Kratom for Chronic Pain? -Wholefoods magazine
Kratom for Chronic Pain? -Wholefoods magazine
Kratom is not legally marketed in the U.S. as a drug or dietary supplement, according to the FDA. But people still use it. Fibromyalgia experts discuss Kratom as a pain relief option used under a healthcare provider’s guidance.
Lower Risk than Opiods
by Jacob Teitelbaum, M.D.
With one third of Americans suffering with chronic pain, approximately 50,000 preventable U.S. deaths each year from arthritis medications (e.g. NSAIDs like ibuprofen), and 5,000 yearly deaths from prescribed narcotics used as directed, we clearly have a major problem in how we treat chronic pain.
Having effectively treated thousands of people with fibromyalgia and other forms of severe chronic pain, and published a number of studies and textbook chapters on this, one simple fact has become very clear: Virtually all pain can be effectively treated, by using the entire healthcare toolkit. This includes both natural and prescription options, as well as socially controversial natural treatments such as marijuana, hemp oil, and kratom.
For example, numerous studies show that using natural options such as a special mix called Curamin, and even a mix of glucosamine plus chondroitin, is as or more effective than arthritis medications. And could save over 50,000 lives a year.
If not for a deadly quirk in our government’s regulatory system.
Basically, it costs anywhere from $100 million to $2.6 billion to put a single treatment through the FDA regulatory system. As nobody can pay this for non-patentable treatments, the enormous body of research using safe natural and low-cost generic medications cannot be effectively discussed or publicized.
Natural remedies, and Kratom is no exception, are not without risk. They simply carry much lower risks than medications. Although in my experience it has been uncommon if the dose is properly regulated, some people will develop cravings or even tolerance to this herbal. So I do not begin with this. Still, I have seen people who failed dozens of other herbals and medications, including narcotics, and had dramatic relief with Kratom.
As a physician, one learns to do a risk/benefit analysis. This includes looking at the validity of the data being used. As of 2017, the FDA reported 44 deaths worldwide associated with Kratom. But it is important to understand what the words “associated with” mean: simply that if they found any evidence of Kratom in the bloodstream when somebody died, even if they had a massive narcotic overdose and a gallon of tequila in them, this death is then “associated with” Kratom (1).
This faulty approach would claim that millions of deaths are associated with the use of milk, coffee or even toilet paper.
The bottom line? Kratom can be a very helpful tool in the healthcare toolkit when used with a health practitioner’s guidance; Kratom is far safer than ibuprofen and codeine; and Kratom should be reserved for when other natural treatment options have failed. To make it illegal will trigger far more suffering and deaths than it would prevent.
Still Too Risky
by Ginevra Liptan, M.D.
Kratom has significant medicinal potential for both pain management and easing opioid withdrawal, but most health care professionals do not recommend it due to safety concerns. Regardless of medical advice, consumers are using it—over 2 million Americans take kratom every year. While kratom is currently sold over the counter, its legal status is murky. Sales of kratom have been banned in six U.S. states, and in 2016 the DEA attempted to make it a Schedule I drug, but backed off after a public outcry.
I’ve found a surprising number of my patients are trying kratom without informing any of their doctors. Several of my patients report significant pain reduction with kratom, with some using it to successfully wean themselves off prescription opioids. Health care providers need to understand the pharmacology of this plant so they can discuss the risks and benefits with their patients.
Kratom has well documented medicinal actions, but its pharmacology is complex. The effects of kratom on the body are dosage dependent, lower doses give stimulant effects and larger doses provide analgesic and sedative effects. Kratom contains at least 40 different known phytochemicals with actions on multiple brain receptors. Its main active ingredients bind primarily to opioid receptors.
The biggest benefit of kratom is that while it has analgesic effects comparable to morphine, it causes less constipation, respiratory depression, and tolerance compared to opioids. However chronic use is not without risk and has been associated with drug dependency and development of opioid withdrawal symptoms. Rare side effects of kratom include psychosis, hypertension and liver failure. Although kratom has less respiratory suppression effects compared to opioids, it still can be deadly when mixed with other compounds. There are case reports of overdose deaths due to mixtures of kratom with over-the-counter cold medications, sleep medications, or benzodiazepines. However in total, kratom appears to be a much safer option than opioids.
Currently the biggest safety issue around kratom is the lack of supplement consistency and quality control as it is not being produced by any large or reputable supplement companies. There have been concerning reports of products adulterated with medications, or contaminated by bacteria, as occurred in a multistate Salmonella outbreak.
Kratom does have exciting therapeutic potential as a pain treatment, but for it to be really useful medically we need more information about safe dosing and interactions with other medications and access to high quality, standardized products.