Dangers Of Kratom – A Pharmacist Shares His Thoughts

Author: Dr. Brian Straub, Pharm.D.


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Dangers Of Kratom – A Pharmacist Shares His Thoughts

Note: This article was written by Brian Straub, a licensed pharmacist.  The views expressed below are his opinion.

Reviewing Kratom supplements in an unbiased way has been no easy task.

Depending on what you read you will walk away thinking it is a wonder supplement or an illicit drug that kills people.

The truth, as always, lies somewhere in between.

Kratom Overview – Anecdotal Stories

Being trained as a pharmacist, unbiased data and clinical studies trump everything.

But it’s also important to take into account the real life experience of patients, even if it isn’t always fleshed out in the literature.

For any new treatment, as the number of anecdotes and real experiences of people begin to grow, it is hard to deny the potential benefits. Kratom falls into this category.

If you do a few Google searches you’ll begin to find heaps of personal stories about the positive effects of kratom.

This Forbes article does a great job of highlighting some of them.

Is Kratom Safe?

Building on this, what makes kratom even more appealing on its surface is that the proposed mechanism of action found in studies match up with the effects.

But, this is also where it gets a little bit dicey.

Case reports show that kratom improves mood, relieves pain, and can help with opioid addiction.

This would make sense, because many of the active compounds bind to opioid receptors in the brain.

Unfortunately, there is a reason why opioid drugs are highly regulated.

While they are exceptional at inducing euphoria and relieving pain, they also have some pretty serious potential side effects including addiction, withdrawal, respiratory depression, and many drug interactions.

The side effects and potential serious adverse effects sky rocket when this supplement is taken in conjunction with certain other medications, supplements, and illicit drugs.

Potential Adverse Effects Of Kratom

There are many different types of kratom as well as ways to take it.

Generally speaking, lower doses generally provide a stimulating effect and the adverse effects related to this may include anxiety, blushing, contracted pupils, agitation, nausea, itching, loss of appetite and increased urination.

As you begin to increase the dose, you begin to see opioid type of effects.

The side effects of moderate doses are very similar to opioids with:

  • Constipation
  • Dry mouth
  • Nausea
  • Sweating
  • Hypotension
  • Increased heart rate.

At higher doses you may begin to experience tremors, anorexia, weight loss, seizures, and psychosis.

Like opioids, if kratom is taken consistently and stopped, withdrawal symptoms will occur.

Potential Drug Interactions With Kratom

There are few, if any, true studies of kratom in the human body and most of the information gathered is from case reports and sophisticated pharmacologic modeling by the FDA. What is abundantly clear is that the risk of adverse effects with kratom sky rockets when combined with other medications.

The most dangerous drugs to take with kratom include any mind altering, psychoactive, stimulating or narcotic substances.

This includes all medications for depression and anxiety such as SSRI’s, benzodiazepines, atypical antipsychotics and so on.

Any medication that acts on opioid receptors such as oxycodone, codeine, morphine, loperamide and so on.

Stimulating medications such as Adderall, Ritalin, Concerta, and others.

Additionally, due to the potential for liver toxicity, it is important to avoid any medications that are either toxic to the liver or heavily metabolized by the liver.

The one that comes immediately to mind would be Tylenol.

FDA Regulation Of Kratom

For these reasons, the FDA is very clear on where it stands on kratom.

In February of 2018, the FDA stated that that there is no evidence that kratom is safe or effective for treating any condition.

The FDA has cited 44 kratom related deaths between 2011-2017. After reading through these case reports, it was pretty clear that kratom alone did not seem to be the cause of death, unless it was due to adulteration of the product, which in itself is a major concern as shown by the 199 cases of Salmonella caused by tainted kratom in early 2018. The issue was when people chose to use kratom with other prescription drugs; most often psychiatric medications, opioids or benzodiazepines; taking in very large doses and often with concomitant psychiatric disorders.

Is The FDA Being Overly Cautious?

I understand that some people may think that the FDA can be overly cautious, especially if you are a biohacker, but their announcement is truly worth the read.

The ultimate conclusion aligns with what I mentioned earlier about the implications of the supplement binding to opioid receptors and its lack of proper study and regulation.

They also emphasize the point, which I strongly agree, that just because something is a plant does not make it safe.

Conclusion

So what does all of this mean?

I am not saying this supplement may not have its role, but if you decide to take that journey, take it with your eyes wide open. I would suggest that this supplement should be saved for the experienced biohacker, who is well aware of all of the risks involved.

  1. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm595622.htm
  2. https://www.cdc.gov/salmonella/kratom-02-18/map.html
  3. https://en.wikipedia.org/wiki/Mitragyna_speciosa#Adverse_effects

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Author: Dr. Brian Straub, Pharm.D.

Brian Straub is a medical science liaison and licensed clinical pharmacist. He graduated from the University of Pittsburgh School of Pharmacy in 2011, and is also a registered yoga instructor.