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Cracking the Code on Kratom: Why Nature’s Opioid Isn’t as Harmless as It Seems

For millennia, humans have looked to the healing bounty of the earth to ease their pain, soothe their anxieties, and in general suffuse them with a sense of peace and wellbeing. We have used medicinal and psychogenic botanicals to make teas, ointments, tinctures, and more. Quite often our lives have been longer, healthier, and happier for them.

However, that does not mean that everything that blooms from the earth is a friend to humanity. Consider deadly nightshade. Oleander. Hemlock.

It can be tempting to equate everything that comes from nature as invariably safe, protective, life-giving, and life-restoring. These false assumptions can have lethal consequences.

Take, for instance, the psychoactive herb, Mitragyna speciosa, better known as kratom, which, in recent years, has gained widespread popularity as an ostensibly “safe” alternative to opioids. Users claim that kratom offers a myriad of physiological and psychological benefits, from alleviating pain to promoting relaxation, and even preventing panic attacks.

Despite the lofty claims made by kratom users, supporting evidence remains scarce at best. What is not in dispute, though, are the real and documented harms linked to the use of the herb, including nearly 2,000 reports in the United States alone of kratom poisonings, some fatal, between 2011 and 2017. The simple fact is, if you’re looking for a safe, natural, non-addictive way to ease your pain or reduce your anxiety, you need to search elsewhere. This article explores the significant and wide-ranging risks of turning to kratom as an opioid alternative.

The Myth of Harmlessness

The significant popularity that kratom has attained in recent years derives largely from widespread assertions regarding its safety. Much like the false narrative surrounding the use of “medicinal marijuana,” the prevailing kratom myth claims that kratom presents far fewer health risks than opioids because it does not act on the central nervous system (CNS) in the same way opiates do. Thus, according to these claims, users do not have to fear the principal threat of opioids, which is severe respiratory depression (1).

To be sure, kratom does not appear to pose the risk of respiratory depression and respiratory arrest that opiates do (2). That does not mean, however, that kratom cannot act on the central nervous system, particularly when combined with other drugs. Indeed, because the mechanisms through which kratom may interact with other drugs are not yet well understood, researchers and healthcare providers alike are sounding the alarm over the use of the herb in conjunction with prescription pharmaceuticals, illicit drugs, and other supplements (2). In fact, there is mounting evidence that undetected drug interactions may well have caused a significant number of kratom-related deaths, particularly given kratom’s documented impacts on liver metabolism (2, 3, 4, 5).

Organ Toxicity

As significant as the threat of fatal drug interactions may be, this is far from the only risk associated with the use of kratom. There is vast evidence that links kratom use to organ toxicity and failure. This risk appears to be particularly significant for the liver, kidneys, and heart (6, 7, 8). These studies have linked kratom use to the development of life-threatening hepatitis, cirrhosis, liver failure, and heart failure (9, 10).

In one vivid example, researchers explored the case of an otherwise healthy 35-year-old male who suffered cardiac arrest following kratom ingestion (11). The patient was found to have no comorbidities or pre-existing risk factors, nor had the patient ingested any substances other than the herb. Nevertheless, the patient was found to have experienced both heart rhythm dysfunction and multiple small strokes after ingesting the drug, resulting in cardiac arrest (11).

Neurological Effects

In addition to the risk of organ toxicity, kratom use has also been strongly associated with severe neurological impacts. The most prevalent of these adverse neurological impacts is the development of treatment-resistant seizures in patients with no prior history of epilepsy or other seizure disorders (12, 13). The research also suggests that kratom use can induce breakthrough seizure activity in persons undergoing treatment for epilepsy (14).

Abuse, Addiction, and Withdrawal

Perhaps one of the most dangerous myths associated with the use of kratom as an opioid alternative is that, unlike opioids, kratom is non-addictive and does not produce withdrawal symptoms. In fact, evidence indicating the addictive potential of kratom is strong, with increasing reports of misuse, abuse, and withdrawal (15, 16, 17).

Indeed, Shah et al. (2021) recently examined both the increasing prevalence of kratom abuse and addiction and intensifying efforts to classify kratom as a Schedule I drug (18). These concerns, the authors note, have been galvanized by the growing awareness of the mechanisms of kratom and, in particular, its nearly identical properties to opiates at high doses, combined with a risk for organ toxicity and drug interactions that appears to be even greater than the risk posed by opioids (18).

Lending further support to emerging claims of the addictive potential of kratom are recent studies describing cases of neonatal abstinence syndrome (NAS) in newborns exposed to kratom prenatally (19, 20, 21). The research indicates that instances of kratom-related NAS produced moderate to severe symptomatology which typically resulted in prolonged hospitalization after birth, as well as opioid treatment to manage withdrawal symptoms during the first months of life.

How Bayshore Can Help

If you or someone you love is struggling with opioid addiction, you don’t have to resort to an unproven and demonstrably dangerous substance such as kratom. Likewise, if you are experiencing a kratom dependency, you don’t have to risk the dangers of unassisted detox.

Our expert team of recovery specialists at Bayshore is uniquely qualified to provide the comprehensive care you need to break free of your addiction. We offer a full range of services, from nutrition education to art therapy to yoga, to treat the whole person, not the addiction. Our onsite mental health specialists provide individual, group, and family counseling, and our medical teams are licensed to prescribe short-term pharmaceutical treatment as appropriate during the detoxification phase of your recovery.

Contact us today to discuss how the team at Bayshore can help you break the chains of opiate addiction or escape the shadow of kratom.

At Bayshore Retreat we have extensive knowledge in treating substance abuse and co-occurring mental health issues. We understand that Mental Health Disorders can be the root cause of substance abuse. We use the latest scientific research and holistic approach for drug and alcohol addiction treatment.

References:

  1. Gupta, Kapila; Prasad, Aruna; Nagappa, Mahesh B; Wong, Jeana; Abrahamyan, Lusinec,d; Chung, Frances F.a Risk factors for opioid-induced respiratory depression and failure to rescue, Current Opinion in Anaesthesiology: February 2018 – Volume 31 – Issue 1 – p 110-119 doi: 10.1097/ACO.0000000000000541 
  2. White C. M. (2019). Pharmacologic and clinical assessment of kratom: An update. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 76(23), 1915–1925. https://doi.org/10.1093/ajhp/zxz221
  3. Kamble, S. H., Sharma, A., King, T. I., Berthold, E. C., León, F., Meyer, P., Kanumuri, S., McMahon, L. R., McCurdy, C. R., & Avery, B. A. (2020). Exploration of cytochrome P450 inhibition mediated drug-drug interaction potential of kratom alkaloids. Toxicology letters, 319, 148–154. https://doi.org/10.1016/j.toxlet.2019.11.005
  4. Todd, D. A., Kellogg, J. J., Wallace, E. D., Khin, M., Flores-Bocanegra, L., Tanna, R. S., McIntosh, S., Raja, H. A., Graf, T. N., Hemby, S. E., Paine, M. F., Oberlies, N. H., & Cech, N. B. (2020). Chemical composition and biological effects of kratom (Mitragyna speciosa): In vitro studies with implications for efficacy and drug interactions. Scientific reports, 10(1), 19158. https://doi.org/10.1038/s41598-020-76119-w
  5. Tanna, R. S., Tian, D. D., Cech, N. B., Oberlies, N. H., Rettie, A. E., Thummel, K. E., & Paine, M. F. (2021). Refined Prediction of Pharmacokinetic Kratom-Drug Interactions: Time-Dependent Inhibition Considerations. The Journal of pharmacology and experimental therapeutics, 376(1), 64–73. https://doi.org/10.1124/jpet.120.000270
  6. Botejue, M., Walia, G., Shahin, O., Sharma, J., & Zackria, R. (2021). Kratom-Induced Liver Injury: A Case Series and Clinical Implications. Cureus, 13(4), e14679. https://doi.org/10.7759/cureus.14679
  7. Khan, M. Z., Saleh, M. A., Alkhayyat, M., Roberts, D. E., & Lindenmeyer, C. C. (2021). Multiorgan Dysfunction Related to Kratom Ingestion. ACG case reports journal, 8(8), e00647. https://doi.org/10.14309/crj.0000000000000647
  8. Allison, D. R., Mubarak, M., Sharma, N., & Rao, D. S. (2022). Kratom (Mitragyna speciosa)-Induced Hepatitis. ACG case reports journal, 9(4), e00715. https://doi.org/10.14309/crj.0000000000000715
  9. Sangani, V., Sunnoqrot, N., Gargis, K., Ranabhotu, A., Mubasher, A., & Pokal, M. (2021). Unusual Presentation of Kratom Overdose With Rhabdomyolysis, Transient Hearing Loss, and Heart Failure. Journal of investigative medicine high impact case reports, 9, 23247096211005069. https://doi.org/10.1177/23247096211005069
  10. Patel, P., Aknouk, M., Keating, S., Richard, I., Kata, P., Ali, R. Y., & Cheriyath, P. (2021). Cheating Death: A Rare Case Presentation of Kratom Toxicity. Cureus, 13(7), e16582. https://doi.org/10.7759/cureus.16582
  11. Abdullah, H., Haq, I., & Lamfers, R. (2019). Cardiac arrest in a young healthy male patient secondary to kratom ingestion: is this ‘legal high’ substance more dangerous than initially thought ?. BMJ case reports, 12(7), e229778. https://doi.org/10.1136/bcr-2019-229778
  12. Tatum, W. O., Hasan, T. F., Coonan, E. E., & Smelick, C. P. (2018). Recurrent seizures from chronic kratom use, an atypical herbal opioid. Epilepsy & behavior case reports, 10, 18–20. https://doi.org/10.1016/j.ebcr.2018.04.002
  13. Afzal, H., Esang, M., & Rahman, S. (2020). A Case of Kratom-induced Seizures. Cureus, 12(1), e6588. https://doi.org/10.7759/cureus.6588
  14. Burke, D. J., Mahonski, S. G., & Van Cott, A. C. (2021). Breakthrough Seizure Associated With Kratom Use in Patients With Epilepsy. Neurology. Clinical practice, 11(1), 78–84. https://doi.org/10.1212/CPJ.0000000000000846
  15. Sethi, R., Hoang, N., Ravishankar, D. A., McCracken, M., & Manzardo, A. M. (2020). Kratom (Mitragyna speciosa): Friend or Foe?. The primary care companion for CNS disorders, 22(1), 19nr02507. https://doi.org/10.4088/PCC.19nr02507
  16. Galbis-Reig D. (2016). A Case Report of Kratom Addiction and Withdrawal. WMJ : official publication of the State Medical Society of Wisconsin, 115(1), 49–53.
  17. Demick, D. S., Lee, T. T., Summers, A. T., & El-Mallakh, R. S. (2020). Kratom: A growing substance of abuse in the United States. Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists, 32(4), 275–280. https://doi.org/10.12788/acp.0012
  18. Shah, K., Tankersley, W., & Mekala, H. (2021). Kratom: An Emerging Issue and Need for Regulations in the United States. The primary care companion for CNS disorders, 23(1), 20r02770. https://doi.org/10.4088/PCC.20r02770
  19. Murthy, P., & Clark, D. (2019). An unusual cause for neonatal abstinence syndrome. Paediatrics & child health, 24(1), 12–14. https://doi.org/10.1093/pch/pxy084
  20. Eldridge, W. B., Foster, C., & Wyble, L. (2018). Neonatal Abstinence Syndrome Due to Maternal Kratom Use. Pediatrics, 142(6), e20181839. https://doi.org/10.1542/peds.2018-1839
  21. Davidson, L., Rawat, M., Stojanovski, S., & Chandrasekharan, P. (2019). Natural drugs, not so natural effects: Neonatal abstinence syndrome secondary to ‘kratom’. Journal of neonatal-perinatal medicine, 12(1), 109–112. https://doi.org/10.3233/NPM-1863
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