One reason kratom, a popular herb of Southeast Asian origin, remains so controversial is because there's no consensus about its safety as a pain reliever or effectiveness as a tool for helping people get off heroin and other opiates. Take a recent post in which one Colorado parent said the substance turned his son into a jittery wreck and another claimed it had literally saved her daughter's life.
A similar disconnect is evident among clinicians in Colorado.
"We're seeing quite a lot of kratom-use disorders, and it seems to be on the rise," says Dr. Nathan Moore, a board-certified addiction specialist currently working with the Denver branch of the Coleman Institute, a treatment center with offices across the country. Moore adds that ending a dependency on the substance shares plenty in common with the process involved in kicking the aforementioned deadly drugs.
Contrast that with the observations of Jeff Burt, a licensed addiction counselor and clinical director for AspenRidge Recovery in Lakewood. He says that, in his experience, addiction to kratom remains fairly rare even in Colorado, where it's widely available, and while he has not yet seen much evidence of it being a magic bullet, as its advocates maintain, he's open to the idea of further scientific study to see if it can be used successfully in a professionally supervised medical setting.
In Burt's words, "I'm on the front lines of the fight against opiates, so research that could help keep someone alive, and help them gain some insight so they can live a clean and sober life, I'm on board for that."
In Denver, kratom has been banned for human consumption, and it's been the subject of numerous health warnings from the federal Food and Drug Administration, which recently seized 540 kilos of the herb from a local company called Kratom Cafe USA in conjunction with the U.S. Customs and Border Protection agency.
A clinic in Maine has made a name for itself by creating an addiction treatment program using kratom and marijuana. Yet kratom-related calls to the Rocky Mountain Poison Control Center are said to have doubled in recent years.
That doesn't surprise The Coleman Institute's Moore, who says Denver's human consumption ban hasn't had much of an effect on the growing number of folks seeking help to wean themselves off kratom. He talks about a recent patient "in our detox protocol who was using about 20 grams of kratom a day. And I've had guys come in and eat it dry, they're so addicted to it. They're not mixing it with water or making it into a tea. They're eating it straight out of the bag."
Moore acknowledges that "detoxes for kratom tend to go better than they do for patients who are using heroin or oxycodone or fentanyl. But they still go through a fairly severe withdrawal for several days if they just stop using it. The symptoms are very similar to withdrawal you see with your traditional opiates: nausea, sweats, severe agitation, even vomiting and diarrhea. We also see muscle cramps, body aches, insomnia and twitching when they're withdrawing from the kratom."
There's an ongoing debate over whether kratom can be considered an opiate. Proponents note that kratom is a relative of coffee, but the FDA maintains that it contains opioid compounds. Moore characterizes it as "an opiate analogue. It's going to trigger those same receptors in the brain to some degree. So you can use it to detox from other opiates, and it's going to work for that. But then you've got a kratom problem, and what are you going to do? Probably a minority of people are going to be able to stop using kratom by themselves and eventually be completely drug-free — and the majority are going to have a kratom dependence. In some ways, it may be safer, but it can be equally habit-forming and dependence-creating."
Far from viewing kratom as an aid to breaking addiction to heroin and the like, Moore says that "most of what I see is patients going the other way: They become dependent on kratom and start chasing a stronger high — and they start using opiates instead. But kratom problems can be really bad. If people are really addicted to it, they can't function, they can't do hardly anything."
AspenRidge Recovery's Burt believes such scenarios remain the exception, not the rule. "It's still pretty rare to see kratom being a person's primary drug of choice — their preference drug, the one they'd buy if they had ten or twenty bucks in their pocket," he allows. "But we do see a lot of opiate addicts that have had experience with kratom, with mixed results."
Prior to chatting with Westword about kratom, Burt quizzed a group of 25 or so individuals going through treatment at AspenRidge Recovery about the substance. He estimates that about a quarter of those with whom he spoke had tried kratom, "but they said it did pretty much nothing or had a very minimal effect on them. Granted, we're talking about men and women who had pretty severe opiate-use disorders and pretty high tolerances — and if somebody has a high tolerance for heroin or prescription drugs, I don't think something like kratom's really going to touch it."
In his view, "it's probably like drinking a Mountain Dew when you're a meth addict. You're not really going to feel it that much."
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Granted, some patients have indeed gone through AspenRidge Recovery for kratom dependence, but not many. "We may get one or two," he estimates. "And we see similar kinds of withdrawal symptoms as you would with an opiate: flu-like symptoms and some nausea, stuff like that. But it typically will last three or four days, whereas full-on heroin withdrawal will usually last seven or eight days."
More commonly, AspenRidge Recovery patients come in for other addictions and are subsequently discovered to have included kratom in their pharmacological cocktail. "The only other times we see it is when a client doesn't think we test for it," Burt allows. "They go out and take some, take a little bit of the tea, and then pop hot for it, because it's on our panel and we actually do test for it. In the past, people would use synthetic cannabinoids to get around tests, because most standard tests only have eight or ten panels and they weren't going to catch that — and those wouldn't catch kratom, either. But we do a forty-some-panel test. We try to catch everything."
As for kratom's efficacy in addiction treatment, Burt sees more possible impact for patients needing medication-assisted treatment, or MAT, from suboxone, "which will activate the opiate receptors, too, but it has a lower ceiling, so users won't get the flash high they get from heroin."
Still, he'd like to know if kratom has more potential for good rather than ill — "but I would definitely want there to be more research, so we would be able to dose it correctly and see if it does what some people say it does."