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Kratom - Another drug to OD on? - (2/20/2018)

By Dr. Ron Gasbarro

Jim Brown came into the pharmacy and said to the pharmacist, “What the heck is this stuff? I found it in my son’s room.” Jim tossed a packet onto the counter. The pharmacist saw the word “kratom” on the package label and knew right away what it was. The US Food and Drug Administration (FDA) has recently declared it dangerous and has classified it as an opioid, similar to oxycodone and hydrocodone. Kratom affects the same opioid brain receptors as morphine. Phone calls to American poison control centers regarding the use of kratom increased tenfold from 2010 to 2015. In February 2018, the FDA has received reports of at least 44 kratom-associated deaths, up from 36 in November 2017. The agency is also aware of reports that kratom is being laced with other opioids, making it even more toxic.

Kratom is an herbal substance made of the crushed leaves of a tropical tree, Mitragyna speciosa, which grows in Southeast Asia. The leaves have been chewed or infused in teas for thousands of years to ease muscle pain. Sold in pill or powder form and mixed into beverages, the drug produces a stimulant effect in small amounts. In larger amounts, it acts as a sedative. At very extreme doses, kratom has caused delusions or hallucinations. Long-term users of this drug have experienced anorexia, weight loss, sleep disturbance, constipation, frequent urination, dry mouth and darkened skin. Withdrawal from kratom can produce irritability, aggression, hostility, muscle aches, and limb spasms.

The FDA is warning consumers not to use kratom because, chemically, it is an opioid. The agency is concerned that kratom appears to have properties that expose users to the risks of addiction, abuse, and dependence. There are no FDA-approved uses for kratom, and the agency has received worrying reports about the safety of kratom. FDA is actively evaluating all available scientific information on this issue and continues to warn consumers not to use any products labeled as containing kratom or its psychoactive compounds, mitragynine, and 7-hydroxymitragynine. FDA encourages more research to better understand kratom’s safety profile, including the use of kratom combined with other drugs. According to the National Institute on Drug Abuse, kratom goes by other names such as herbal speedball, biak-biak, ketum, kahuam, thang, and thom.

There are those who consider kratom-containing supplements to be beneficial as not only a pain reliever but also as a way to soften the withdrawal symptoms of opioid addiction. Yet, no controlled studies have been performed to determine whether these claims are true and what dose would be beneficial rather than lethal. The US Drug Enforcement Administration (DEA) recently declared that it will hold off on a previously announced ban of kratom, as there is a need for additional input regarding this decision from the public and the FDA. In August 2016, the DEA suggested that it planned to add the psychoactive compounds found in kratom to the list of Schedule I drugs banned under the Controlled Substances Act, drugs such as heroin and LSD. This led to significant outrage and clamor from individuals who believe that kratom can help people struggling with different medical issues.

Nevertheless, Jim Brown was troubled by the possible use of this drug by his 15-year old son. “My son and I are going to have a discussion,” he told the pharmacist. The pharmacist agreed because the drug has not been proven to be either safe or effective. 

Ron Gasbarro, PharmD is a registered pharmacist, medical writer, and principal at Rx-Press.com. Read more at www.rx-press.com


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