Chances are, if you are someone who lives with chronic pain, you have heard of kratom. Kratom is a natural herb that is often used to treat pain. It has also fallen under a great deal of scrutiny, because there are many people who wish to criminalize anything that some people might use for pleasure. I personally suffer from the severe chronic pain associated with Ehlers-Danlos Syndrome. I do not want to be dependent on opiate-based painkillers, and I would like to have some power over the debilitating pain I experience. I posted a query on an online support group to see if anyone knew about kratom. This resulted in one person, who had only seen the Wikipedia entry on kratom, going all-out War on Drugs ballistic, and my query being removed. I have spoken to several people who have had licensed physicians recommend kratom for pain – either because the person could not take opiates, or because they lived in a state where it was difficult to obtain such a prescription. Kratom is currently completely legal in the United States, and has even been effective in helping people break addictions to dangerous substances like heroin and methamphetamines, but it seems that many Americans have been brainwashed into thinking that anything that might be misused by other people is immediately evil.
Since I was barred from asking other people with my condition about their experiences with kratom, I began doing some research. I started with a regular Google search, and I turned up a few interesting articles. I wanted much more in-depth information, however, so the next time I had a feature assignment for my journalism class, I asked if I could cover the topic. I read about 20 peer reviewed articles about kratom, but found that, although kratom has been in use for hundreds of years, there were no formal long-term studies. Since the journals I read generally indicated that it was safe in moderation and had many beneficial properties, and since it is completely legal, I decided to try it.
I want to make it very clear that I am not telling people to run out and buy this substance, since I have experienced the way that some people hear painkiller and think evil demonic possession. I also want to make clear somethng that Lisa-Michelle McMullan told me before I tried it: “Be careful. If you find yourself building a tolerance and find that you need more to achieve the same results, then stop use immediately.” I, personally, did not find this. I took between 1/8 and 1/4 teaspoon of powdered kratom only when the pain from frequent dislocations was so severe as to impair my ability to function. I mixed it with a tablespoon of raw honey or maple syrup to lessen the unpleasant flavor. It generally worked within 20 minutes. I did not experience a “high” – but an actual reduction of pain. I was able to think clearly and function, I was alert and awake. This was significantly different than I felt the few times I was prescribed oxycodone for pain, where I felt high, was completely aware that the pain was still present, and had a hard time with focusing. Kratom actually eliminated the pain for up to 8 hours, without any noticeable negative side effects. On days where I was not experiencing debilitating pain, I did not take any kratom, and I did not feel compelled to take it, or that I needed to rely on it. The other thing I noticed was that areas where I have suffered nerve damage and a loss of feeling from frequent dislocations and inflammation, as well as areas of dulled feeling from past surgeries, actually seemed to have sensation again! I was quite impressed, but again, I was not taking this every day. Although I have rather persistent pain, I was only taking kratom when I dislocated a major joint, like a shoulder, knee, hip, spine, or ribs (or any combination of the above). One thing I do not like about the oft-prescribed narcotic patch for chronic pain is that you have a steady, constant stream of medication. I want to only take something when absolutely necessary.
When, after a couple months, I looked into getting more kratom for emergency pain management, I found that the place I had found it previously no longer carried kratom. I have asked my doctors about other pain alternatives, and have only been told to use arnica gel (which made it clear that they do not understand the level of pain that is caused by Ehlers-Danlos Syndrome). I decided that now would be a good time to share the article I wrote for my class (I received an A on the assignment). I urge anyone who is inclined to jump on the War on Kratom bandwagon to take to time to research the substance more fully before condemning it, and to consider how many people live with chronic pain every day because other people are in such a panic that somebody else might use it to get a buzz.
The Question of Kratom
Kratom is a controversial herbal compound indigenous to South Asia with unique properties that allow it to be used as a stimulant and an analgesic (Babu, McCurdy, & Boyer, 2008). The leaves are used in traditional medicine as an analgesic. Kratom is presently legal in the United States and many other countries, but the increasing popularity of the herb has caused concern in some communities. The so-called War on Drugs, and the negative sentiment toward any substance that has the potential to give someone a euphoric response has made kratom the target of groups seeking to outlaw the herb. Some also worry that the lackof regulation on kratom and other natural substances could lead to tainted product being shipped into the country, potentially causing harm to those who use the substances. Although there is some concern about possible abuse of kratom as a recreational drug, it has many practical medical applications.
Kratom is an alkaloid plant that is related to the coffee plant. Also known by the technical species name Mitragyna Speciosa Korth, kratom “is a tree found in Southeast Asia that contains medicinally relevant alkaloids known as mitragynines within its leaves” (Ward, Rosenbaum, Hernon, McCurdy, & Boyer, 2011. p. 1000). While kratom has often been utilized as a way to keep manual laborers energized and working in the fields, it is also utilized a “a traditional medicine for common illnesses such as coughing, diarrhea, muscle pain, and hypertension and to cure morphine addicts” (Philipp, Meyer, Wissenbach, Weber, Zoerntlein, Zweipfenning, & Maurer, 2011. p. 127). Kratom is now becoming more widely available in the United States, and is sought out for its ability to help reduce opiate withdrawals and to reduce pain. In fact, “its use to treat pain and opium withdrawal was described as early as the nineteenth century” (Babu, McCurdy, & Boyer, 2008. p. 149). With such a long history of use, it seems surprising that it has not officially been utilized for medical applications in the United States.
Part of the recent concern and controversy surrounding the use of kratom has been prompted by the fear that it might be used to obtain a legal high. In Ireland, between 2009 and 2010, there was a large controversy surrounding the use of legal recreational drugs through local shops (Ryall & Butler, 2011). As the history of medical marijuana shows, many people are heavily opposed to herbs that may have significant medical applications of they can also create a euphoria in casual users. However, while the concern of a possible kratom addiction exists, some substances can be far more helpful than harmful. Some of the concern regarding kratom may be related to the fact that , as in the case of the legal high scandal in Ireland, the media have tended to “present the most extreme and negative effects of legal highs as the norm” (Ryall & Butler, 2011. p. 308). However, despite the negative publicity surrounding kratom and other legal substances that may produce a high when being used in a non-medicinal manner, there have been no reported deaths from the use of kratom in the United States (Babu, McCurdy, & Boyer, 2008).
While kratom is legal in the united states, there is some concern about the safety of having the herb available for public consumption. Credentialed Alcoholism Substance Abuse Counselor (CASAC) Lisa-Michelle McMullan is a forensic psychologist who specializes in addiction. When asked about the effects of kratom, she shared some useful information on the subject of addiction, as well as the way that kratom is perceived and how it works. Many basic questions that people have regarding kratom haven’t been fully answered, such as the appropriate dosage or the extended effects of long-term use. McMullan states that “Kratom hasn’t been extensively studied, but it does have a long history of human use” (McMullan, 2013). Although kratom is legal in the United States and Europe, it “has been illegal in Thailand since 1946, and was criminalized in Australia in 2005” (Babu, McCurdy, & Boyer, 2008. P. 149). There is no agency that regulated kratom in the United States, and, without more extensive studies, there is not a great deal of literature to calm the anti-drug reaction of the public.
Although there have not been many extensive studies regarding kratom, it is quickly becoming known as a viable analgesic alternative to those who suffer from chronic pain. In fact, people who suffer from chronic pain, but can not take opiates, may benefit from further research into the benefits of kratom (McMullan 2013). A growing online community has been lauding the use of kratom as an affordable, viable means to privately overcome addiction to opiates such as morphine and heroin, and “at $10 to $40 per ounce of plant material, kratom is an economical alternative to other opioid-replacement medications (such as buprenorphorphine), and can be obtained without a prescription” (Babu, McCurdy, & Boyer, 2008. p. 149). Some medical doctors even recommend that patients try using kratom to treat the chronic pain of conditions such as fibromyalgia, chronic migraine, rheumatoid arthritis, and Ehlers-Danlos syndrome. Given that one of the traditional aplications for kratom has been as an analgesic, this stands to reason.
How does addition work? According to McMullan, addiction is a two-part process, which occurs over time, is persistent, and gets worse. The experience of each person who uses a substance will be different, and some people will become addicted while others will not. In fact, it is possible for people to become addicted to almost anything. Says McMullan, “people can be addicted to eating, sex, and even every-day behaviors – it’s not necessarily a substance, but about how it affects the brain” (McMullan, 2013). In her experience as an addiction specialist, McMullan has never encountered someone who had an addiction to kratom. While certain behaviors and dependencies can be classified as an addiction, there are also addictive substances. A substance is addictive when “the substance itself produces withdrawal, and the user has to increase the amount taken to have the same experience the next time” (McMullan, 2013). Kratom is thought to have some addictive properties, similar to that of coffee. McMullan warns that, even though some health practitioners recommend kratom, consumers should proceed with caution.
Given the need for an alternative to opiates, and the benefits of a substance with fewer and less-severe side-effects than opiates, kratom may have a future as a practical medication in this country. However, as evidenced by the ongoing battle to legalize the use of marijuana for medicinal purposes, the process of studying and legalizing an herbal medication can be long-going. As kratom becomes more popular, and more people hear about the possibility for a legal high, there is likely to be more opposition to the use of the plant. This backlash could hamper the possibility of kratom being used to help people wean themselves from an addiction to a more dangerous drug, or to offer people with chronic pain an opportunity to manage their condition without opiates.
One area in which kratom is being studied is to find ways to create a test that will detect the substance in urine. With the outlawing of the substance in Australia nearly a decade ago, the need for a test became more urgent. Could the ability to test for this substance speed up the process of making it illegal in the United States and Europe as well? Scientists have been able to pinpoint the metabolites of kratom in human and rat urine, and are developing a test to detect the presence of the substance (Philipp, Meyer, Wissenbach, Weber, Zoerntlein, Zweipfenning, & Maurer, 2011). While this is certainly a useful application that may lead to further studies on the metabolism and effects of kratom, it may also lead to a change in the regulation of the substance. Since kratom does not thrive in locations other than where it naturally occurs, there may also be future political and tax considerations regarding the production, harvest, and import of the plant.
Whether looked at from a purely scientific perspective, or from the viewpoint of a prospective user, kratom is an interesting substance. Although there are some risks associated with taking large doses, there are also many benefits associated with the use of kratom for management of chronic pain and for the treatment of addiction. Perhaps, with so many concerns about synthetic pharmaceuticals, it is wise to further investigate the possibilities natural substances like kratom have to offer.
Babu, K. M., McCurdy, C. R., & Boyer, E. W. (2008). Opioid receptors and legal highs: Salvia divinorum and Kratom. Clinical Toxicology (15563650), 46(2), 146-152. doi:10.1080/15563650701241795
McMullan, L.M., (2013, October 2). Personal interview.
Philipp, A., Meyer, M., Wissenbach, D., Weber, A., Zoerntlein, S., Zweipfenning, P., & Maurer, H. (2011). Monitoring of kratom or Krypton intake in urine using GC-MS in clinical and forensic toxicology. Analytical And Bioanalytical Chemistry, 400(1), 127-135. doi:10.1007/s00216-010-4464-3
Ryall, G., & Butler, S. (2011). The great Irish head shop controversy. Drugs: Education,Prevention & Policy, 18(4), 303-311. doi:10.3109/09687637.2011.560911
Ward, J., Rosenbaum, C., Hernon, C., McCurdy, C. R., & Boyer, E. W. (2011). Herbal Medicines for the Management of Opioid Addiction. CNS Drugs, 25(12), 999- 1007.