Kratom, Save ‘em, Bait ‘em, or Crate ‘em

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Several weeks ago, I was approached by local commentator Benita Zahn of Channel 13, to interview as part of an exposé on kratom, a popular over-the-counter natural remedy that has been used for centuries as a mild stimulant and analgesic.  Mitragyna speciose known as kratom is an evergreen plant similar is some ways to the coffee plant family which grows naturally in Indonesia, Malaysia, Papua New Guinea, and Thailand.

I must say, the attention this got upon release of the initial trailer early on February 2nd was surprising, but the sequalae to follow the full story was astonishing. I received several welcomed phone calls, e-mails, and social media posts from patients and kratom support groups nationwide. While I certainly understand their concerns about loosing a natural drug that has helped them, many of them ignored the potential pitfalls or harm that were reported.  Like any drug, kratom has benefits and risks.

As a follow-up to all the hoopla, I decided to post this blog in order to clarify the pharmacology of kratom, outline the benefits, and risks, and publicly answer some of the questions posed to me. But before diving in, I will say this…

KUDOS TO THE KRATOM COMMUNITY AND ADVOCATES FOR LOOKING OUT FOR EACH OTHER AND PROMPTING THIS BLOG!

Here are some of the questions and comments and my responses:

Kratom is a natural product, so how can it be harmful. 
Lots of natural plant products are beneficial in low doses and harmful at a miniscule amount more, and other drugs obviously require much higher doses than their recommended amount to cause harm.  Three examples of natural products that have a very narrow therapeutic and toxic index (small differences above therapeutic dose can cause harm or death) include: 1) vincristine and vinblastine from the periwinkle plant, popular to treat various cancers; 2) digitalis from foxglove used to treat supraventricular heart arrhythmias or to strengthen heart rhythm ; and 3) various atropine alkaloids from belladonna (also known as deadly nightshade), the ingredient from berries used by Romeo and Juliet to cause death.

Show me one article that proves kratom can be harmful.
See below, 1-7.

Dr. Fudin implies kratom is an opioid. It’s not. You can simply Google it, and then look up the definition of opioid.
The original definition of an “opiate” is a drug derived from the poppy plant, or opium, that combines with one or more opiate receptors in the body. Opium is a concentrated form of morphine. Kratom is the only naturally occurring non-poppy derived opiate-type drug, but not an opiate by the strictest definition. It combines with more than one opiate receptor including the mu receptors as a partial agonist. Most often, the receptors we refer to are those found in the central nervous system such as mu-type receptors responsible for typical outcomes such as analgesia, euphoria, sedation, respiratory depression, constipation, etc. Semi-synthetic opiates have been renamed collectively as opioids. The semi-synthetics share a chemical nucleus with opium.  Some of these include heroin (2-molecules of morphine connected by a 2-carbon chain), oxycodone, hydrocodone, and several others. Kratom does in fact have opioid activity at higher doses because it does in fact combine with mu and other opiate receptors. More specifically, certain kratom alkaloids are partial agonists at the mu-opioid receptor and competitive antagonists at the kappa- and delta-opioid receptors.

If kratom is an opiate, why doesn’t it cause a positive urine screen for opiates?
This is one of my favorite questions! It has to do with the chemistry. Typically, when a urine screen is performed in a doctor’s office, it is of the immunoassay (IA) variety, a less sophisticated test compared to chromatography. This test is specific for morphine, not all opioids. Drugs that will always test positive for morphine include codeine (which is metabolized to morphine), morphine, opium (concentrated morphine), and heroin (diacetyl-morphine). The semi-synthetics which share the morphine nucleus will only test positive at higher doses. Certain opioids will never test positive for an opiate screen because the chemistry is completely different than morphine.  Some examples include fentanyl and derivatives, meperidine (Demerol), methadone, and tramadol. Kratom has a different chemical structure than all of these, and also will not test positive on an IA urine screen for opiates. Just like fentanyl and derivatives, meperidine (Demerol), methadone, and tramadol, kratom require a specific urine tests by chromatography to be identified.  To see a picture of what I’m describing, see Chemical Classes of Opioids.

Dr. Fudin incorrectly stated that kratom can interact with other drugs and cause agitation, heart attack and stroke.
In order to understand why these are very real possibilities, one must understand the pharmacology of kratom.  Kratom’s effects are clearly dependent on dose escalation. At lower doses it is a CNS stimulant (working similarly to antidepressants and low dose cocaine) and at higher doses it may do the opposite because the opiate activity becomes more prevalent. At low doses it is an alpha-2-adrenergic agonist with sympathomimetic activity – this is the very same thing that cocaine does, although these activities of cocaine happen at lower relative doses. More specifically, kratom combines with serotonin (5-HT2A), and dopamine type 1 and 2 receptors, and is also a dopamine type 2 receptor antagonist. All of these activities have common pharmacology with various prescription antidepressants alone or combined, including but not limited to specific serotonin reuptake inhibitor (SSRIs) like fluoxetine (Prozac), paroxetine (Paxil), and serotonin norepinephrine reuptake inhibitors like venlafaxine (Effexor), duloxetine (Cymbalta), and atypicals like bupropion (Wellbutrin), mirtazapine (Remeron), and tricyclic antidepressants such as amitriptyline and others.  Of important note also is that all of these drugs in their own right have significant drug interactions with various foods and drugs because they reduce or enhance liver enzymes that may increase or decrease blood levels of other drugs that rely on those liver enzymes to be metabolized to more active or less active forms of the parent drug that is taken by a patient. But irrespective of these liver enzyme interactions, combining any or all of these drugs together and/or with kratom could end in agitation, heart attack or stroke simply by layering them on top of each other due to overlapping similar pharmacology.  And there are many other drugs used for multiple disease states that are not antidepressants which can also be problematic in terms of drug interactions and toxicity when combined with kratom. One such drug is tramadol with enhances norepinephrine and serotonin, but also has weak opiate activity.  Interestingly, one commercial product called Krypton combines kratom with tramadol.  Since tramadol has complex metabolism that depends in part on your genetic make-up, it could cause harm or death as seen in Unintentional fatal intoxications with mitragynine and O-desmethyltramadol from the herbal blend Krypton. Some drug interactions with kratom and various “designer drugs” are outlined in Practical Pain Management’s Interactions Between Pain Medications And Illicit Street Drugs.

Dr. Fudin either made this up off the top of his head, or someone told him this.
Not true – see above.

There is no use for using naloxone on a kratom overdose. If you “overdose” you get sick and puke.
If someone takes high doses of kratom, we are dealing with two emergencies; 1) noradrenergic overstimulation which can be treated with combined benzodiazepine (alprazolam, diazepam, etc.) to reduce agitation plus beta blockers (propranolol and others) to slow the heart rate and reduce blood pressure; and 2) opioid overdose which can be treated with naloxone to block the opioid receptors.

Dr. Fudin, what are your thoughts on keeping kratom and marijuana legal?
This is probably my second favorite question.  There’s a part of me that believes all drugs should be declassified and legalized in order to eliminate a black market and reduce crime.  If people want advice or direction, they can seek professional advice from their doctor or pharmacist.  If they want to abuse drugs, they can do that too, because they’re doing it anyway. But as you can see from the outrage among innocent kratom users, many don’t have all the facts in order to make an informed, educated choice simply by searching Google.

Another part of me believes that the government should put controls in place to protect the public, however this is not the case with tobacco or alcohol because they are heavily taxed and a tremendous revenue source for the government. Notwithstanding, this past November, FDA Commissioner Dr. Scott Gottlieb, M.D. issued an FDA advisory about “deadly risks associated with kratom”. That may be viewed HERE.

I do believe that kratom has incredible potential to be used therapeutically in the right patients as long as they are carefully monitored for medical conditions and drug-drug or drug-food interactions. This is the case with most prescription medications.  I have seen much harm and death over more than 3-decades from innocent persons that went to multiple doctors and pharmacies where drug interactions were overlooked just because of poor communication. I have seen similar outcomes in people who purchased bath salts, spice, or other products from head shops or gas stations.  I have seen people purchase more common drugs like cough and cold products from a grocery store or gas station that ended in death because of drug interactions that the pharmacist never had an opportunity to evaluate.  Perhaps one way to avoid such risks is to have a class of drugs, such as kratom, that are available through a pharmacy and require evaluation and counseling by a prescribing community pharmacist.

The true is, I don’t have an answer to the problems associated with kratom but I do acknowledge there could be benefits in a controlled environment where every purchase assured consistency with all the labeled alkaloids and milligram strengths – this is something that is currently missing and adds to the dangers.

And finally, “Dr. Fudin is not a patient advocate and doesn’t have his facts straight” at least in my opinion couldn’t be further than the truth. It is because I care that I have taken the time to write this blog post.

So, after reading this blog, you decide.
Should anyone have access to kratom (save ‘em)?
Are you being lured by political and advocacy rhetoric without having all the facts (bait ‘em)?
Will you end up a statistic because a drug interaction was missed (crate ‘em)?

As always, comments are encouraged and welcome!

References per request:

  1. Nelsen JL, Lapoint J, Hodgman MJ, Aldous KM. Seizure and coma following Kratom (Mitragyninaspeciosa Korth) exposure. Journal of medical toxicology. 2010 Dec 1;6(4):424-6.
  2. Neerman MF, Frost RE, Deking J. A drug fatality involving Kratom. Journal of forensic sciences.2013 Jan 1;58(s1).
  3. Trakulsrichai S, Tongpo A, Sriapha C, Wongvisawakorn S, Rittilert P, Kaojarern S, Wananukul W.Kratom abuse in Ramathibodi Poison Center, Thailand: a five-year experience. Journal ofpsychoactive drugs. 2013 Nov 1;45(5):404-8.
  4. Babu KM, McCurdy CR, Boyer EW. Opioid receptors and legal highs: Salvia divinorum andKratom. Clinical Toxicology. 2008 Jan 1;46(2):146-52.
  5. Warner ML, Kaufman NC, Grundmann O. The pharmacology and toxicology of kratom: fromtraditional herb to drug of abuse. International journal of legal medicine. 2016 Jan 1;130(1):127-38.
  6. Kapp FG, Maurer HH, Auwärter V, Winkelmann M, Hermanns-Clausen M. Intrahepaticcholestasis following abuse of powdered kratom (Mitragyna speciosa). Journal of MedicalToxicology. 2011 Sep 1;7(3):227-31.
  7. Galbis-Reig D. A case report of kratom addiction and withdrawal. WMJ. 2016 Feb;115(1):49-52.

116 thoughts on “Kratom, Save ‘em, Bait ‘em, or Crate ‘em

  1. Understandably, I realize you can’t list every possible interaction. But I wish that we could get a more comprehensive list of what possible interactions pose a danger. It might not be a hot topic for those from the addiction side of the community who aren’t on multiple meds. Those flooding in from the chronic pain world more often than not have chronic illnesses, Lupus, MS, the list goes on and on. I don’t have to tell you the long list of meds that comes with such illnesses.

    When the chronic pain/invisible illness (autoimmune) communities started experiencing the aftermath of the new guideline recommendations for pain meds, we saw countless people losing their pain doctors, and/or paid meds overnight. This was a hard and frightening time. It’s still happening. People were so confident it would not impact true chronic pain or cancer patients. Wrong. I remember being contacted by an 86 year old woman, she was refused her prescription and was terrified of the coming wd. She had been on her same dose of pain meds for a decade. Then boom, overnight she was cut off. She was given the name of another pain management Dr which she promptly got into see in order to get her prescription. He refused it. Said he would give her an antidepressant and low dose of tramadol. Poor thing was in tears. Personally, I was with one of my best friends who was battling cancer for the second time. Having breast cancer which she beat the first time, it returned with a vengeance. The second time so much worse. Her stomach filling with fluid so fast she had to have it drained weekly. She would lay on my couch and scream in agony. It was awful. This was after her doctor cut her pain meds in HALF. Due to the new recommend guidelines. So much for cancer patients not being impacted. Her funeral was this past Sat. Her battle with getting the appropriate pain management lasted up until the end. They even gave her a diagnosis of substance …forgive me the name escapes me at the moment. But it is similar to substance abuse. She had less than a month to live at the time. She kept asking for an adjustment as what she was being given wasn’t touching her pain and time and time again, she was told they would in the past but now it’s harder. One doctor telling her the “red tape” was ridiculous. Personally I feel this is a big reason she gave up. No one can live like that. I digress.

    Thankfully for those losing their meds overnight we were able to send care packages of Kratom and at the very least ease their withdrawals until we could help them get a new PM doctor or fix whatever issue they had. Some switching back to pain meds eventually and others just sticking to Kratom. But there were some issues along the way for some. We did this for so many people that despite not being versed in pharmacology we figured out that certain meds didn’t mix well. Again, nothing to back that up other than what we were seeing. But that’s when, for me anyway, this became more important of an issue. Not a popular one in the Kratom community but I personally don’t think one that should be denied. Having had Seratonin Syndrome twice (before I ever tried Kratom) I wouldn’t wish that hell on anyone.

    Years back I stumbled on an article by some doctors in Australia I believe that listed several herbal and drug interactions and I’ve always mentioned that when introducing anyone to Kratom but the fact we lack a real comprehensive list or even classes of what meds to avoid is beyond frustrating. I understand we don’t have clinical trials, I get it we need more studies. But I also know that even from what we know right now about Kratom as a whole and its Alkaloids, how they works, all those big words I can’t spell and don’t know the meaning of, it stands to reason we should also be able to say at the very least what to avoid, yes? Please, correct me if I’m wrong. But since you listed SSRIs, we know mixing with opioids is bad, alcohol, St John’s, I’m thinking it’s not a wild leap to say that more are known. At least to professionals taking the time to dig and find out.

    I’ve gotten some help from the nice people over in the Pharm sub on Reddit. I’m grateful for those who have taken the time to explain a few meds to me and how they might or might not interact with Kratom. I do appreciate and I am of the belief that although there is quite a bit of misinformation and fear mongering, there is also a serious lack of education and that in the end will be far more harmful than not. I understand the community being so fearful of anyone mentioning negatives associated with Kratom, if you were around in 2016, you know the fear and possibly even saw the lives we lost when people decided death was preferable to losing access to it during the proposed ban. It was an awful time.

    Now even with all thats known now, there is a lot of questions unanswered by the medical community and agencies attacking Kratom why so many deaths attributed to Kratom or rather Mitragynine Toxicity, have so many other drugs in their system at levels known to cause death and yet Kratom was to blame. The lack of an explanation is what makes the community believe it’s a witch-hunt. If there is one then great, someone please explain. Otherwise the community will continue to ignore these potential dangers. That puts people at risk as does not knowing what drugs not to mix with Kratom. You know what the community is doing right now to try and avoid issue like this? Listing the substances found in deaths where Kratom was also found. While that is absolutely not a bad thing. It’s sad that is the best we can do.

    As you know there are people trying to be proactive and reduce the risks for those that are taking Kratom. As one of those people, I applaud you for not throwing up your hands and never wanting to hear the word Kratom again. Also, for not thinking it wasn’t worth your time to address what you have.

    So, my question. Other than what you’ve listed above, what else would one be wise to not combine with Kratom? Again, I understand that’s a potentially long list, even types or classes (whatever the proper word is) would be appreciated. One hot trend in the community is to mix Kratom with citrus, including grapefruit to boost effects. You know why that is concerning obviously, and it’s surprising how many don’t realize that. I’ve even seen some taking meds that clearly list the warning to avoid grapefruit on the prescription bottle but that seems to escape them when it’s time to take Kratom. Very concerning.

    I won’t get started about the stance that it can’t possible be addictive or that it’s safe to take while pregnant. I’ve rambled enough and also I’m sure I’ve already upset some fellow Kratomites so I’ll leave it at. Thank you for your time and effort Dr.

    1. TA; Thank you for this post. because of the complexity, and to answer your excellent question comprehensively, I will work with one of my mentee’s to develop an entire new post which addresses your question. It may take a couple of weeks.

  2. Thank you for this wonderful article. I’ve been taking kratom for many years. It is completely impossible to reason with most kratom users. I’ve been saying the majority of what your saying here for years. Especially the narcan one. One unfortunate day, I accidentally took a naltrexone and was knocked into severe withdrawal. I’ve overdose on opiates many times unfortunately, it was nothing compared to those. Regardless it was still happening. Talking blasphemy in a forum full of users and your hung up on a cross. I can’t imagine the response you got.

  3. Dr. Fudin, I just spent the last month detoxing off Kratom. I was taking 25 grams 3x a day for a total of 75 grams a day of bali kratom powder. I am now down to 5 grams once a day cause I still get the shakes. Anyway, even now I notice that if I take either oxycodone or lorazepam I am blocked from both, just like suboxone blocks opiates. Have you ever heard of kratom doing this and if so, how long do you have to be abstinent from Kratom before you will not be blocked by either opiates or benzos?

    1. Alaura, There is no mechanism by which Kratom can or will block full agonist opioids such as oxycodone or benzodiazepines like lorazepam. However, Kratom can cause agitation and wakefulness, which it the opposite of what lorazepam does.

    2. I’ve been on Methadone for years. On Sunday I took Kratom. I felt good but I started feeling opiod withdrawl effects on Tuesday. Now it’s Wednesday morning & I cant wait to get to the clinic.

  4. We are finding that some of our methadone patients test positive for fentanyl on their drug screens after taking Kratom. Up until a few days ago we had no explanation for all of these people testing positive for fentanyl but negative for norfentanyl, which we request for confirmation purposes. Our reference lab has confirmed that Kratom can cause a false positive for fentanyl on their tests. They recommend specific testing for Kratom if there is any question.
    This is a recent development which raises the question of whether the overdose deaths where both fentanyl and Kratom are found could actually be due to Kratom alone. Typically, when no fentanyl metabolites are found, it has been attributed to rapid death and reduced time for fentanyl to be metabolized, It would be helpful to know the particular testing method the coroners used to detect and/or confirm fentanyl,.

    1. CDH, You bring up some interesting points. ME’s use chromatography testing for fentanyl and fentanyl analogues, so this should not be a problem because the false positives are from immunoassay.

        1. I’ve seen lots of patients on kratom and have not seen a false positive fentanyl yet. if that happens, just be honest with your doctor and ask him/her to send the sample for definitive testing and that will prove that you didn’t use fentanyl (assuming you didn’t).

  5. After having my pain medication for AVN of the hips, lupus, and Dermatomyositis tapered to 1/4 (against my wishes), I decided to try kratom.
    It worked like a dream!
    My only concern is that there could be some heavy metal contamination, though I got it from the top website (Coastline Kratom).
    How do I find out about heavy metals??

  6. I’m just order my first round, I’m still virgin to it. But I am in pain management and wondering if Kratom will show up on a drug screen, I’m ultimately wanting to decrease my pain pill usage.

    1. It will only show up if your provider specifically orders it separately or if h=it part of his/her usual panel of tests. It is not a typical order. But my advice is that if you’re thinking of using kratom, you should let your doctor know because there are MANY drug interactions and it could be dangerous for that reason alone, although here are other risks.

    2. I’m a physician in a methadone clinic. Kratom can show up as fentanyl on our lab’s drug screen. Confirmatory testing for norfentanyl is negative with Kratom. Most pain management offices wouldn’t check for fentanyl but obviously we do because many of our patients are here because of fentanyl addiction. You should check with your physician because the potential drug interactions with opioid pain meds could pose a risk to you.

    1. Methadone does not block the effects of anything. But, any activity that kratom hasm is additive to kratom. That include activity to increase norephineprhine, serotonin, and opioid agonist properties as described in this article.

      1. So say I take 120 mg of methadone everyday in the morning could I take kratom later in the day when I feel down

        1. Jacob, I can’t give medical advice here, BUT, methadone sticks around for a VERY long time, so taking kratom later in the day is just like taking it with methadone. The interaction with these two drugs is outlined in the blog post.

          1. Ok so hypothetically then if someone was having horrible nightmares and cravings everyday while going to the methadone clinic and taking 120 mg a day could they take kratom to help curve the cravings

  7. I appreciate that thank you. I’ve been addicted to opiates for 10 years. I’ve been on methadone for 5… I’m curious on the symptoms of withdrawal.. if I missed my clinic and felt like I was beginning withdrawals what would happen if I took kratom to reverse the withdrawal until the next time I go to my clinic? Would the kratom cause immediate withdrawal symptoms or help relieve the symptoms? Please let me know thank you. -FJA

    1. Hey, I think I understand enough to answer. It would probably help ease withdrawal more than anything. But, there is a chance that kratom could make you feel a little worse. Due to the adrenergic activity of kratom it might make you a little anxious, and if you are in withdrawal you would not want that. Probably best to make sure you can get to that methadone clinic

      1. Please do not give someone who wants to get off of methadone the ultimately stupid advice of getting to the methadone clinic. Kratom can and does free methadone addicts every single day. Google and research people….

        1. Joe – Michelle gave very sound advice. If the pt really wants off methadone, going to the clinic to start tapering the dose is the best and safest option. Talking in person to a clinic nurse/Dr about tapering, to stave off withdrawal symptoms, is probably better than following any blog commentary as well. (No offense Dr Fudin, you give great advice & fun & exciting facts!) No one is saying kratom is bad, or doesn’t work, quite the opposite, but methadone has many special considerations better addressed with someone who knows the pt’s full history and has a vested interest in their recovery. Take care!

          1. You’re right about this, but I do believe in select people tapering away from methadone, Kratom can be a valuable tool. But, if your doctor advises against it, then don’t. Simple as that. However, there’s nothing that says you can’t get a second or even third opinion about this. Being informed helps too. Most addiction medicine experts don’t expect their day to day patients to be as informed as one might be had they consulted some REPUTABLE (keyword there…) sources of research, preferably clinical and non-biased, and then patient feedback, in that order.

            A personal account:
            I’ve been tapering down from Methadone. I’ve now been on MMT 5 years of now, after 2-3 years of pharmaceutical opioid/opiate addiction. I’ve been able to drop from 85mg/day to around 32.5mg/day and plan to continue until I make the jump to zero.

            There have been some tough phases, I’m not going to lie. Basically, I taper every two weeks, at first in 5mg intervals, and slower now that the total dosage is lower. I’ve been a very stable patient and in many ways it’s given me my life back, but still the toll of dependency weighs upon me. This is why I’m tapering as fast as I can without unreasonable health complications or extreme discomfort.

            I’ve found that a small dose of kratom can bridge the gaps between dosing times on those first few days of taper drops, whereas I’d normally start craving and getting restless around 3 or 4am….In this very limited. My doctor was kind of blase on the whole concept, but my tapering progress is progressing at intended pace and my kratom usage is low to nominal at best, and is not increasing. Nor will it. In this way it’s been helpful to me. Hell, it could even be placibo. Don’t know, don’t care. Maeng Da is cheap around here. CBD has also been IMMENSELY helpful in my own personal experience, but I will not RECCOMEND either kratom or CBD to anyone here.
            This really shouldn’t be a decision you make based on word of mouth accounts about kratom’s efficacy as an opiate detox tool.

  8. Hi! Is it okay to take Kratom and methadone on the same day? I took my low dose of methadone this morning and was going to try the recommended dose of Kratom today.,I just wanted to Make sure it wouldnt throw me into witjdrawek♠

    1. Kratom with methadone is a very bad idea. There is an overlap on opioid activity at higher doses of kratom, and at lower to higher doses, there s an overlap of norephiniephrine, serotonin, and dopamine activity, which alone and combined could be very dangerous as outlined in the original post.

  9. It doesn’t comfort me at all that kratom is similar to SSRIs, which have caused enough problems on their own, documented by Robert Whitaker in Anatomy of an Epidemic. I successfully avoided the SSRIs recommended to me by pushy PCPs since the 80s, only to end up with a kratom habit doing the same thing to me: making me more depressed and lethargic when I even think about quitting. And now it’s just a 2g/day habit!

    Just don’t go there.

  10. You are doing such a great service to the community by providing the important answers to these questions.

    You may have solved a recent new problem I’m having with heart racing, heart palpitations that make me feel like it is anxiety, but very different than my usual anxiety episodes.

    I take 100 mg Zoloft daily and started Kratom a few months ago.
    I was having a hard time deciphering whether it is anxiety or withdrawal symptoms. But after reading your posts that Kratom is like Serotonin – I am therefore increasing my antidepressant dose from what you are saying and can’t really measure how much with the Kratom.

    I do have a history of depression of the Zoloft was increased to 100mg for pain purpose. What do you suggest one would do in my case since it’s been a few months now that I’ve done this.

    Also adding that I take Acyclovir as needed and 50 mg topomax every night as well. Didn’t know if either of them would be a concern.

    Thank you so much for your time.
    The Marketplace made some major error in my insurance application and I am in between coverage at the time, so your information is so awesome.

    1. Terry, You should not adjust your Zoloft dose without direction from your doctor – that can be very dangerous, with or without kratom. That said, Zoloft has no effect as an analgesic, but several other antidepressants do. Those antidepressants with norepinephrine activity alone or combined with serotonin could be used to treat pain and depression. See on this website, ANTIDEPRESSANT PHARMACOLOGY. 5-Ht stands for serotonin and NE stands fro norepinephrine. Acyclovir is not an “as needed” drug and should not be taken that way.

      1. Can taking kratom destroy the effects of pregablin works. I have stopped taking kratom and noticed the pregablin I was taking isn’t working the same to keep my migraines away

      2. Hi im on methadone 187 milligrams i split dose 2x a day. I just heard abt kratom, and am now very interested. Iv been wanting 2 get off methadone 4 yrs. Iv been on it for 10 yrs. I was on saboxine for 2 yrs, i got pregnant so my dr. Referred me 2 the methadone clinic. Iv had 3 babies being on it. It was rough. Anyways im wondering if im able 2 take methadone and kratom together? And slowly wing off methadone. Will that b safe? And does kratom come up n a test? I test @ the clinic 1x a month. Iv never had a dirty, dont wana start now…… I only go 2 the clinic 2x a month so i wont b able 2 ask the clinic that question so im asking u……thx so much….

        1. Jennifer, This is too complex of a case to answer here. I have a pharmacotherapy service that your medical provider can work with by contacting me through this website.

          1. I appreciate that thank you. I’ve been addicted to opiates for 10 years. I’ve been on methadone for 5… I’m curious on the symptoms of withdrawal.. if I missed my clinic and felt like I was beginning withdrawals what would happen if I took kratom to reverse the withdrawal until the next time I go to my clinic? Would the kratom cause immediate withdrawal symptoms or help relieve the symptoms? Please let me know thank you. -FJA

      3. I don’t think they were saying they’d increased their Zoloft dosage on their own. When they said they had thereby increased their dosage of antidepressants I’m pretty sure they were just saying that by taking kratom along with the Zoloft that it was basically just like taking more of the antidepressant from what they could understand you were saying regarding the effects of kratom on serotonin, etc. And then the other time they say they had recently increased I took it that they meant the dr had upped them, not that they had done it themself, for purposes of pain relief.

        Interesting that you say Zoloft is ineffective as an analgesic. Would you say this is true of all anti-depressants in general or just certain ones? I don’t think there is really any use in taking anti-depressants for pain relief myself. However, where I’m from all of a sudden we started seeing this trend of doctors prescribing anti-depressants for pain relief and everything else. Can you not sleep? Take an anti-depressant. Suffering from horrible migraines? You need an anti-depressant. Do you have debilitating back pain/any other type of bodily pain? An anti-depressant will help you!

        I have honestly had them prescribe me anti-depressants for all of those reasons. Oh that and anxiety, too. I forgot that one. It is kinda funny to me because depression isn’t something I’ve ever suffered from. I mean, I’ve had some situational depression before that lasted a few days but never been clinically depressed. Some people out there can hardly function because of depression and I’m not one of those people but one doctor suggested to me something along the lines of doctors prescribing anti-depressants for all of these off-label uses being due to the fact that they feel that depression may physically manifest itself as pain, insomnia, etc.. I guess that’s possible in some people but for every single person that walks into a doctor’s office, to suggest that any issue they have is simply caused by underlying depression is pretty ridiculous.

        I have had them tell me that anti-depressants would be wonderful for my back pain. I think it was amitriptyline that they gave me which of course basically turned me into a daytime zombie although I did sleep well at night for a while. No pain relief though. And of course the several different anti-depressants they’ve given me for sleep at various times have worked for a while. I’ve been tried on so many different ones for anxiety it isn’t even funny and is honestly insulting to me that doctors would just continue to switch me from one antidepressant to another to another etc acting like eventually one is going to help my anxiety. In the meantime, you’ve got me over here having panic attacks all the time and anxiety running so high I can barely function lots of times throughout the week. There doesn’t have to be any reason behind it, either. There can be absolutely nothing going on that should bother me and I’ll just go into a full blown panic for no reason. My husband will ask what I’m worried about or what I’m thinking about that caused it and it is difficult for me to make him understand that NOTHING is worrying me or bothering me. I’m like, 5 minutes ago I was great and now I’m just flipping out and no, there is absolutely not a thing that has triggered it. It comes out of nowhere. It is a serious insult to me that I tried to get something done about my anxiety for years and every single time, they would put me on an anti-depressant. And I’d take it as prescribed for however many weeks they said it would take it to get into my system. They’d tell me “this one will take 2 weeks to work” or “this one will take about a month.” They would say to come back in 2 weeks or a month or however long if it didn’t work and of course it never did. And I also had horrible side effects from many of them. If anything I felt worse from most of them and then from a couple I got really sick. I finally said forget it…I will just suffer before I continue to let them treat me like an experiment. Yes, I get that benzos are dangerous but I don’t agree with them being prescribed to people to take daily or to take for longer than a few months at best. It would be nice to be able to have one if I am in panic mode but finally I discovered Hemp Bombs CBD and began drinking their max chill shots. My smartwatch measures my anxiety and I can watch it literally drop after I drink one of them. They make me feel so much better. But the last couple of doctors I’ve mentioned my anxiety to haven’t even responded. They said nothing whatsoever about it when I tried to tell them how bad it was and that I needed some kind of help with it desperately. That was before I started drinking the CBD drinks. They’ve seriously been a lifesaver. I have used kratom quite a bit, too, and it made me feel significantly better but I relocated and am now in area where I can’t obtain it easily at all so I’ve not had any in months. It made me feel pretty great and my mood was good and my anxiety was pretty much nonexistent. If I could have stockpiled the kratom before I left there I would have because I personally have had wonderful results with it.

        1. L, Thank you for your post. The answer to your questions, “Would you say this is true of all anti-depressants in general or just certain ones?”, is just i ones. This is nicely outlined in an earlier post, Antidepressants are not “Happy Pills”. You will see a hyperlink in that article which brings you to a scientific article by Dr. Mitchell Max and colleagues from 1992. That article in my mind is a classic which well explains why certain antidepressants have real activity in treating pain, while others do not.

  11. My son died two weeks ago from an accidental overdose and I received a call today from the coroner. The level of fentanyl in his blood was 48 (mcg I assume, I haven’t seen the actual report yet) and the level of Kratom was 390. Would either of these alone killed him or only in combination?

    1. Leane, It depends on if it was pharmaceutical fentanyl or a fentanyl derivative. If it was pharmaceutical fentanyl, it is usually measured in ng/mL. if it was 48ng/mL, that is enough to cause death in several people. The kratom will also depend on the units (mcg, mg, ng) per mL or per L.

      1. Hi fred. I just wanted to share my story with you. I just turned 35. When i was 16 i started drinking socially and that eventually led to a big problem. I had 2 DUI’s in my early 20’s and a couple public intox violations. I began drinking to socialize with friends wich wasnt an issue. As it turns out that got worse because i was using drinking to put a band aid on my depression. My life was turned upside down as a result. Had got into legal trouble, lost multiple jobs and the weight kept piling on my shoulders. Adding to my depression and making it worse. About 8 years ago i was introduced to pain pills (hydrocodone) wich was prescribed to me for back pain. I used my prescription as directed but could deffently see why people would get addicted. I kept drinking until i started getting pain meds reguarly then abruptly stopped drinking for good and switched to pain meds to put a band aid on my depression. That only worked for awhile because of access and going through withdrawals when it wasnt available was a nightmare. 2 years ago i tried kratom it felt like a life saver. I went back to college and graduated and had no bad side effects from kratom that i was aware of. I didnt use alot about 1-2 grams every 8 hours of a mixed tea. I did notice after abou. 2 to 3 months of initial use i began to build up a tolerance. After that i began using more and I am now using 5 to 6 grams per 8 hours. I have had no issue’s except for constipation wich i had with prescription pain meds as well. Long story short i know longer go to bed at night wondering if im going to be awake in the morning or pass away due to respiratory failure because of prescription pain meds. I know longer have withdrawal symptoms and im still depressed and need help in that area of my life still. However i dont drink anymore or use prescription pain meds to ease my pain emotional y or physically. Is kratom in my opinion a drug. Absolutely!!!!!! The effects it has on me being able to work or be a good person every day is not even comparable to when i was drinking and using pain meds. Im not sure what should be done with kratom as far as regulating it but it has allowed me to have a better quality of life.. Is my life perfect with it? No, because im still using kratom as a band aid to get through depression. I just strongly feel safer and more predictable using kratom then any other “band aid” substances i have used to get through life. I also want to add i have tried multiple anti depressents with no good outcomes so far.

        1. Jason,
          Thank you so much for your honesty! I suffer from intense constant pain and haven’t gotten any relief from the Tramadol the Dr gave me. I also experience depression and anxiety that do not react to the multiple medications over the years.
          2 months ago I began drinking to function but realized that I am starting to crave more.
          Yesterday someone offered me kratom. I have it but have not opened it. Out of the 10 sites of facts, reviews and sales I found by Googling Kratom, your story coupled with the Dr advice on this site, has helped me decide to try kratom instead of alcohol!

    2. I can bet my entire life it was the fentanyl and the ONLY the fentany!! It’s an extremely STRONG drug. Kratom is unknown to so many, people (including the FDA) can’t wait to point fingers at it and place the blame on it. They’re trying their hardest to ban kratom because people are giving up some heavy medications for it and the FDA and pharmaceutical companies will lose money. Trust me on this, please! Many, many people have dropped meds like prescription opioids and some have even come off heroin with Kratom. However, you still have some people chasing some sort of high and use Kratom for the wrong reasons. You will never get “high” from Kratom and you will NEVER overdose on it. If you take too much, you literally throw up and that’s the end of it!! I’ve been using it myself for almost 5 years and I’m a healthy, tax-paying, productive member of society. I’m very sorry for your loss and you’re in my thoughts. Please know, it was the fentanyl that killed him.

      1. Yes , you certainly can get high on kratom, although it has a ceiling effect, so you won’t get as high as a mainstream opioid would make you. Overdose certainly IS possible with kratom. somebody could feel nauseated and take an anti nausea drug,.. and then may not vomit the overdose, and maybe they get serotonin syndrome because they have other drugs in their body.

  12. Hi Dr. Fudin,
    I hope this note finds you well. I have a question that I’m hoping you can help answer. How long does it takes for kratom and the metabolites to clear the system on a urine drug screen that includes Kratom? I have been prescribed hydrocodone (10 mg) 3x times daily for about 3 years. I have taken it as prescribed with no issues. My doctor recently retired and my primary physician referred me to a pain clinic. I had my first appointment and it went well. The doctor is compassionate and understands my pain.
    I was really anxious about having to go to a pain clinic and was worried that the meds would be discontinued because of the current opioid climate. I was afraid I would suffer withdrawals because I know that I’m physically dependent. Awhile back, while visiting my dad in Florida, a good friend of my dad’s shared that he uses Kratom, a “natural herbal product for pain”, and it really helped him (I had shared my concerns about my prescriptions and dr. retiring). He said he was completely off of painkillers because of Kratom and it was completely natural!! Anyway, I tried it while in Florida and he sent me home with some. I used it for a couple of months on and off, but I didn’t think it helped much and I just felt a bit nauseous from it; and so, I decided to stop using it and got rid of it. Anyway, I had my doc visit at the pain clinic including the urine test that gets sent out to an offsite lab (I’m sure it’s a thorough test), and It occurred to me that they could very well test for kratom. After doing some research on Kratom I’m very concerned about it showing up on the test. I should have thought about it sooner, but truly it never crossed my mind. I take my meds as prescribed and do not abuse or misuse. I took Kratom for the last time two weeks before the urine test, do you have any thoughts about the likelyhood of it showing up? I didn’t even know much about Kratom or “metabolites” other than it appeared to be a safe alternative, but now I’m worried because it seems to be a questionable substance. I just never really gave it much thought because he bought it at his local store. And to make matters worse, I just learned it is illegal in this state—I can’t believe it! I gues I never thought a drug could be legal in one state and illegal in another, unless it was illegal everywhere and then states overturned it (like marijuana). I’m just sick about it. One more question, would you advise that I contact my new doctor to let them know? I’m just so worried that the physician (new doctor, new clinic—no experience with me other than this and review my medical records (doesn’t really know me) will think I’m not compliant and lying, when I really have been …at least I thought I was.
    Thank you for reading this note, and I would be so grateful for any insight you may have.

      1. Yes I’m trying to quit methodone I’m still on 35 mgs a day to I have to quit any period of time before I start Kratom and will I have a lot of withdrawals from the methodone using Kratom

      2. Kratom has a half life of about a day, so it should be out of your system in a week? That makes no sense at all, If it takes a week to clear the system, it sounds like the half life is 3.5 days. Unless half life doesn’t really mean half. Here’s some information. Caffeine, chocolate, cheese, tobacco, alcohol, sugar and on and on and on are all opiate receptor items. If you use Kratom properly and you source it from a reliable company (one who tests it for heavy metals/impurities etc) you should be just fine.
        This idea you should check it against prescriptions is SO old news. If common sense doesn’t prevail, certainly no one would even check to see an article/web site like this.
        You can’t just take random things at random amounts and expect no issues. Also, the idea that people cannot regulate their own intakes is so lame. To the point you want the government to regulate Kratom? The same people who regulated the opiates that killed over 600,000 people during the epidemic. Dr. Fudin…You are a nut that needs more crakin’ and less smackin’ <—talking/typing…SMFH

        1. “Bite Me”, Thank you for the entertainment. First of all, caffeine, chocolate, cheese, tobacco, alcohol, sugar DO NOT in any way combine with opiate receptors. Since you like websites, find a reliable source to review the pharmacology of the items your listed. The items you list may however cause happiness because of a secondary dopamine release, but that is a stretch for anything in your list but sugar. Second, your understanding of half-life is flawed. The definition of half-life is the amount of hours necessary for blood levels to reach 50%. A drug reaches steady state at 5 half-lives, which is the time span necessary for a drug to leave the body (with certain exceptions). Using your example, a half-life of 3.5 days would mean it takes (3.5 days) x 5 = 17.5 days. But, you are also incorrect here, because the half-life of kratom is 7-24 hours depending on alkaloid; therefore the longest we would expect it to be in the blood is (1 day) x 5 = 5 days. n your own words therefore, “You are a nut that needs more crakin’ and less smackin’” Cheers!

  13. I have taken herion kratom together is their any effects to taken the both together or will it cancel the effects of it bc I got cut off my pain med bc of a false positive so I turned to street drugs for pain but trying to get away from them?

    1. There are several risks of using street drugs with or without kratom. heroin is often aced with other drugs. If your supply is laced with a stimulant (cocaine, amphetamine, bath salts), combining that with kratom could cause a heart problems and sudden death. If the heroin is combined with fentanyl, it could result in opioid overdose and death. The safest thing for you is to get to a rehab facility!!!

  14. I am curious about the interaction between Kratom and methadone. I have searched everywhere for this kind of information and have found nothing. Is it dangerous for someone who is prescribed and taking the same daily amount of methadone to try Kratom? Would the addition of Kratom cause the effects of the methadone to be stronger or cause an opiate overdose? Or would the methadone cause the Kratom effects to be multiplied. Just trying to be as safe as possible. Please help. Also curious if if Kratom interacts with suboxone the same way as typical opiates.

    Thank you

    1. Danny, Unless you took high doses of kratom, the opioid effects from kratom would be minor compared to methadone but could be additive. I bigger concern is seizure risk because kratom increases serotonin, norepinephrine, and dopamine, and methadone has a significant effect on serotonin and norepinephrine as well. If you’re looking for the “energy” effects from kratom, you ca get the same thing with and SNRI by prescription without the opioid effects – that would be safer, especially since it would need to be prescribed by a medical provider and can be properly monitored.

      1. Thank you so much. Just to follow up when you say high doses do you mean more than the general guides of Kratom dosages or do you mean enough to be past the “energy stage” and into “pain relieving stage”? And would 24 hours without methadone be long enough to reduce those risks of seizure to try Kratom?

        Once again thank you very much everything I’ve read on this page has been so valuable.

    2. Danny, Unless you took high doses of kratom, the opioid effects from kratom would be minor compared to methadone but could be additive. I bigger concern is seizure risk because kratom increases serotonin, norepinephrine, and dopamine, and methadone has a significant effect on serotonin and norepinephrine as well. If you’re looking for the “energy” effects from kratom, you ca get the same thing with and SNRI by prescription without the opioid effects – that would be safer, especially since it would need to be prescribed by a medical provider and can be properly monitored.

  15. Ok so I’ve been trying kratom for about 6 months off an on for minor pain ive been on pain management for 20 yrs i am prescribed gabapentin Mobic flexeral percocet i had a u.a. last month seen my doctor today and my u.a. showed hydrocodone and ritilitic acid wich he says is ritilan i have no idea how the hell that happened but he’s looking at me like im lying even though in 20 yrs only thing ive ever done they don’t like was i drank heavily in my 20s has kratom ever been known to mess up a u.a. btw this was a labed specimen

    1. Assuming what you say is true, the only way this could happen is if the lab equipment was contaminated. You should ask your doctor to contact the lab to see what samples were run just before yours.

      1. Good idea! I had a situation awhile back to where I was negative for methadone. At this time they took a specimen from me once a week. It happed once n that was it. I wasn’t positive for anything else. Wow, how did I get thru my methadone withdrawal. ( Being fasecious). I will definitely remember that…to check the equipment to see if there was a positive for any other drug before my urine was tested. Thank You!

    2. Did the test confirm that oxycodone was present? Maybe the staff mixed up 2 patients samples and it went unnoticed by everyone. Always make sure the specimen container you are given is labled properly for you. It should be caught by the staff but another pair of eyes never hurts and human error is common.

  16. From reading message boards regarding Kratom, it appears that there are a lot less complaints from 2017 to now Jan of 2019 and that there are actually some quality people (companies) selling it now with brands made specifically for pain, sleep or energy. I am suffering so incredibly bad from pain that I am considering purchasing this. If I die, well – that may not be a bad thing. I have been prescribed back to 15mg of Methadone, but honestly it just doesn’t cut it so I can do simple things like go to the store for groceries or even standing to cook, I now go and sit down just to peel potatoes as it is more comfortable than standing. I feel like my life is being wasted as I know I could have a chance at contributing to my community in many ways if I could just work. I have never considered ending my life so seriously as I just cannot find a comfortable position. I would go to Washington to protest but the pain prevents me from doing this. Just received a letter from my pain clinic stating they are no longer accepting Medicare/ Medicaid so now they just put me back on Methadone and now I am getting kicked out because of this. Real healthcare just doesn’t exist.

  17. Hello Jeff,

    I just want to thank you for all the information you provide here. It’s truly invaluable. As someone who is prescribed the lowest dose of both Cymbalta and Wellbutrin, would I be at risk at consuming any amount of Kratom? I’d rather be safe than sorry!

  18. Hi Dr Fudin – A doctor got me HEAVILY addicted to Oxycontin in the Philippines while I was petitioning my wife here to the USA.

    I am referring to the bad stuff that was outlawed in the USA (not oxycodone “Oxycontin,”) which i know you know about already.

    When I got back to the USA and started withdrawaling I had no clue what was happening as no one ever told me that after I stopped I would sufferer through withdrawal.

    Boy was I nieve then, I was in so much pain I thought I had a kidney stone or food poison.

    Then after many trips to the ER another doctor here prescribed me oxycodone which helped but was the start of 5 years of pain then withdrawal over and over again until I finally told my doctor NO MORE.

    He then started me on methadone and my life has gotten so much better! I went from 6 pills a day down to 2 a day currently in only one year and i feel great!

    However i heard of Kratom last week and got some as that seems like what I should and want to take if it works as well as methadone for my pain.

    As hard as it was to not take my 2 methadone tabs for 24 hours I did it so I could try Kratom and It worked great!

    So this is my question, I am now feeling a withdrawal from the methadone. What do i do?

    The methadone obviously works better like u stated above for my pain because of the binding of our MU receptors which methadone does ONLY.

    The Kratom however makes me feel so much better and gives me energy.

    Based on what you said and explained about our MU receptors and how methadone bonds to them i feel I am doing the right thing as methadone was what FINALLY put a stop to my chronic pain for the first time in 20 year’s.

    So should I keep taking my 2 pills of methadone as I have a pain problem?

    I NEVER had an addiction problem until I had to move overseas to go get my wife and unfortunately met a GREEDY doctor.

    I over came my addiction problem without even having to go to rehab and it is really not a problem anymore.

    The chronic pain in my back and legs is the problem.

    Like you stated methadone is WAY stronger than Kratom.

    Kratom worked but not as well and that’s where my whole question lies.

    Is it safe to take my 2 methadone pills and 1 or 2 Kratom pills later in the day as a way to beat the mild methadone withdrawals i just experienced when trying kratom?

    Or should I just stick with methadone as I feel like based on the MU receptors, Kratom is just not going to fight my pain like the methadone has so well.

    I just turned 40 years old and would really like to NOT have to take methadone anymore but it is THE ONLY thing that has ever worked for my pain and I have tried every kind of pain pill I think.

    I have scoliosis, rumitoid arthritis in my hands, ostio arthritis I believe its called in my back, 2 protruding disks in my back (L4 & L5) and 2 building disks also (L1 & L2). I also have real bad nerve damage on the left side of my face mainly my upper lip from a car accident.

    Up until I found methadone I thought my quality of life was over. Now I am doing so well but still I am taking opioids.

    Is it ok to take a small dose of methadone for my pain as needed for the rest of my life or would getting off the methadone (I have been on it for one and a half years) and taking kratom instead be better if I can make the switch and it continues to fight my pain well?

    I am so lost.

    Please advise.

    Thanks so much for this blog and for ALL your GREAT INFO!

    I don’t charge anyone for my services on my websites LimeLiteXtreme.com and LimeLiteInc.com either, (been on his for 20 years) so if anyone truly knows that you made this blog to help people bcasue you care its ME

    THANK YOU SO MUCH Dr. Fudin!!!

    I am so grateful.

    Bryan

    1. Bryan,

      Thank you for your comments. Whether or not you stay on methadone is between you and your doctor. If your doctor is specifically prescribing methadone for pain, you can discuss with him/her whether it could be beneficial to take the same daily dose split-up throughout the day instead of the whole daily dose at once. Although methadone stays in the body’s tissue for long periods of time, the analgesic activity often does not. If kratom is helping your energy and mood, and you are on low doses, more likely than not it is because of kratoms activity on serotonin, norepinephrine, and/or dopamine. As outlined in my post, there are antidepressants that have one or more of those pharmacological activities. It might therefore be a better option to replace kratom with one or more antidepressants – this too should be discussed with your doctor. I hope this helps!

      1. I have exact same story as Bryan but I’ve been on methadone for 10 yrs. My doctor informed me she’s going to have to wean me off methadone because of new laws I’ve been in pain for thirty yrs tried every thing or acupuncture chiropractic methadone the only thing that really helped me I’ve been so much more active less depressed if I go off methadone I am going to try kraytom. Is it really true that Drs. Can no longer prescribe methadone only to cancer patients and hospice patients

          1. hello, I have pancreatitis and am on 4-10mg Norco a day and have been on them for 3 months and there really hurting my stomach, and not quite getting the job done. I’m afraid to say anything cause I don’t know what pain management will do. I always follow the rules and pass my tests. i just am afraid of addiction with whatever the next step is. I am taking kratom for the first time and it makes me fuzzy headed with no relief. maeng da something like that. any advice. thank you folks

          2. However, the laws are so strict that many chronic pain patients would rather Kratom than go through going to dr every month and being subject to drug test which could come back with false positive which is my case. I’ve been seeing this dr for 3+years and now I’m told that fentynal showed up on my drug tests last few tests. I don’t take fentynal, couldn’t find a place to get it if I tried and the dr knows I haven’t had it prescribed by someone else. What could be causing this, kratom? I took triazodone one month for an earache so I could get some sleep. I need to know what would cause this because I haven’t taken fentynal.

          3. Welll if you Have Elhers Danlos Syndrome you do Not Repsponed to local pain meds. The only thing that works on me for pain. Is Savella. Dr. Daniel Claw on YouTube. At U of M. I been to his class. Only 35% of people respond to it, thank God I am one of them. It’s Not an Opioid. As I do NOT respond to tihose either.. the strange thing is I do redspond to liquid Advil. I take 3 as needed for pain, But NOT all the time. As they can be bad for you as well.. this whole EDS deal is weird.. and I hate it, it’s very scary because they found out in April of 2017 they cross over each other, This is not good.. To have surgery is a big undertaking, as to being ruled out of the very rare kind that can kill you, and to how you will heal.. and keep you under antisteadics so you do not wake up during surgery.. it’s over the top for me.. it’s Bad enough I had breast cancer Surgery and they Forgot to take the Radial Scar Out??!! This is horrific for me. Going under surgery is way more risk for me than any other regular person. ):

        1. Roberta you can go to a methadone clinic, if you have state insurance it might be free, they will prescribe you methadone and you can be in charge of your dose, they monitor you so you go up at a safe rate but if your doctor won’t treat you you can absolutely get methadone there. I go and I don’t have cancer or anything but am just in opiod addiction treatment.

      2. My best-friend has been on Methadone for 17 years…167mg. He’s 43 year’s old. Doctor’s have told him he’ll be on it for life. 7-days/week to the clinc ends up being $11k each year! He is ready to try Kratom to gain his life back. His only concern is that switching will cause “rapid withdrawl”. Please Advise. Roberta

    2. I don’t understand what the big deal on kratom is. It does help tremendously for opioid withdrawals without have to go on methadone or suboxene both being and opioids or opiate. I know people that have been on methadone for most of their lives and that is not kicking the habit. Seems to me that the government can make more money by making kratom illegal and charging insurance companies with the cost of suboxone (which is very expensive) that way they can control the situation. All I see if they classify it, is a way for our government to make more money off of it. I have never heard of any bad side effects nor have I heard of withdrawals from it and have never experienced it myself and from others I know personally. If the government would leave themselves out of this people would have a way to get off opioids. Government won’t pay attention to this either, if the government would have allowed physicians the ability to prescribe opioids as needed after the first cut back on prescriptions the government would not be facing this problem of heroin and fentynal, but instead they made it almost impossible for chronic pain patients to get their medicines and it backfired on the population. The government took the opioid epidemic to far and with open borders things are out of control. Anybody who reports that drs caused their dependence on pain medications are kidding themselves. Good drs know more about prescribing the the government. Good physicians didn’t get patients addicted but pill drs just needed to be shut done. This epidemic will never go away without stopping it from coming in and. Seems congress ignores this meanwhile patients that need the medication can’t get it or enough to make a difference. Now they want to take away a natural remedy, second round for new addicts

      1. Tried to reply to D Flock asking about testing positive for thisis in response to your previous message about testing positive for fentynal. I to have test positive for fentynal and i only take kratom. Having it sent off for additional testing to prove that its only kratom.

  19. Kratom is being used as a herbal alternative for medical treatment. If it is taken with proper instruction and limited dozes. Kratom can be an addiction if one is taking more dozes. People who have used low doses generally report having more energy, being more alert, and feeling more sociable. At high doses, kratom has been reported as being sedative, producing euphoric effects, and dulling emotions and sensations.

  20. Dr. Fundin, you had mentioned something along the lines that kratom can act similar to an SSRI and I read something about serotonin. Anytime I hear that I freak out a little bit because I have suffered serotonin in the last. Are there any risks known for kratom to cause serotonin syndrome?

    1. Not generally if taken in recommended doses, but the problem is that the FDA doesn’t control the purity of these products. The risk of serotonin syndrome is significantly elevated if kratom is taken with prescription antidepressants, tramadol, St. John’s Wort, quetiapine, or any other drugs that affect serotonin.

  21. I understand the need for caution with regard to using Kratom and I know that it’s definitely a drug, but my options to have some quality of life are very limited. I have cauda equina syndrome from a botched spine surgery. I had terrible pain from my crushed nerves but my surgeon decided that my repeatedly asking for pain meds was because I was drug speaking. He ignored all my red flag symptoms (I had all of them) for four days.

    To treat the relentless neuropathy, I was put on massive doses of gabapentin (3600 mg/day), which left me stumbling like a drunk so they switched me to Lyrica, which was an awful drug. It basically shut off my personality, I stopped feeling emotion, I wasn’t able to remember even the most basic facts I had read or heard, I didn’t care about anything, and I lost my ability to think rationally.

    After about six months, I couldn’t stand being a brain dead zombie so I asked for help weaning off Lyrica. My pain management doctors told me to talke one 100 mg capsule less every few days (I was on 400 mg/day) until I was off of it in a couple of weeks. By the second day of my first taper, I thought I would lose my mind. I was having panic attacks lasting hours, racing thoughts, and felt like I would crawl out of my skin. I told my doctors that the withdrawal was intolerable and they all told me that there is no withdrawal with Lyrica and I was making it all up. I had to beg to get a prescription for a lower dosage capsule so I could taper in smaller dosages and then I was on my own. It took me four months of absolute, complete hell. I didn’t sleep for days and then would sleep for a day and a half. I pounded my hands bloody on the wall because of the agitation. I begged my doctors for help but they dismissed everything I said. I realized afterward that they just didn’t want to hear that their main non-opioid pain medication had serious side effects, especially the department head who had at least a half dozen publications praising the efficacy of Lyrica. All these doctors literally watched me psychologically disintegrate and did nothing to help. I told them I was going to kill myself including a description of my suicide plan. They all ignored me or dismissed me. One doctor told me to stop wasting his time. After my suicide attempt I didn’t tell them because I knew they wouldn’t care.

    Compared to Lyrica and even gabapentin, Kratom has minimal side effects and I really have no other pain treatment options. I have no trust left in doctors to be willing to risk trying Cymbalta or a tricyclic for my pain. I know that if I developed any problematic side effects for which both are notorious, I’d be completely on my own and no one would care nor help me. I know that I don’t have the strength to crawl out of another Lyrica type darkness again.

    Even if Kratom cuts my life short, it’s far better than being completely incapacitated with relentless neuropathy knowing that it’s utterly hopeless turning to doctors for help and that even if they want to help, I’m stuck with these terrible meds. I’m terrified that the FDA will outlaw Kratom and I’ll be forced to live in off the chart pain until I give up, walk back out into the woods, and pull the trigger all the way this time.

    1. I have terrible diabetic neuropathy, gabapentin nor lyrica would help. I too was on 3600 mg gabapentin for 2 years then tried lyrica for 2 months with no help from it. I decided to go to a methadone clinic for opioid addiction treatment (I didnt have an addiction, but I needed relief from the pain. It helped! The pain was gone, finally. It’s been a year and a half now on methadone and the pain is still gone and hasn’t come back. I know I’m now addicted to methadone, another opiate but the treatment center will help wean me off when I’m ready. Hope this helps!
      Ps… I was ready for my life to be over as well!

  22. Great article dr. Fudin as someone who just graduated from pharmacy school its good to understand more about kratom… I actually just went to this kratom shop in my town in Tampa florida to see what it was about… Its a shop that people go into and they sell kratom in powder form and use it in teas…. People use it for anxiety and other stuff the guy at the front counter said…. Interesting I just saw that shop on my way home… It had kratom on huge letters lol

  23. Hi Jeff,

    I applaud your professional opinion on Kratom. Thank you.

    As a professional rare disease and pain advocate for more than half my adult life closely affiliated with health and human service NP’s for just as long and as a nurse for nearly 4 decades, and a lifetime CPP, the resounding repeated theme I continue to hear is CPP’s have been and are left suffering in agony because of tapered prescription opiates and the advancement to none. Victims of the so called “opiate crisis” they are not responsible for causing. These constituents have often typically been opiate maintained for many years. I hear from the CPP’s with CRPS, a host of rare diseases associated with crippling pain, those with FBS, PN, RA, MS, malignant pain and a litany of other horrendously painful diseases/_disorders, pain from trauma. Specifically. I am referring to many CPP’s I have come to know well through their pain journeys, met many in person.

    By no means am I implying prescription opiates are appropriate for all CPP pts.,
    , but rather, recognizing that by the time most CCP’s have come to a pain practitioner for consult, they’ve already run the gamut of multiple treatments, often surgical interventions, etc. which has not been successful in managing their pain. All this respective pain population hopes for is a reasonably functional life with an “acceptable” pain level and a semblance of life quality. The Regulatories have robbed this population, denied their med access.

    I believe the take away here can be summed up by stating “Many CPP’s are living in agony now, unable to function, left with no quality of life because they no longer have access to the legal meds which were successful in managing their individual pain circumstances. When pts. are left suffering, understandably, they’ care not what the financial or physical hardships, just “tame the PAIN and suffering.” It’s understandable these are pts. willing to take a chance, try anything for relief. If It’s legal, they’ll take a chance, if it works for their pain, they’ll continue that treatment course. If it doesn’t, the only remaining alternatives are to either resort to the streets and risk the strong possibility of grave consequences or, resort to paying the ultimate price…and permanent solution, suicide.

    Overall, the infinite depth of frustration, incompetence, irresponsible guidelines from CDC which have spread like flesh eating bacteria to other Regulatories, to the qualified, legit. pain practitioners, onto their CPP’s has been over the top, appalling.

    Most once pain managed, legit. opiate maintained CPP’s by and large do NOT fault their pain practitioners for the tapering and eventual discontinuance of opiate therapies. Most CPP’s do understand their practitioner’s have become “strangled” by state laws, by the CDC, FDA, DEA, bigots, politicians, the climate of the “opiate hysteria.” CPP’s are well aware pain practitioners practices have been and are continuing to be driven out of practice, dome have been shuttered. The NP’s and MD’s whose specialty has been/is pain management routinely voice their fear of the DEA. This should not be the case for these individuals who are well qualified, responsible, capable, totally legitimate, compassionate professionals. They should be allowed to practice in the specialty of pain, which they chose. The only people who should be involved in directing and managing the CPP are the CPP and their pain practitioner and whomever else the pain practitioner may suggest for adjunctive collaborative efforts to aim for the best possible pain relief for the patient.

    “Googling” to fish for medical info. is no substitute for the years of education and experience of licensed health professionals. I know someone who yrs. ago suffered frostbite to both feet. She had been outside for an extended period of time, initially she had no idea she had developed frostbite. She took a hot bath immediately upon returning inside, went to bed, awakened from terrible pain a brief time later. She resorted to the internet having googled “frostbite treatment.” The site advised rubbing the affected areas with snow! !This person is an intelligent individual. Fortunately, she did not follow this disastrous treatment recommendation, instead consulted emergent medical care. Imagine the additional permanent tissue death had she followed Google’s site treatment.

    Kratom obviously needs considerable research. I believe users are setting themselves up for “risky business” at this juncture….The fear of the unknown is scary.

  24. Would you say that kratom is relatively safe for people who aren’t taking any other medications? Could the risks be handled by educating people about what foods they should avoid?

    1. Lindsay, Thank you for these very reasonable questions. The answer to both are YES. But do keep in mind that there are no controls on potency if kratom from batch to batch, so the doses may very within and between brands.

    2. To expand on what Jeff notes, GF, even if we educate patients on what to eat and not eat and medication interactions…compliance isn’t always particularly good. Look at MAOIs – very effective, but they’ve proven deadly to the point that they’re rarely prescribed at this point.

  25. Sir, you assume we dont oay attention to the “potential hazards” of Kratom. That is an uneducated guess on your part. Ths science behind Kratom has provem the risk level is low if not zero. As with anything in life moderation is key.

    I am a Gulf War vet and s left leg amputee. My oain is costant. Kratom manages my pain without the need for the real culpret, opiates.

    1. Can you share the “science” that “proves” that the risks associated with Kratom are “low if not zero”? Please understand that as Editor-in-Chief of the Journal of Pain Research, my idea of what constitutes “proof” are likely to be scientifically rigorous. But I’m always happy to learn.

    2. You sir are wrong,look at your spelling in your post? Opiates for chonic pain caused by diseases is only one of the drugs used to keep these patients walking & able to take care of their families.You should know better than to go along with government dummies, they are hurting vets as we speak by with holding medications!

      1. His spelling is fine just hit the wrong letter but he knows how to spell. I agree with him that the risks are low to zero. I have taken it for about 3’years now and never have experienced any bad side effects. It’s just another way for the government to make illegal. Chronic pain patients have suffered through this opioid epidemic. The only people being controlled by the new laws are patients. Addicts can get their opioids anytime on the streets from Mexican herioin and fentynal, after the strict laws were passed, the epidemic grew and many more overdoses. Can’t understand why congress doesn’t realize this and pass better immigration laws. Now they want to take away kratom which is not even close to the dangers of methadone, along with suboxone seems to just be another addiction, which allow big pharma to get wealthier if kratom becomes illegal.

  26. I would refer people to my PDF in the American Journal of Health-System Pharmacists for more information regarding kratom and its benefit to risk profile. Kratom is a very complex product and it does not lend itself to soundbites or small OpEd pieces. http://www.ajhp.org/content/ajhp/early/2017/12/14/ajhp161035.full.pdf?sso-checked=true

    What I think is that if we are willing to move past semantics we have a potentially very promising product with the potential to help a lot of people but it is not candy, it is not coffee, and it should not be sold via vending machines or to children. It is also a lot more promising than proven and the data is in its infancy versus its competitors used for pain relief or opioid maintenance. I wish this were not so and that we had data for kratom like we do for medical marijuana but the reality is we do not.

    If you want to join the conversation about my article, the OpEd based off of it, or the Dr Oz Show on the topic, I am happy to entertain your comments on The Conversation site. https://theconversation.com/the-dangers-and-potential-of-natural-opioid-kratom-87581 I think if you read through the comments, you will see it was quite a good discussion between many people around the country and I on this complex topic.

    This includes a discussion about whether or not kratom is an opioid or not. Ultimately the determination is one of convention and disputing it may make for good marketing but is nothing more than semantics. In healthcare, drugs that stimulate opioid receptors are opioids and two constituents from kratom do stimulate opioid receptors. The stimulation of these opioid receptors does not cause respiratory depression in animal studies however and in human anecdotal experience, there should be a lot of bodies piled up if it was a potent respiratory depressant which we do not see.

    Having said that, saying that kratom is impossible to overdose on or that it is impossible to hurt or kill you because it causes stomach upset and vomiting is inaccurate. Either directly via overdose or as a result of drug interactions (which needs to be part of the risk benefit profile) there are reasons to believe that it can cause serious adverse events and until better conducted larger trials are conducted, the full incidence or extent of these harms cannot be known. Simply hanging your hat on a low incidence of adverse events versus consumption numbers is dangerous because if it is not in the national consciousness, especially among health professionals and law enforcement. As such its ties to other cases of injury cannot be made. It is not detected upon routine drug screens in the United States. We do need much better data in order to make evidence based decisions.

    Should it be made a DEA Schedule I drug, I do not believe so but I also believe it should be more controlled than it currently is. I do feel for the people are using it and believe that it helps them or people without access to other options they find effective. It can be a scary time for you. Your feelings and concerns should be a part of this discussion. Having a large number of people move onto illicit heroin or fentanyl based products which can cause respiratory depression is certainly not prudent at this juncture for them or for the country. The legal route to achieving more control without a ban will be very difficult for kratom based on how the current laws are structured but I am confident that if we can have an open conversation about it and the average person can hear the current pluses and minuses, a reasonable middle ground can be reached.

    As a final thought, I know Dr Fudin and his work with pain patients pretty well and I have always been impressed by his caring when helping people struggling with pain issues and willingness to try to new things.

    1. Awesome commentary.. Really fair and balanced… Michael… I like what you said that just because the little evidence we have now that says its low adverse effects doesn’t mean we should just turn a blind eye to it… Anything we injest whether its a drug herb plant etc… Anything in overconsumption will cause detrimental effects in the body…

    2. I am very interested in the dual nature of Kratom in that it has both opiate properties as well as those of an opiate agonist? If this is the case, is that also not the way the drug Suboxone was designed as a treatment for addiction? Could this explain why so many people claim it is such a valuable alternative for withdrawals and for maintanance after? I also want to thank you for the informative blog. During this time of crisis within the government, as well as both the CPP and the drug addicted community, good scientific information is so valuable.

      1. R, There are some similarities between buprenorphine and kratom. Both are partial agonists at the mu-opioid receptor and competitive antagonists at the kappa and delta opioid receptors. the major difference is that buprenorphine has much higher binding affinity for the mu receptors compared to kratom and in fact at moderate to high doses buprenorphine cannot easily be reversed by nalaoxone for that reason.

        1. There are probably not many opioids that can give buprenorphine a run for the money when it comes to it’s ability to out compete them for the mu receptors. Maybe fentanyl or some of the stronger analogs of it.

  27. A little better even though the damage is more or less done when you go on TV and throw out words like heart attack, stroke, and respiratory depression. You are still not providing any evidence or support of a kratom only death. The public would be served better with regulations and guidance on drug interactions but this ban the plant completely is non sense. You have already added fuel to the propaganda driving the desire for a all out ban. A blog post after getting called out for spewing nonsense on TV is really not going to cut it.

    1. Spot on. The Dr. claimed that kratom can cause death and respiratory depression which is not at all true. Unless mixed with an illicit substance and/or prescription there have never been any deaths due to kratom. This story did damage to the work that the kratom community has done to educate the public about the reality of the leaf. The FDA and DEA (heavily fueled by big pharma) have gone on a fear mongering rampage spreading misinformation and lies about a leaf that is as safer than any pharmaceutical substance. The Doctor needs to own up to the damage that he has done by using his position to spread lies created by the FDA and DEA. Either he was totally ignorant and just spewed all of this becuase he didn’t know better or he is educated and chose to lie about it. I saw on facebook that he had been given links to the research on kratom last week but then claimed that he wasn’t aware of the 8 factor analysis or the research by University of Florida. That, in of itself was a lie as I saw it on his page. From what I can gather, Pain Dr wants to keep his patients coming back for more prescriptions and away from a botanical substance they can treat themselves with. A blog post is not enough to fix this.

      1. Pain Dr. is a Pharm.D. and a pain educator, and doesn’t currently get paid to treat patients. He is widely considered one of the leading pharmacologists in the world, and dedicates a lot of his time, pro bono, educating patients. From where do you critics have your doctorates? Are you trained to critique the research that he cited? This is what Dr. Fudin and I would call “Kratom Neuromysticism”, i.e. you want it to be true, so you “make it” true. #Pathetic!

        1. Dr. S, while I normally agree with you, and I know you have great respect for Dr. F, but discounting the abilities of people to interpret research papers based upon lack of formal credentials is insulting. It’s not difficult to identify logical fallacies or incorrect causality. I’ll admit, there are without a doubt nuanced techniques for true analysis, but just because a paper is published in a journal doesn’t make it sound science. You know that, you’ve seen some of the Opioid Hysteria papers.

          1. You’re right, GB: Publication in a journal doesn’t make something true, as there are a lot of terrible-quality journals out there. However, my dear friend and colleague, Dr. Fudin, is smart enough to separate out the bad research from the good, and I’ve never seen him cite the bad research in order to prove a point.

        2. Hi Jeff,

          I applaud your professional opinion on Kratom. Thank you.

          As a professional rare disease and pain advocate for more than half my adult life closely affiliated with health and human service NP’s for just as long and as a nurse for nearly 4 decades, and a lifetime CPP, the resounding repeated theme I continue to hear is CPP’s have been and are left suffering in agony because of tapered prescription opiates and the advancement to none. Victims of the so called “opiate crisis” they are not responsible for causing. These constituents have often typically been opiate maintained for many years. I hear from the CPP’s with CRPS, a host of rare diseases associated with crippling pain, those with FBS, PN, RA, MS, malignant pain and a litany of other horrendously painful diseases/_disorders, pain from trauma. Specifically. I am referring to many CPP’s I have come to know well through their pain journeys, met many in person.

          By no means am I implying prescription opiates are appropriate for all CPP pts.,
          , but rather, recognizing that by the time most CCP’s have come to a pain practitioner for consult, they’ve already run the gamut of multiple treatments, often surgical interventions, etc. which has not been successful in managing their pain. All this respective pain population hopes for is a reasonably functional life with an “acceptable” pain level and a semblance of life quality. The Regulatories have robbed this population, denied their med access.

          I believe the take away here can be summed up by stating “Many CPP’s are living in agony now, unable to function, left with no quality of life because they no longer have access to the legal meds which were successful in managing their individual pain circumstances. When pts. are left suffering, understandably, they’ care not what the financial or physical hardships, just “tame the PAIN and suffering.” It’s understandable these are pts. willing to take a chance, try anything for relief. If It’s legal, they’ll take a chance, if it works for their pain, they’ll continue that treatment course. If it doesn’t, the only remaining alternatives are to either resort to the streets and risk the strong possibility of grave consequences or, resort to paying the ultimate price…and permanent solution, suicide.

          Overall, the infinite depth of frustration, incompetence, irresponsible guidelines from CDC which have spread like flesh eating bacteria to other Regulatories, to the qualified, legit. pain practitioners, onto their CPP’s has been over the top, appalling.

          Most once pain managed, legit. opiate maintained CPP’s by and large do NOT fault their pain practitioners for the tapering and eventual discontinuance of opiate therapies. Most CPP’s do understand their practitioner’s have become “strangled” by state laws, by the CDC, FDA, DEA, bigots, politicians, the climate of the “opiate hysteria.” CPP’s are well aware pain practitioners practices have been and are continuing to be driven out of practice, dome have been shuttered. The NP’s and MD’s whose specialty has been/is pain management routinely voice their fear of the DEA. This should not be the case for these individuals who are well qualified, responsible, capable, totally legitimate, compassionate professionals. They should be allowed to practice in the specialty of pain, which they chose. The only people who should be involved in directing and managing the CPP are the CPP and their pain practitioner and whomever else the pain practitioner may suggest for adjunctive collaborative efforts to aim for the best possible pain relief for the patient.

          “Googling” to fish for medical info. is no substitute for the years of education and experience of licensed health professionals. I know someone who yrs. ago suffered frostbite to both feet. She had been outside for an extended period of time, initially she had no idea she had developed frostbite. She took a hot bath immediately upon returning inside, went to bed, awakened from terrible pain a brief time later. She resorted to the internet having googled “frostbite treatment.” The site advised rubbing the affected areas with snow! !This person is an intelligent individual. Fortunately, she did not follow this disastrous treatment recommendation, instead consulted emergent medical care. Imagine the additional permanent tissue death had she followed Google’s site treatment.

          Kratom obviously needs considerable research. I believe users are setting themselves up for “risky business” at this juncture….The fear of the unknown is scary.

          Again, thank you, Jeff, for your insight into Kramtom.

          Best regards,
          Susan

          P.S. Dr. Schatman- You are spot on in your comment. I could not agree more. Thans!

          1. Hi Jeff,

            I applaud your professional opinion on Kratom. Thank you.

            As a professional rare disease and pain advocate for more than half my adult life closely affiliated with health and human service NP’s for just as long and as a nurse for nearly 4 decades, and a lifetime CPP, the resounding repeated theme I continue to hear is CPP’s have been and are left suffering in agony because of tapered prescription opiates and the advancement to none. Victims of the so called “opiate crisis” they are not responsible for causing. These constituents have often typically been opiate maintained for many years. I hear from the CPP’s with CRPS, a host of rare diseases associated with crippling pain, those with FBS, PN, RA, MS, malignant pain and a litany of other horrendously painful diseases/_disorders, pain from trauma. Specifically. I am referring to many CPP’s I have come to know well through their pain journeys, met many in person.

            By no means am I implying prescription opiates are appropriate for all CPP pts.,
            , but rather, recognizing that by the time most CCP’s have come to a pain practitioner for consult, they’ve already run the gamut of multiple treatments, often surgical interventions, etc. which has not been successful in managing their pain. All this respective pain population hopes for is a reasonably functional life with an “acceptable” pain level and a semblance of life quality. The Regulatories have robbed this population, denied their med access.

            I believe the take away here can be summed up by stating “Many CPP’s are living in agony now, unable to function, left with no quality of life because they no longer have access to the legal meds which were successful in managing their individual pain circumstances. When pts. are left suffering, understandably, they’ care not what the financial or physical hardships, just “tame the PAIN and suffering.” It’s understandable these are pts. willing to take a chance, try anything for relief. If It’s legal, they’ll take a chance, if it works for their pain, they’ll continue that treatment course. If it doesn’t, the only remaining alternatives are to either resort to the streets and risk the strong possibility of grave consequences or, resort to paying the ultimate price…and permanent solution, suicide.

            Overall, the infinite depth of frustration, incompetence, irresponsible guidelines from CDC which have spread like flesh eating bacteria to other Regulatories, to the qualified, legit. pain practitioners, onto their CPP’s has been over the top, appalling.

            Most once pain managed, legit. opiate maintained CPP’s by and large do NOT fault their pain practitioners for the tapering and eventual discontinuance of opiate therapies. Most CPP’s do understand their practitioner’s have become “strangled” by state laws, by the CDC, FDA, DEA, bigots, politicians, the climate of the “opiate hysteria.” CPP’s are well aware pain practitioners practices have been and are continuing to be driven out of practice, dome have been shuttered. The NP’s and MD’s whose specialty has been/is pain management routinely voice their fear of the DEA. This should not be the case for these individuals who are well qualified, responsible, capable, totally legitimate, compassionate professionals. They should be allowed to practice in the specialty of pain, which they chose. The only people who should be involved in directing and managing the CPP are the CPP and their pain practitioner and whomever else the pain practitioner may suggest for adjunctive collaborative efforts to aim for the best possible pain relief for the patient.

            “Googling” to fish for medical info. is no substitute for the years of education and experience of licensed health professionals. I know someone who yrs. ago suffered frostbite to both feet. She had been outside for an extended period of time, initially she had no idea she had developed frostbite. She took a hot bath immediately upon returning inside, went to bed, awakened from terrible pain a brief time later. She resorted to the internet having googled “frostbite treatment.” The site advised rubbing the affected areas with snow! !This person is an intelligent individual. Fortunately, she did not follow this disastrous treatment recommendation, instead consulted emergent medical care. Imagine the additional permanent tissue death had she followed Google’s site treatment.

            Kratom obviously needs considerable research. I believe users are setting themselves up for “risky business” at this juncture….The fear of the unknown is scary.

            Again, thank you, Jeff, for your insight into Kratom.

            Best regards,
            Susan

            P.S. Dr. Schatman- You are spot on in your comment. I could not agree more. Thanks!

          2. Susan, Thank you for your comments and sorry for the late “post”. For some reason it went to the spam box. I too believe there are attributes to kratom but we need to get a better handle on doses, purity, consistency, and toxicities. But perhaps most importantly, people taking it must be well-informed about potential for drug interactions. This nonsense by advocates that there is no harm or it hasn’t been proven to be harmful is a recipe for disaster. After all, aeronautics engineers haven’t studied that jumping out of a plane without a parachute ends n death – we just know it because of the science (and a little common sense). I would expect a little more appreciation from these groups for telling the truth in the original post and taking the time to explain the issues.

        3. Thank you to Dr Fudin for the article.

          But especially, thank you thank you thank you Dr Schatman for your comment. I’ve just gone through a bout of insanity that is very well explained by Kratom Neuromysticism! I was tag teamed by the Kratom Krew. No neutral or negative comments about kratom are allowed to be entertained, in fact no questioning. You are only allowed to say it is a miracle or else you are a horrible person, the worst the world has ever seen. I honestly felt like I was talking to a group of kindergarteners about the existence of the Easter Bunny and Tooth Fairy. This is exactly it; i.e. you want it to be true, so you “make it” true. #Pathetic!

          1. You’re very welcome, Donna. People on Twitter who are essentially “addicted” to Kratom (clearly a possibility when you combine an agent that has mu agonist affinity with personalities prone to a SUD) are enraged when Jeff and I suggest that there are insufficient safety data.These folks “dost protest too much”, rejecting science (or the lack thereof), as they sooooo want it to be a “fact” that Kratom is safe. I agree that it’s pathetic, and my (and Jeff’s) careers are not contingent upon every blind soul agreeing with us. Good luck!!! Michael

  28. People, pain management patients are FORCED to use a substance, any substance that we can “legally” acquire to manage pain……now. I prefer to not use alcohol, tobacco, an even the “legal” kratom but, 80 percent of medication that I have RESPONSIBLY used, been prescribed for 23 YEARS has been forceably removed from my overall health care, and specifically…….pain management. I realize that it is NOT FDA approved but, I would rather use kratom as to end my life. The hypocites in DC do not even realize what they are doing in the fight against the “opioid crisis”. WE, the pain unmanaged patients KNOW that even JEFF would smoke a joint to reduce pain. He would stick a joint in any orafice and inhale if it would recue lifetime, incurable, un managed pain. He may even use an illicit substance if he did not have PRIVILEGE to get whatever he needs for pain mange,ment. Don’t get me wrong, I could not wish lifetime pain on anyone, no more than I wish to see a grieving family over a members drug overdose. The “opioid crisis” IS being addressed completely wrong as millions of patients are negatively, deadly affected with CDC “policy” Hayden Hamby Jr.

    1. What you mention there about the pain unmanaged. That part struck me, as a personal experience I’ve had and continue to have. I have pttd. It’s a foot issue, anyway I dealt with it for months then I was finally sent to a foot dr. Then I had to wear the braces, and what not. I’ll add I’m a shop supervisor and I also work on machines and start them up. Basically my day consists of walking around for 8 hours sometimes more. Definitely not the ideal job for this particular issue. Anyhow I felt weird asking my dr to begin wit but I needed something for pain. He was really reluctant and finally gave me Tylenol with codeine, didn’t hell at all. Next he tells me tramadol is the most he can do. He tells me that the I don’t remember some agency looks into dr giving patients stronger stuff. The whole time I’m thinking and your point I have excruciating pain. So I try the tramadol and nothing, he tells me to double what I’m already taking, again nothing. I finally get to my surgegy after two and a half years and the issue I have was supposedly due to extra bone so they didn’t have to take tendon from my calf area for my foot. Now I’ve got some kinda metal plate and block and screws in my foot. My heal was also cut to adjust it to be more straight. Problem is I’m still having issues. They put me in a walking boot for a bit then told me to get some special insoles. Still nothing helps. Now I’m waiting on an appointment to get a specialized shoe. Anyway to bring this to the topic at hand. Since the Dr’s were of no use of actually helping me with pain I turned to the “street”. The thing about this is buying pain relief like that just got real expensive. I’ve recently been turned onto kratom by someone and honestly it does give off pain relief. It worked better then anything the Dr’s were willing to give me. So in cases like mine I hope they just leave kratom alone or just legalize it to regulate it better. People like me where the Dr’s won’t do anything for you are left with very few options already.

      Thank you

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