.

The AKA points to numerous studies which seem to show that kratom can be used safely by the vast majority of people. It also warns that any attempt to classify kratom as a Schedule 1 drug (subject to criminal prosecution) as the FDA is considering, “would lead to increases in opioid overdose deaths when thousands of former users return to opioid use.” It also cautions that many of those who depend on it for pain relief could be driven to black market sources, thus exposing them to adulterated supplies.

While it’s true that any drug, even aspirin, can have serious side effects, and it’s also true that the poisoning cases attributed to kratom represent a small fraction of reported users, we would prefer that our patients not take the risk. If you want to use kratom for any reason, please at least discuss it with us first. We can present the facts that can help you make that decision.

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