Kratom – what ?: another widely available opioid… should it be ?… should it be regulated ?… what to do?
Steven Lippmann, M.D.
I bet that most of you have never heard of kratom. Well, it is an opioid type of drug widely available in this country with little restriction … yes, surprising ! Already used by millions of people, its widening distribution is again in the news recently as a public health hazard and cause of some morbidity and mortality. Kratom is easily accessible from at least many smoke and vape shops.
This alkaloid substance comes from tropical Mitragyna speciosa trees; in low doses it yields stimulation that combats fatigue and produces alertness (similar to cocaine). In bigger qualities it induces opioid properties with analgesia and sedation much like morphine and/or most other narcotic agents. Kratom has the potential for creating addiction and all sorts of substance abuse issues.
Activity targets a host of many brain receptors that prominently also includes the mu-, delta, and kappa opioid versions with potent physiological effects. Indeed, it can attenuate narcotic withdrawal. However, it also induces its own dose-dependent influence on the brain and arguments other opioids such as fentanyl or heroin (etc.). Thus, kratom can create obtundation and sometimes death, especially when in combination with other narcotic pharmaceuticals.
Without going into more detail, kratom’s rising presence alerts us to be aware of it and the risks. In can dangerously come into your own patient’s clinical lives. Hopefully, some of you might exert influence for better control of kratom via administrative, political, community, and/or organized medical organization pressures.
Good luck. Somebody needs to start better kratom-control actions… it might ought to be you.
Steven Lippmann, M.D. is Emeritus Professor, University of Louisville School of Medicine, Louisville, Kentucky.