Kratom and the Opioid Crisis

Never judge someone until you walk a mile in their shoes.  Which, even in the context of sharing numerous similar experiences, will actually never happen.  Therefore, judgement is best shelved. 

 

Ideally, we strive for the best.  We strive for a drug free, minimal supplement state in which function is optimal.  Again, this is the ideal, not always reality.  In fact, more likely than not it isn’t the case.  Be that as it may, we then keep it idealistic and if function is indeed suboptimal, and there exists signs and symptoms due to it; rather than throw symptom silencing medications or supplements at the complaint, we shoot to identify the causative dysfunction at that root level and rectify it; with the attainable and often achieved end goal being elimination of the ultimate manifestation(s) of the underlying dysfunction: the symptom.

 

One more time; this is the ideal.

 

However, first off what is ideal is subjective. My ideal may not be your ideal.  Perspective, preference, choice and the freedom to do what works best for you must be acknowledged and respected.

 

Second, sometimes based upon a virtual countless number of influential variables unique to each individual and their journey endured, those powerful lifestyle strategies and interventions can fall short of an individual’s satisfactory, livable expectations.  

 

Never is this more true than when it comes to pain.  It is such a complex, layered phenomenon that it can literally lead some to opt for death over the sustained experience of it.  There is a need for pain control in our society, and brilliant minded thought leaders,  innovators, scientists and chemists have brought many options and alternatives to the table.  Some of these options are more natural than others; with some working for some people, some for others.

 

The advent of the now traditional pharmaceutical opioid has been highly effective in accomplishing the main objective; pain control.  This has been a literal (although perhaps temporary and not without massive collateral damage) quality and quantity of life preserver for many who find themselves in a state of unrelenting, debilitating pain.  

 

Stop and think for a second before passing judgement.  Think about the combat wounded veteran; those permanently injured in any type of accident; those whose profession has left them in excruciating pain, like a manual laborer, our service personal or even a professional athlete. Many of these people have tried other routes and for one reason or another still come up short in attaining a tolerable level of pain.  Many are still searching for a natural, intervention free solution, but have the search and progress impeded by the pain or side effects of the current standard protocol.

 

Now there will always be people who take advantage of and abuse every system in place.  However, many of these systems and options exist because there is a legitimate need for them.  You shouldn’t punish, penalize or impede those truly in need of the assistance available on the account of the system abusers.  You haven’t walked in their shoes.  You don’t know what they’re going through.  You don’t know how the world is perceived and processed in another brain.

 

Having said ALL that, this opioid use, which has escalated to a haphazard level, has not been without consequence.  We can point fingers at big pharma, prescribing doctors, the individual end user, or a combination of the three, but that doesn’t change the fact that the epidemic that kills over 90 people a day is real.  It doesn’t change the fact that the genesis of the current state was sparked due to a demand; a demand for a remedy to control pain.  Like it or not we live in a medicated society, where it is widely accepted and expected as the norm to be provided a pill for this and a pill for that.  The approach to pain has been no different.

 

Without dismantling every aspect of the entire system; which ultimately may be the ideal longterm solution, a more immediate plan would be to identify and provide a safer alternative to the life destroying opioids.  That is what finally brings us to the topic of this post.  In the office last week, on four separate occasions, patients inquired or shared information on a substance known as Kratom.  The information was mixed and often contradictory as it seems there is much confusion and ignorance when it comes to this plant derivative.  However, in light of the now nationally recognized opioid crisis and the war on it, at the very least options such as Kratom should be understood and explored as a potentially safer alternative to dig us out of this mess with less carnage being left in the wake.

 

WHAT IS KRATOM?

 

Kratom (mitragyna speciosa) is a plant, more specifically a tropical evergreen tree indigenous to the far east (Southeast Asia), with much of the documented history behind it coming out of Thailand & Malaysia.  It has been used “safely” there for over 100 years.  Although much of the negative backlash to the plant derivative is based upon it being an opioid (not an opiate; more on that distinction to follow), it’s major traditional use is as a stimulant for field workers.  The leaf is commonly picked in the morning, brewed into a tea or “juice,” then cooled and 50% diluted with water.  Sipping this throughout the day allows laborers to better endure the outdoor elements and work longer days.  More recently, eastern women have been using it as an assistive stimulant in handling family care and daily household chores.  

 

(Sounds a lot like the western use of coffee to me; which makes sense as the two plants fall under the same family (Rubiaceae) classification.)

 

Another traditional application is by men in the evenings as they would come together, drink their Kratom tea, socialize and use to wind down for the evening.  

 

(Do you have a glass of wine in the evening or a beer with some friends that serves a similar purpose? Sounds a lot like the western use of alcohol, or more increasingly, cannibis.)

 

It is also used as a substitute for opium, to help avoid withdrawals when opium is unavailable.  This property also has made Kratom an option in helping people get off other more addictive opioids as it does indeed interact directly with our opioid receptors, but again, with substantially less withdrawal affect.  The withdrawal affect or withdrawal

syndrome experienced from Kratom use has been described as being more inline with that experienced by habitual coffee drinkers when they miss their caffeine dose.  Again this would make sense as the plants share similarities that place them under the same family classification.

 

And of course, of particular relevance to the topic at hand, Kratom is also used as a naturally occurring analgesic aka a pain killer.

 

HOW DOES IT WORK?

 

Kratom is made up of over 40 different chemical compounds called alkaloids.  (We also find alkaloids in nightshade fruits and vegetables, herbs like ashwagandha, and nicotine.) Two of these alkaloids (mitragynine & 7-hydroxymitragynine) are currently acknowledged as being the active analgesic or pain killing ingredients that are theoretically (depends on the source) isolated or in higher concentrations in the therapeutic intended extracts.  These alkaloids interact directly with the opioid receptors in our brain, landing them under the opioid classification. 

 

Well that settles it.  By definition it is an opioid.  Opioids are bad.  Kratom is an opioid, so Kratom is bad.  Is it that black and white?  Is a better, perhaps even basic understanding of opioids and opiates necessary before speaking emphatically on the topic?  One would logically think so.

 

OPIOIDS & OPIATES

 

To be clear, in order to be classified as an opioid, the substance must bind with or interact with our opioid receptors in the body.  We know the alkaloids in Kratom do this, hence the long known, but more recent FDA public proclamation of Kratom as an opioid.  We are familiar with the main subjects of the opioid epidemic in things like hydrocodone, fentanyl, morphine, codeine and heroin, but what are some other opioids?

 

Do you eat bread?

We’ve covered this in a past discussion (https://onebody.live/2018/02/01/is-gluten-addictive/), but the complex gluten molecule contains two peptides called gluteomorphins & prodynorphin that stimulate the opioid receptor, therefore landing gluten constituents under the opioid classification.  It’s no wonder so many can struggle to give up their bagels, breads, baked goods, cereals, and pastas.  

 

How about sugar?

As with gluten, sugar consumption leads to stimulation of opioid receptors, triggering the same pathway (but to a lesser degree) as morphine, codeine or even heroin.  

 

Talk about a semi “it’s not your fault,” moment.  We know sugar is diabetes and obesity provoking, but it’s not simply due to the blood sugar spiking, insulin sensitivity disrupting, body fat depositing effects.  These sugar, these types of carbs, these types of grains; they also alter your brain chemistry in stimulating opioid receptors, providing a reward or high, and potentially triggering addiction, abuse, and even withdrawal.  If you struggle with food, you need to know this.  You need to wake up and take your brain back as it, along with the rest of your health has been hijacked by the food industry.  You have the knowledge.  You are empowered.  Use it and take action.  

 

Wow.  

How’s that for a side-note, rabbit hole tangent during a Kratom post?  

All good.

It’s ALL relevant when it comes to your health.

 

When we begin to understand the biochemistry behind the way food interacts with our body, legitimate explanations behind binge or emotional eating habits become clear.  It would be quite naive to assume that the food industry does not know and take advantage of this when they include gluten and/or sugar in the mass majority of the foods out there to literally tip the scales towards higher consumption and congruent profits.  Are we to ban these foods/ingredients because they meet technical opioid classification? 

(I’m fine with that.)

 

This will obviously not happen, with one major reason being the money behind it.  Regardless of the mounting numbers of lives being destroyed, it takes a massive shift motivated by sustained outcry in order to trim or cutdown a money tree that many draw from.  We can apply this to food or the current opioid crisis.  Lives have been being ruined for years now, but it thankfully finally reached a tipping point.  It comes with great reluctance that the powerful industries making billions off of the traditional pharmaceutical opioids are finally forced to acknowledge a problem and portray people over profit; at least on the surface; at least for the moment.

 

Piggy backing on that point brings us back to the backlash and negative spin on Kratom.  If we continue to follow the money, we see that Kratom is still being studied (the only way to safely understand it) and not yet cleared for the pharmaceutical industry to make money off it; in particular money to replace the revenue stream provided by the prescription opioids on the market; opioids that, based on studies already done out of the University of Florida, Kratom may just be a safer alternative to.

 

There was a portion of time that Kratom was made illegal in Thailand after years of traditional use (again, similar to the way the western world uses coffee as a stimulant and alcohol to socialize and relax).  It is postulated that the motivation behind this criminal label being slapped on Kratom was due to Kratom detracting from the exuberant profits being made by Thailand’s heroin trade, despite the fact that Kratom is a more affordable and by most accounts, safer alternative.  However, food was being taken off the plate of the powerful who profited off of heroin, leading to not just an FDA declaration and negative PR campaign against Kratom like here in the states, but an outright law making the substance illegal.  

We’ve got to follow the money to get the whole story.

 

Soap box moment:  We need to check our sources before accepting information as gospel or fact.  It doesn’t matter what news channel you caught that segment on the dangers of something like Kratom from.  Chances are there is Big Pharma advertising playing a role in content conveyed.  Just watch the commercials and you’d be hard pressed to go a commercial break segment without at least one medicinal ad.

 

But back to Kratom, Opioids & Opiates…

 

Have you ever heard of runner’s high?  Well, that phenomenon takes place due to the release of beta-endorphins in the body, post run or many types of challenging physical activities.  Guess what the beta-endorphins interact with in order to provide that sense of euphoria? You got it; the opioid receptors. 

 

How about the sun?  The same end result transpires.  Exposure to the sun leads to a release of opioid receptor stimulating beta-endorphins.  

 

The point to be acknowledged here is that before we go dismissing something because it falls under the opioid label; we should understand what the actual term means and also includes.  We should also realize that an opioid is different from an opiate.  An opiate is a psychoactive alkaloid compound naturally found in the opium poppy plant (Papaver somniferum) most commonly morphine,  codeine, and thebaine, and to a much lesser, more rare degree hydrocodone and oxycodone.  They also stimulate the opioid receptors, naturally garnishing them with opioid classification status.  All opiates are opioids, but, as we illuminated above not all opioids are opiates.

 

HOW IS KRATOM DIFFERENT?

 

The major issue with the current opioid epidemic is the harm and death it has been causing to the lives of countless individuals. Let’s touch on some of the dangerous aspects of the current commonly prescribed opioids and how Kratom appears to differ.

 

33,000+ people dying a year due to opioids is no number to scoff at.  In the majority of these cases, the deaths are attributed to respiratory depression, as the current pharmaceutical opioids inhibit the central nervous system via interaction with beta-arrestin proteins.  Thus far, the Kratom alkaloids do not appear to interact with this protein, potentially eliminating or vastly attenuating stimulation of the mechanism responsible for the mass majority of opioid fatalities.  

 

Another issue with the current pharmaceutical opioids is that they lead to a nasty withdrawal syndrome, increasing the likelihood of abuse and addiction.  Withdrawal syndrome has been noted in chronic, heavy users of Kratom, but to a lesser degree (as we noted earlier, similar to that of caffeine).  One of the reasons our current pharma opioids are so addictive is that they are highly selective (more or less exclusive) for the opioid receptors.  This makes their punch more potent on every level.  

 

Kratom is a made up of ~40 different alkaloids (perhaps contingent upon batch and strain) still being studied.  It is highly speculated that some of these other alkaloids stimulate different receptors in the body that mitigate the potential adverse effects.  One of these receptors is the alpha-2 adrenergic receptor, which is the same receptor the drug clonidine targets, to lessen the withdrawal symptoms that often lead to abuse and subsequent addiction.  By stimulating this pathway, Kratom appears to concurrently lessen the likelihood of abuse and addiction.

 

A major attraction to Kratom is the therapeutic potential the plant has, particularly when utilized in it’s whole form  rather than simply isolating analgesic alkaloids. This is where it seems we often get into trouble.  Plant purists would argue that the other parts of the plant are there for a purpose, despite the fact that our minds may have yet to discover what that is or how it works.  This rationale is often applied towards turmeric v. isolating the curcuminoids, cannibis sativa v. isolating the canabadiol (cbd), or even white willow bark v. isolating the salicylic acid (from which acetylsalicylic acid is formulated aka Aspirin and Bufferin).

 

When we think we are smarter than nature, we often pay the consequences.  Many pharmaceuticals are synthetic versions of plant derived compounds.  However, they are designed based on one component or property of the plant, for one purpose, i.e. an isolated opioid receptor stimulating alkaloid for pain killing purposes.  Well, some of those other components that naturally occur with the targeted therapeutic portion of the plant often work synergistically to either enhance the intended result or, maybe even more importantly, attenuate or eliminate the undesirable side effects; i.e. respiratory depression, abuse and addiction provoking withdrawal.

 

Kratom is also the focus of studies pertaining to patients with serious illnesses in which they choose medication, or at this stage of the game, find medication to truly be the best available option.  For example, 90% of HIV patients who control the disease by talking potent retroviral meds, experience neuropathic pain or nerve damage due to the drugs.  This is often addressed with our current pharma opioids, which as we know are not with consequential, further quality (and in many cases quantity) of life diminishing side effects.  Kratom could offer these people better pain control, but with less and/or less severe side effects.

 

Which brings us to yet another point.  People on opioids often complain of brain fog, mental and physical fatigue and an inability to keep up or contribute to society.  While Kratom is indeed an opioid pain killer, it actually can have a stimulatory effect similar to your coffee.  Most utilize stimulants to combat brain fog, mental and physical fatigue, keep up, etc. and Kratom or caffeine allow one to do just that; and in the case of Kratom while congruently controlling potentially debilitating pain; another impediment to productivity.

 

At this point, justified concern pertaining to Kratom, or any unregulated substance should be paid to quality and consistency of product.  The Kratom native to Thailand and Malaysia is not the same as much of the Kratom we see here in the states, as the majority of our supply comes from Indonesia.  Traditional, long known use has been when the leaves are picked off the trees, made into a tea and cooled; all derived from fresh, wet leaves.  Much of the import to the west are dried leaves, grinded with an anti-caking agent like silicon dioxide.  This difference alone can begin to alter the chemical profile, and thus the pharmacology of the plant.

 

Equally of concern is the unregulated marketplace.  It should go without saying that you should steer clear of a therapeutically intended product, Kratom or otherwise, that is available on a gas station counter, smoke shop, or non-reputable internet source.  Without a proven, trusted supplier or independent, third party testing, purity and safety is a gamble at best as often times traces of lethal opioids like fentanyl are found, but not labeled in products packaged and sold as Kratom.

 

These two factors justify concern and are a large reason for a portion of the bad rap.  However, the unknown and suspect practices should not cancel out the powerful potential that may be available here.  If anything, it signifies a need for more education and understanding, not outright elimination.

 

So what are we left with?  Well, a lot of unknown, but a lot of promise; hence the comprehensive studies already in motion on Kratom and all of its alkaloids.  I again echo the perspective that the need for an exogenous analgesic or stimulant should never be considered ideal, and it is more often than not indicative of underlying dysfunction that needs to be addressed in order to function optimally in a pain free and energy rich state.  However, this is a choice.  If one chooses to go the pharmaceutical route due to preference or lack of another personally effective solution, we should at the very least be open to researching and allowing access to one that does not leave 90+ corpses in its wake on a daily basis.

 

For more information on this topic check out the work of:

 

Dr. Chris McCurdy out of UF

&

Chris Bell’s Documentary: A Leaf of Face

 

Intriguing.

Educational. 

And hopefully a bridge to a little less ignorance and judgement.