Kratom: The Down and Dirty

First came Spice1, then Bathsalts,2then Krokodil,3and now Kratom.4  All considered designer drugs by the National Institute of Drug Abuse (NIDA) and all with significant risk factors that today’s physicians need to be aware. Emergency room physicians and psychiatrists especially, but all physicians need to be aware as with the earlier designer drugs Spice and Bathsalts, Kratom is increasingly being seen in the clinical setting and with significant clinical problems. The CDC5reported over 150 deaths between 2016-2017 involved Kratom. Considered a drug of abuse:

“Kratom (Mitragyna speciosa), a plant native to Southeast Asia, has been growing in popularity as an herbal supplement. Consuming low doses of it may have stimulant like effects, while higher doses may produce opioid-like effects, the report’s author’s note.”

US Drug Enforcement Administration (DEA) calls it a “drug of concern6” and is being considered for DEA classification of schedule 1. There have also been reports of both salmonella and heavy metals in Kratom products. According to the DEA,7Kratom 

  • At low doses, increased alertness, physical energy, and talkativeness
  • At high doses, sedation
  • Addictive: causes hallucinations, delusion, and confusion
  • Nausea, itching, sweating, dry mouth, constipation, increased urination, and loss of appetite
  • Long-term use can cause anorexia, weight loss, and insomnia

The National Institute of Health8reported:

“studies in experimental animals suggest that high doses of kratom may be less likely than high doses of opioids to be fatal. However, some deaths in people have been linked to kratom. Typically, they have involved the use of kratom in combination with opioids or various prescription or over-the-counter drugs.”

Reported side effects include anxiety, irritability, and increased aggression, which may be related to the drug’s stimulant effects; and sedation, nausea, constipation, and itching, which may be related to its opioid-like effects. Increased pigmentation of the cheeks, tremor, loss of appetite, weight loss, and psychosis have been seen in long-term kratom users. Seizures have been reported in users of high doses of kratom.8 

If you are a doctor then Kratom should be a “drug of concern” for you too.

REFERENCES

  1. https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids-k2spice
  2. https://www.drugabuse.gov/publications/drugfacts/synthetic-cathinones-bath-salts
  3. https://medicalxpress.com/news/2018-11-krokodil-flesh-eating-zombie-drug-global.html
  4. Kuehn B. Kratom-Related Deaths. JAMA. 2019;321(20):1966. doi:10.1001/jama.2019.6339
  5. https://www.cdc.gov/mmwr/volumes/68/wr/mm6814a2.htm?s_cid=mm6814a2_w
  6. https://www.dea.gov/factsheets/kratom
  7. https://www.dea.gov/sites/default/files/sites/getsmartaboutdrugs.com/files/publications/DoA_2017Ed_Updated_6.16.17.pdf#page=84

Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  8 comments for “Kratom: The Down and Dirty

  1. Pat
    June 5, 2019 at 9:56 am

    I sincerely believe in abolishing ALL drug laws, and letting adults ingest, shoot, smoke, or snort whatever they want. And yes, I think junkies should be able to buy all the cheap hydrocodone and Mexican fentanyl they want.

    Doctors advocating drug laws as a way to “protect the public” are using government to force their prescriptions on others, which is flat wrong, and we’re only making things worse. I’m sick of the nanny state, and of doctors that are a part of it.

    • Sir Lance-a-lot
      June 5, 2019 at 11:02 am

      You tell ’em Pat.

      Even amongst (recovering) druggies, what’s one of the first rules?
      “Live and Let LIve.”

      Your right to swing your fist ends at the tip of my nose, your right to smoke ends at the door to my house, and your right to do drugs ends at my car stereo – so long as you don’t hurt anyone else, we all have the right to go to the Devil in our own way.

  2. Sir Lance-a-lot
    June 5, 2019 at 9:45 am

    Doug, what’s with these testimonials?

    Are these people previous posters here, or did they materialize out of the blue for this particular post?

    I smell ‘bots.

    • Douglas Farrago MD
      June 5, 2019 at 10:05 am

      Not really sure

  3. melody
    June 5, 2019 at 9:04 am

    So, what does the family, of kratom consumers, say about kratom?

    My husband is a retired band/choir director. We have been married for 32 years. To say he’s conservative is an understatement. He graduated from 2 Christian colleges and taught at 2 Christian private schools before he went into the public school sector. His first drink was at age 25 and his first beer was at age 30. He is a strong strong advocate for Kratom and supports me taking it 100 percent. He is more than willing to talk to anyone about Kratom and what it’s done for me and our family.

    “Friends and family, Many of you know how Melody has suffered for several years with fibromyalgia. She was on a regimen of barely effective prescription meds with horrible side effects that left her nearly bedridden and robbed her of any quality of life, and deprived our kids of their mom and me of my wife. She found relief in taking 1 ounce of Kratom a day. Kratom is a natural herbal, no more than a ground-up leaf from a tree in SE Asia. Now, with virtually no scientific evidence as a basis, the DEA plans to ban two of the chemical components in this herb by making them a felony to purchase. The reason we surmise is that big pharma is behind this, trying to force dependence on their drugs. Melody is grieving losing the quality of life she now enjoys. Please pray that logic and reason will prevail and our family will not lose Melody once again. If you wish, sign the “We the People” link I shared.”

    That was from 2016 when we fought the DEA and won. my adult children feel the exact same way and donate money to the American kratom association. They don’t want to lose me again either.

  4. melody
    June 5, 2019 at 9:03 am

    Life for 8 years before taking Kratom
    *taking 11 medications including prescribed dilaudid and fentanyl
    *Bedridden
    *Using a wheelchair and walker
    *rarely left the house
    *couldnt go see my mom after she went to the nursing home for 3 years
    *missed out on ALL activities my kids had at school
    *i had no relationships with my kids

    I have been taking KRATOM now for 5 years and this is my life now
    * taking ZERO medications and my dr approves of Kratom
    * I bike several miles a day through a nature preserve near our home or walk 2 miles a day.
    *go out to places several times a week for dinner, coffee etc
    *I saw my mom often on a regular basis.Which is truly a blessing because she just died March 23.
    * I went on a family camping and road trip from Michigan to Wyoming for the solar eclipse where I even did some rock climbing
    * I have been able to get to know my kids and establish a relationship. I am so lucky they all go to local colleges or I never would have gotten to know them. It’s my pleasure to take care of them, as much as I can because they are adults now, even if it is just preparing their meals. For many years they pretty much raised themselves. I am so grateful for Kratom.

  5. Amber Cook
    June 5, 2019 at 8:59 am

    Kratom has saved me from my severe depression. I started experiencing depression at 21 after having my 1st child. Over the next 14 years I continued to battle it. I tried just about every antidepressant on the market, and only got worse. I found Kratom in 2014, and it has been life changing for me. I’m now the mom that my 3 kids deserve.

  6. Sir Lance-a-lot
    June 5, 2019 at 8:32 am

    “All considered designer drugs by the National Institute of Drug Abuse (NIDA)…”

    “Kratom (Mitragyna speciosa), a plant native to Southeast Asia…”

    It can’t be both a “designer drug” and a native plant species.
    Pick one.

    “Long-term use can cause anorexia, weight loss, and insomnia”

    Sounds like an effective weight loss drug.
    And if most deaths “have involved the use of kratom in combination with opioids or various prescription or over-the-counter drugs,” then it’s probably safer than phentermine.

    Where do I get it? Is it on the USP yet?

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