The Mystery of Kratom in Nashville: It acts like an Opioid, but it is Not

H1:The Mystery of Kratom in Nashville: It acts like an Opioid, but it is Not

am. Dr. William Conway, MD, FACP, FASAM. I treat Kratom addiction in my addiction medicine practice in Nashville, Tennessee.

The majority of my patients on buprenorphine or suboxone maintenance treatment took years to understand how they ended up on suboxone. Understanding the history of opioids in the United States is complicated. It has long been understood that opioids relieve pain. Imagine a major injury to a Civil War soldier requiring surgery. There was no anesthesia. The only pain relief for amputations was alcohol and opium. With a life-threatening injury, addiction was not a consideration in treatment. After the Civil War, opium was freely available in cough medicine and elixirs. It was not until 1915 that the Harrison Act was passed, which prohibited a physician from giving opioids to a patient with Opioid Addiction.  After the passage of the Harrison Act, physicians stopped prescribing opioids.

In the 1990s,times had changed. It was widely believed that opioids for pain relief were safe. The era of OxyContin began. Pain became the fifth vital sign. Opioids were widely and easily prescribed. Many of my patients had the onset of their disease from prescriptions prescribed by their physician.

In 2015, the era of easy opioid prescribing was over. Pain clinics were closed. Rules were passed for suboxone. From 1860 until the present, we have gone through multiple eras of “easy opioids” alternating with eras of tightly regulated opioids. With such historical complexity, it is not surprising that patients are easily confused.

Addiction as a disease is unique. It begins in pleasure experienced after the first ingestion. The first ingestion can lead to cravings for the substance. Over time, the patient continues to take the substance, not really aware that discontinuing the substance will produce suffering. Society’s rules change over time for virtually every substance.

H2:   What is an Opioid in Plain English?

An opioid is a drug that activates the mu receptor, or the opioid receptor, in the brain. Activation of the Mu receptor produces pleasure and pain relief.

Opioids as drugs are a gift of God, relieving pain. Anesthesia without opioids would be painful. Anesthesia with opioids makes surgery painless. Modern medical care depends upon being pain-free. Modern medical care depends on opioids.

The dark side of opioids is that, given consistently over time, they change the fundamental structure of the pleasure centers of the brain. Over time, a greater dose is required to achieve the same amount of pain relief or pleasure. Over time, the brain adapts to a constant, consistent supply of opioids. When the brain does not receive the expected dose at the expected time, the brain reacts by going into a total body reaction similar to “bad flu.” This is labeled withdrawal.

In summary, an opioid is a drug that

• Reduces Pain or Produces Pleasure
• Requires an increasing amount to produce the same pain relief
• Produces suffering when the drug is discontinued or the dose is reduced
• Acts at a brain center called the Mu Receptor

An opioid is a substance or drug that binds to opioid receptors. An opioid relieves pain and produces sedation and euphoria.

H2:  What does Kratom do to the Brain?

Kratom is a plant-based substance that binds to opioid receptors. It can also relieve pain and produce euphoria. Kratom produces the same relief of pain or production of pleasure that other opioids do. When Kratom is given consistently, the brain adapts, requiring constant, predictable Kratom for a sense of well-being

H2:  Why Kratom Feels Like an Opioid to Patients?

Kratom mimics the relief of pain and production of pleasure, which is similar to OxyContin. Patient accidently learn that Kratom has the same effect upon them as hydrocodone

Kratom begins with pleasure. Kratom is easy to get. Kraton is easy to take more of. Kratom seems harmless upon beginning. For a patient already with an opioid addiction from fentanyl or hydrocodone, it is so easy to buy Kratom at the gas station.

H2:  Why is Kratom not Classified as an Opioid?

Because Kratom is derived from plants with additional effects, it has not been classified as an opioid. The regulation of substances is complicated, done carefully with great rule making. To date, Kratom has not been regulated as a controlled substance.

H2:  Why This Distinction Matters for  Real Patients?

Patients often underestimate the risks of Kratom when it is not labeled as a controlled substance,

Patients buy Kratom at drug stores at their pleasure. Patients buy controlled substances at pharmacies after a prescription from a physician. It is reasonable to think that anything you buy at a gas station for ingestion is safe.

H2: Be Careful, Even if it is Sold at a Gas Station

Be careful. Kratom is widely available at gas stations, but it remains a pharmacologically active substance with a real risk of dependence and withdrawal. Caveat Emptor. Let the buyer beware.

For virtually all of my patients on Suboxone, their opioid addiction developed gradually, beneath their awareness and consciousness. In general, only after painful withdrawal, the patients then discover that they have a disease which produces craving, controls them, and produces ill effects not expected.

So, be careful about buying Kratom at the gas station

Conclusion

In my Nashville practice, I have patients who have developed Kraton addiction and withdrawal without realizing the risk. I am  Dr. William Conway, MD, FACP, FASAM, in Nashville. I treat Kratom Addiction.

I explain Kratom to them in the context of their entire life. We work on recovery together.   

📞Call 615-708-0390 to begin Kratom Addiction Treatment in Nashville