As of the beginning of August 2017, the National Institutes of Health (NIH) published notice of the state of the opioid epidemic in America. They estimated that of the 91.8 million people who were prescribed opiate pain killers, 2 million are addicted with an average of 142 dying from overdose daily. This means that every three weeks the same number of Americans die from opioids as died in 9/11.
Up to now, opioids and related compounds all derived from the poppy (Papaver somniferum) are the most reliable pain-relieving drugs since the American Civil war. Unfortunately, there is a price to pay when these drugs are too heavily used. That price is addiction, accompanied with the need to obtain more and stronger drugs to achieve similar pain relief. The problem for the addict is compounded, for as the drugs wear off there is even more intense pain and mental discomfort that acts as a disincentive to detoxification. Yet, another genre of pain-relieving drugs sold as over-the-counter anti-inflammatories includes acetaminophen, which are known to cause liver damage.
Most doctors agree that there is a need for another drug or substance to relieve pain; a few doctors even encourage their suffering and addicted patients to try the pain-relieving herb Mitragyna speciosa, commonly known as kratom. Herbalists, acupuncturists and naturopaths, however, have been overly wary of promoting yet another fad in the form of an herb that they have not heard of before. In the case of kratom, it is known to be widely used as a recreational drug and it has been the object of legal scrutiny. Its clinical value yet to be appreciated.
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The medicinal properties of all herbs were first discovered through trial and error. Kratom is no different. It has been used for thousands of years by natives of southeastern Asian islands for various health purposes, among them pain relief. Eventually, millions of individuals in America and Europe and throughout the world, seeking yet another drug with which to get ‘high,’ tried kratom. Kratom in normal low to medium dose is feeble compared to other drugs like cannabis but since the late 1800’s people have increasingly used it to withdraw from opiate and alcohol addiction and to relieve pain. On this note, consider how long it has taken for cannabis, once vilified as a dangerous recreational drug, to be found in recent years to offer potent health and medicinal benefits.
I’m a strong advocate for the use of kratom clinically and have had considerable personal experience using kratom leaf powder for the relief of chronic, intractable pain. In fact, I can’t think of any herb other than opioid drugs derived from poppies that provides such immediate pain relief and overall sense of well-being.
How does kratom relieve pain?
There are more than 40 compounds in kratom leaves, including 25 alkaloids besides mitragynine which is the most abundant, occupying 1.2-2.1% of the total. Mitragynine is believed to be principally responsible for its pain-killing effects. Mitragynine is considered the main psychoactive constituent and functions as an opioid agonist, meaning that it has a special affinity for the opioid receptors in the brain.
Most people who take a sufficient amount of kratom internally will experience pain relief in less than a half hour. Kratom is usually taken as a powder. Dosage is variable depending on the strength of the kratom, the severity of the condition for which it is intended, and the size of the person who takes it. Further, kratom is known to have both stimulant and sedating properties. Stimulant properties are associated with lower doses and sedation with higher doses. I will describe dosage guidelines next week, but clinically the goal is to use as low an effective dose as possible. Discounting whether it will act as either a stimulant like coffee to which it is related or a sedative like opium, I recommend beginning with a teaspoon (about 3 grams) of the powder swallowed and chased down with water once or twice a day. Regardless of its sedative or stimulant properties in an individual, kratom will relieve pain.
It’s taken me some time to complete this article because I first wanted to scour and interview patients, stores and others who have recommended or used kratom with great benefit to themselves and others. I took it myself for a minor shoulder sprain and was amazed at how benign it seemed; I had no adverse reactions, no disorientation, no grogginess, and my pain was relieved within 30 minutes. Even several hours later when the effects of kratom surely would have subsided, I realized that the pain did not come back. I know it doesn’t work for everyone that way but my experience suggested that the alkaloids in kratom were not only analgesic but anti-inflammatory as well.
Since then I have recommended kratom to several patients suffering severe chronic pain and depression. Their respective pain and discomfort was well managed and with no adverse reaction.
Cases
Cases 1 and 2 are from my own clinical experience. Case 3 was reported to me.
- A woman in her mid-70s had advanced osteoporosis of the spine that caused constant pain making it difficult for her to sleep at night. Acupuncture and carefully prescribed herbal treatments were of limited benefit. Realizing how important sleep is for healing, I decided to try kratom. That night she took only one teaspoon of green-veined maeng da kratom. She gratefully reported that it was the first night she could get 6 continuous hours of uninterrupted sleep.
- Another patient was a woman diagnosed with rheumatoid arthritis. She had severe and constant pains in all of her joints especially her fingers. Again the pain inhibited her ability to relax and get much needed sleep. At first she was suspicious of taking any substance to relieve pain. Perhaps she vaguely heard that kratom was being used as a recreational drug and she might get hooked. While she was still in my clinic, I was able to convince her to take a teaspoon of the powdered leaf followed by a glass of water. She predictably objected to the taste but I heard from her the next day that she had such tremendous relief from the single dose, but she was trepidatious of taking it daily. I convinced her that she should not be afraid to use as much as she needed. It turned out that she only needed to take one or two teaspoons of kratom for a week, during which time diet changes and deeper-acting herbs I gave her helped eliminate her pain completely, and she had no further need for kratom.
- It was personally reported to me by a saleswoman working at a local store specializing in selling cannabis and other psychoactive herbs that she has dozens of clients who purchase kratom strictly for its pain-relieving therapeutic value. According this saleswoman, these are people who have tried everything; many were already heavily drugged and addicted to doctor-prescribed opiates. Among the many cases she mentioned, the one that seemed most amazing to me was a woman with cystic fibrosis who had for a long time been on several different prescribed pain-killing opioid drugs and a number of different antidepressants. With great determination, she wanted to “get her life back” and decided to use kratom to wean herself off of all her drugs. (I don’t know what dose she needed to take, but generally speaking, the more severe the condition, the higher the dose of kratom.) Years later, this woman, still with cystic fibrosis, is able to completely manage her pain with red-veined kratom. Red-veined is the variety that has stronger sedative and pain-killing properties.
Interviewing other patients and practitioners, I learned how kratom is the only thing some have found to manage the pain associated with chronic fatigue syndrome, fibromyalgia and Lyme disease.
Not Just for Pain
Kratom also relieves depression, and unlike opiates, it can promote a sense of mental clarity with no grogginess when used in the above described doses. Further, as an alternative to antidepressants, kratom does not interfere with selective serotonin reuptake inhibitor drugs (SSRIs or antidepressants) so they can be used concurrently. By so doing, many have been able to withdraw from antidepressants by gradually replacing them with kratom. However, I strongly caution against this without the advice and guidance of their medical doctor.
Kratom and Opioid Addiction
One of the most important uses of kratom is to ease physical and psychological pain associated with opiates, including morphine and heroin and alcohol addiction. The use of kratom for opium addiction was first employed in Thailand around the end of the 1800s at a time when opium was proliferating throughout China and eventually spread to the islands of Indonesia and Thailand. It was so effective for that purpose that the Thai government made kratom illegal. The reason was not that it was harmful to the people or addicting but because the government was being denied a then important part of its revenue based on the taxes levied on the sale of opium. To this day, kratom is illegal in its native habitat where people had been using it medicinally for centuries. However, with the rise in heroin and alcohol addiction, there is a movement to get the government to rescind its kratom ban.
Legal Issues
How effective kratom has and continues to be for pain relief and drug addiction was shown when the US Drug Enforcement Administration (DEA) on August 30, 2016, proposed to place kratom into a Schedule I category of Controlled Substances. This is the same category in which the most addictive drugs such as heroin and methamphetamine are classified: completely illegal. This met with a widespread groundswell of protests, mostly by people who were using it for pain management or opioid withdrawal. Approximately 140,000 protesters signed an online petition and were able to enlist 51 members of the US House of Representatives with nine senators on their side in protest of the DEAs proposed ruling. As a result, the DEA temporarily withdrew its notice of intent and for the last year it has been inviting public comment. See the document Assessment of Kratom under the CSA Eight Factors and Scheduling Recommendation submitted to the DEA here.
At present, kratom is legal in all but six states (Alabama, Arkansas, Indiana, Tennessee, Vermont, and Wisconsin). Kratom is also illegal for use by the US military. It could still be banned and we would lose access to one of the most valuable herbs in the world. According to the American Kratom Association, currently 26,000 Americans have asked President Trump to keep kratom legal. Over 1,000 doctors, scientists and law officers told the DEA they don’t want a kratom ban. In fact there have been no deaths reported from pure kratom. Unfortunately, some companies decided to spike their kratom with an illegal opioid called tramadol. The resultant product called “kryptom” did result in some deaths and is now banned from sale.
The risk of dying from pure kratom overdose (whatever that may be) is nil. In fact high dosage of kratom is self-limiting as people who do so experience temporary gastric discomfort, nausea, and vomiting.
I’ve never personally seen or heard of kratom addiction and to the extent that it may exist it is quite rare. Individuals can form a dependency, which some may describe as ‘addiction’ but this is described as mild and comparable to withdrawal from coffee.
At present, these are the facts:
- 100 million Americans suffer from chronic pain;
- Of these, 21 million are also dealing with substance abuse;
- Of these, 2 million abuse prescription pain drugs.
- Drug overdose, which has gone up 4 times, has become the leading cause of accidental death.
I recommend visiting some of the online kratom support sites such as the American Kratom Association to read more about kratom’s history, biochemistry and the many anecdotal cases attesting to the positive effects of kratom for pain control and opioid and alcohol addiction. If you visit the AKA link above, be sure to sign the petition to keep kratom legal. In my estimation, it is one of the most important medicinal herbs for pain management other than opium.
Next week, I’ll post the clinical classification, uses, dosage, and preferred administrations of kratom, along with some reputable sources. (See Part 2 of my series on kratom here.)