is kratom safe

Use Caution with Kratom

, , , , , , Healthy Living, Medications

Our concierge primary care doctors in Jupiter know that many of our patients are interested in over-the-counter (OTC) alternative treatments for their ailments.

One of the more popular of these is kratom, an herb that has been used for centuries in Asian countries as a way to reduce fatigue and ease various aches and pains. In this country, it is sold in drinks or as supplements and is said to treat such common conditions as anxiety, depression, and opioid withdrawal.

One report estimated that as many as 16 million Americans also use kratom for pain relief in such chronic diseases as lupus, multiple sclerosis, fibromyalgia, rheumatoid arthritis, and other similar conditions.

Testimonials from users include such claims as, “Kratom gave me my life back after being addicted to pain pills;” “It has helped me enormously with chronic back pain;” and, “It got me off a 20-plus-year addiction to narcotics and opioids.”

On the other side are statements like these from a former user who told The Washington Post that “kratom was fun—it was like having morphine and cocaine at the same time”—until he got addicted. Withdrawal, he reported, was like “getting ripped apart by fishhooks.”

Agencies fighting it

Various agencies including the U.S. Food and Drug Administration (FDA), the World Health Organization (WHO), and even the U.S. Drug Enforcement Agency (DEA) have spent the last several years trying to ban it. Six states have already done so, with several others considering it. It is still legal in Florida, but may be banned or controlled in some localities here.

In April, the FDA released a statement warning consumers not to use the herb, Mitragyna speciosa, commonly known as kratom:

“FDA is concerned that kratom, which affects the same opioid brain receptors as morphine, appears to have properties that expose users to the risks of addiction, abuse, and dependence.”

FDA

Opponents have been buoyed in their arguments by several studies linking kratom to serious side effects.

One such study in 2019 reported that the number of phone calls to U.S. poison control centers regarding adverse effects from kratom have soared, from 13 calls in 2011 to 682 in 2017. Reported effects of kratom overdose included rapid heartbeat, agitation, high blood pressure, seizures, coma, kidney failure, and 11 deaths during the study period. Two of those deaths were attributed to kratom alone, while the other nine occurred in people who combined kratom with other drugs.

Another study on kratom use disorder (KUD) by the National Institute on Drug Abuse (NIDA), published in the Journal of Addiction Medicine in March, found that over half of 129 past and current kratom users showed no signs of addiction. But 29.5 percent met the diagnostic criteria for KUD, which includes increased use, tolerance, withdrawal, unsuccessful attempts to quit, and cravings.

Counter-arguments

Proponents attribute these adverse reports to a profit motive on the part of drug companies, overly restrictive U.S. drug policies, and poor research. They say it has been used successfully for thousands of years in Southeast Asia without a problem.

Advocates also maintain that, in these times of widespread and deadly opioid addiction, kratom is an acceptable alternative and that its dangers have been wildly overblown.

In a recent editorial published in the Scientific American, Maia Szalavitz, an author and journalist who focuses on science, public policy, and addiction treatment, writes that kratom “does appear to be far safer than all illegal and most prescription opioids.” She referred to a Centers for Disease Control and Prevention (CDC) study in 2016 and 2017 of some 27,000 kratom-related overdoses. Of those, kratom was implicated in less than one percent of overdose deaths.

“Moreover, in nearly all overdose deaths associated with kratom, it was accompanied by stronger drugs that kill more often, so it is not clear that it actually played a major role or even any at all,” she wrote.

“For example, around two-thirds of the 152 deaths the CDC studied also involved illicit fentanyl and its analogues, which are thousands of times more potent. In only seven cases was kratom the only only substance identified—and even here, researchers cannot rule out the possibility of undetected drugs,” she added.

Caution warranted

Nevertheless, most medical experts warn that kratom use can have adverse consequences. According to the Cleveland Clinic, “kratom’s potential for serious side effects outweigh its potential benefits.”

It lists the following most common side effects of kratom:

  • aggression
  • altered mental status
  • anxiety and irritability
  • constipation
  • delusion and hallucination
  • drowsiness and sedation
  • dry mouth
  • frequent urination
  • itching
  • nausea and vomiting
  • tongue numbness

More serious side effects can include:

  • cardiac issues, such as heart attack, abnormal heart rhythms, and high blood pressure
  • encephalopathy (brain disease)
  • hypothyroidism (underactive thyroid)
  • insomnia
  • liver damage and liver failure
  • loss of appetite
  • psychosis
  • respiratory depression (difficulty breathing)
  • seizure
  • tremor
  • weight loss

In addition, people going through kratom withdrawal may experience:

  • muscle spasms
  • pain
  • rhabdomyolysis (a condition leading to kidney damage when muscles disintegrate and release a protein into the blood)
  • rigidity
  • seizures
  • tremors

Think twice about kratom

While proponents hope more research will eventually vindicate kratom as a useful supplement, the medical community generally holds that its side effects more than outweigh any potential benefits. It can be especially dangerous when combined with other legal and illegal drugs.

While it’s up to you, we would suggest that our patients not take the risk of using this substance. If you’re thinking of using kratom for any reason, please discuss it with us first. We may be able to help you find other safer treatment options.

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Supplement Benefits: All In the Mind?

Concierge Medicine, Health Basics, Medications, Preventative Health

It sounds so easy: Pop a pill (or pills) every day and enjoy radiant health. Unfortunately, our concierge doctors have to caution you that it may not be not that simple. And, according to a new study, the claimed benefits of taking supplements might not even be true.

The study, published this month in the journal BMJ, suggests that the perceived benefits of over-the-counter (OTC) vitamin and mineral supplements may largely be due to the power of the mind.

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Think Twice About Marijuana During Pregnancy

, , , , , Medications

As more places around the country legalize marijuana for recreational use, many people have come to accept the idea that it is a harmless substance. As with any drug, however, our concierge doctors want to caution you that it does contain risks, especially for pregnant women. A new study underscores just how risky it could be during pregnancy.

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downside of marijuana

Be Aware of the Downsides of Marijuana

Concierge Medicine, Medications

Florida legalized the use of medical marijuana this past March. Thirty-four other states have already done so, and 10 states and the District of Columbia have legalized the use of recreational marijuana. But our concierge family doctors at MD 2.0 in Jupiter want to offer a few words of caution about the possible downsides of this increasingly legal drug.

First, be aware that any drug can cause side effects. This includes prescription or over-the-counter (OTC) medications, alcohol, even aspirin. Every body is unique, and reacts differently to different substances. What can cause problems for some people won’t have the same effect in others.

That said, despite many decades of illegal use, little scientific research has been performed on marijuana because until recently federal law has forbidden any scientific studies of the drug. So reports of its effects are largely anecdotal. Many users compare it favorably to alcohol, noting the lack of a hangover after use, the lower potential for addiction, and statistics showing that marijuana rarely results in the violence so often associated with alcohol abuse.

 

What is known, however, is that:

a) today’s marijuana is far more potent that that used by previous generations;

b) the higher THC content can trigger problems not seen in earlier users of the less potent varieties; and,

c) there are more recent reports of adverse effects on younger users, especially teenagers and young adults.

Let’s examine each of these individually.

 

Potency

Due to advanced growing techniques and hybridization, the marijuana available today has a far higher concentration of THC, or tetrahydrocannabinol, than even as recently as the 1980s. (THC is the psychoactive compound that produces the classic marijuana “high.”) Federal officials say the THC potency then averaged around four percent. Today’s levels have been found to be as high as 20-30 percent. In the 1960s it was around two percent.

Some products made from marijuana, often designed to be used with vaping devices—such as some edibles, oils, and substances called shatter, crumble, budder, and crystalline—have an even higher THC concentration, averaging 68 percent and occasionally as high as 95 percent. As the popular expression has it, “This is not your father’s weed.”

 

Side effects

These higher levels can increase the chances of an adverse reaction, either in new users or in those who haven’t used the drug in decades. These side effects can include:

  • anxiety or panic attacks
  • increased heart rate
  • dizziness
  • breathing difficulties
  • impaired memory
  • concentration difficulties

 

Danger to younger users

Other more serious side effects have been reported in younger users, especially in Colorado and Washington, where recreational use was legalized first. Children’s Hospital Colorado in Denver reported 777 cases of cyclic vomiting, paranoia, psychosis, and other acute reactions among their emergency cases in 2015. Heavy use of high-potency marijuana during adolescence up to the age of about 30 has also been associated with creating or worsening such mental health problems as anxiety, depression, psychosis, and suicidal ideation.

This is partly due to the high potency and partly to the incomplete development of the adolescent brain. Most experts consider the brain to reach full development between the ages of about 25 to 30. Until that time, neural pathways are more susceptible to damage from psychoactive substances.

 

Medical marijuana

As noted, medical marijuana (low-THC cannabis or synthetic cannabis) can now be prescribed to legal Florida residents by qualified physicians for certain conditions, including chronic pain, anorexia due to HIV/AIDS or cancer treatment, glaucoma, seizure disorders, terminal illness, and others.

Depending on the type employed, users may or may not experience the “high.” Some medical marijuana has been specially formulated to eliminate the mood-altering effects while still providing relief from symptoms.

However, users may still encounter one or more of the negative side effects listed above. This is why, with marijuana, it is especially important not to self-medicate, but instead allow us to help you find the right symptom relief associated with your condition.

 

While recreational marijuana is still illegal in Florida, we know that some will use it anyway. Just be aware of the potential downsides to this common substance.

New Findings Change Aspirin-a-Day Guidelines

Concierge Medicine, Medications, Preventative Health

Our concierge family practice doctors in Jupiter understand the temptation to pop a pill—whether a prescription medication or a supplement—to stay healthy, instead of following more difficult suggestions regarding exercise and diet.

And to be sure, the long-standing belief that taking a daily low-dose aspirin can prevent heart attacks has some scientific basis for those who’ve already suffered a heart attack. In addition, some earlier research did seem to support daily aspirin use for reducing the risk of numerous cancers as well as Alzheimer’s disease.

Latest findings

But the good thing about science in general and medical research in particular is that researchers are constantly reviewing and refining established knowledge. In the case of the aspirin-a-day approach, for example, several new studies in the last year have challenged the practice of taking a low-dose (81 mg.) aspirin to prevent cardiovascular disease (CVD). And this month the American College of Cardiology (ACC) and the American Heart Association (AHA) released new guidelines recommending against the use of daily low-dose aspirin, based on these studies.

One study published last month in the Journal of the American Medical Association (JAMA), for example, found that people without heart trouble who took a daily dose of aspirin had a lower risk of heart attack, stroke, and death. These benefits, however, were canceled out by the increased risk of bleeding in the intestinal tract or the brain, which can often be deadly.

Researchers in that study performed a meta-analysis of 13 studies that included 164,225 participants, none of whom had CVD when the studies began.

“For every 256 patients treated with aspirin for five years, one heart attack, stroke or death from cardiovascular disease would be prevented,” Dr. Sean Zheng, lead author of the study and and academic clinical fellow in cardiology at King’s College Hospital in London, told CNN. “On the other hand, for every 210 patients treated with an aspirin over the same period, one would have a serious bleeding event.”

“This calls into question the net benefit of taking aspirin, and whether people who have not previously had cardiovascular disease should take aspirin,” Zheng said.

Another study published last fall in the New England Journal of Medicine (NEJM) reported similar results, even finding that older patients experienced no health benefits at all from daily aspirin use. These and other recent studies are what led to this month’s revised recommendations from the AHA/ACC.

“We knew there would be an increased risk of bleeding with aspirin, because there has always been,” recommendations co-author Dr. Anne Murray told NBC News. “But not only did it not decrease risk of disability or death, it did not decrease the risk of heart attack and stroke, and there was an increase in the rate of death.” Murray is also a geriatrician and epidemiologist at the Hennepin Healthcare Research Institute and the University of Minnesota, Minneapolis.

In their statement, the AHA/ACC advised against taking a preventive aspirin a day, saying it may actually cause more harm than good.

“We’re talking about healthy people who don’t have known heart disease or stroke, who might have been considering or [are] already taking an aspirin to prevent that heart attack or stroke in the first place,” said Dr. Erin Michos, another of the authors of the new AHA/ACC guidelines.

The AHA stressed that the new recommendations do not apply to people who have already had a heart attack or stroke, or who have undergone such procedures as receiving a coronary artery stent or bypass surgery. But for the elderly (people over 70) and those with a high risk of internal bleeding, the AHA cautioned that “aspirin may do more harm than good, but there are no absolutes, so these decisions need to be tailored to individuals.”

Another co-author of the revised recommendations suggested that doctors might advise their patients who have a strong family history of heart disease to take a daily aspirin. This could also apply to those whose tests reveal considerable plaque build-up in their arteries. But for those with a low or moderate risk, lifestyle changes could have a more salient effect.

“Eat a heart-healthy diet, get regular physical activity, control blood pressure and control cholesterol,” Michos said. “If [people] need a statin, take it. Those are much more important when compared to recommending aspirin.”

As with so many other over-the-counter remedies, we always recommend you check with us before taking them. Each person is different and their needs and sensitivities are also different. We can help determine the best course for you.

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