Kratom, Pain Management, and Lupus

Some Lupus Warriors use kratom, an herbal supplement, to relieve pain, anxiety, and get through the day. However, the risks may not outweigh the benefits.

Kratom (Mytragyna speciose) is a plant native to Thailand, Malaysia, Indonesia, and Paupua New Guinea. The “leaves contain compounds that can have psychotropic (mind-altering) effects.“

Kratom is both a cooking ingredient and a part of traditional medicine. Potential health benefits include:

• anti-diharrheal
• pain reliever
• mitigator of opioid addiction

Kratom is a thick green leaf with red or white veins. These veins are typically removed before use, though they can be used as an indicator of potency. It can be chewed fresh, but is usually dried, ground, and prepared with warm water into a tea.

Kratom does have pain relief and – potentially – some mood-boosting effects (in part due to its effects on the opioid receptors). Some people use it as a substitute for prescription opioid painkillers.

Many people with chronic illnesses, including people with lupus, swear by kratom tea and claim that it has life-changing effects. However, because it is an opioid, it can lead to opioid craving, addiction, and withdrawal. It is also known to cause or exacerbate brain symptoms of lupus such as delusions and brain fog, encourage alcohol use, and lead to convulsions.

Benefits of Kratom – What Does it Do?

When it comes to clinical research, the jury is still out on the benefits of kratom.

People taking it claim it can:

• reduce pain
• suppress appetite
• provide resistance against panic attacks
• prevent diarrhea
• offset opiate withdrawal

Kratom acts like an opioid. The active alkaloid (plant chemical) in kratom is called mitragynine and it activates opioid receptors in the brain. Opioid receptors control many major biological functions including digestion and pain experience.

• At lower doses, kratom can act as a stimulant:
  • boosting mood
  • increasing energy
  • granting feelings of alertness.
• At higher doses, kratom is a sedative, causing:
  • drowsiness
  • a relaxed state
  • reducing pain

Dose can, however, be difficult to control, due to differences in quality from plant to plant, strain to strain, and method of consumption. The dose will control how long the effects last (2-5 hours depending on quantity ingested). However, kratom will generally take effect within 5-10 minutes.

The Herbal Supplement Myth

Kratom is an herbal supplement available in the United States. Herbal supplements are often considered  “healthy,” “natural,” and “safe” because they are minimally processed. However, this is often not the case. Manufactured medicines are consistently produced to meet particular chemical definitions. But, they have the stigma of lab production and being “artificial.”

Herbal supplements do have effects on the body depending on their dose. However, because there are few product requirements, the amount of the chemicals that cause those effects can vary greatly. The plants also have several active chemicals at once, which can include antioxidants, essential oils, and other alkaloids. These chemicals can interact with each other, produce conflicting effects in the body, or even trigger allergies. It can be difficult to predict how each person, with their unique bodies and healthcare needs, will react to herbal supplements.

Further unpredictability in herbal supplements comes from the plant’s growth. Many things can impact plant growth including:

• The particular strain (variety) of plant
• the environmental conditions during growth
  • weather
  • soil type
  • region
• the time of year during harvest
• the skill of the grower
• pure random chance

This variation can make dosage difficult. It creates a risk of accidental overdose or mis-dosing, particularly for kratom.

Kratom extracts can help equalize the dose, but it is less common to find and consume it in this form. Dried leaves are the typical form that a Lupus Warrior might be able to find.

Side Effects and Dangers of Kratom

Through 2011-2017, kratom may have caused approximately 1,800 calls to the poison control center in the United States. High blood pressure, seizures, and even death were usually the reason for the calls, and kratom use is linked to many other side effects.

Kratom use can cause:

• Liver damage
• Kidney damage (and urine changes)
• Muscle pains and cramps
• Weight Loss
• Dry Mouth
• Chills, nausea, and vomiting (common symptoms of opiate withdrawal)
• Dizziness
• Drowsiness
• Hallucinations
• Delusions
• Depression and Anxiety
• Seizures 
• Breathing difficulty

And, during an overdose, coma and death. Kratom shares many of these side effects with opiate use and withdrawal from opiate addiction. Likely pointing to its activation of the opioid receptors in the brain as the cause. Tapering and withdrawal treatments for opioid addiction – such as the medications naloxone (Narcan) and Buprenorphine (buprenex) can help with the cravings and the side effects of kratom.

It can also react unpredictably with other medications or other supplements.

Kratom and Salmonella

In 2018, the FDA investigated salmonella outbreaks related to kratom that affected more than 130 people in 38 states. Contaminants existed in many kratom-containing supplements available in the market. The plant itself gets contaminated, similar to spinach and lettuce, and the suppliers may have been using similar sources.

Salmonella is a bacterium that causes severe and sometimes deadly infections when consumed, and can pass from contaminated products to other surfaces that they touch. Salmonella can survive on the outside and inside of plants that come into contact with the feces of infected animals (as fertilizer) or contaminated water (as irrigation.) They might also end up sprayed onto the plants through nozzles that deliver pesticides to the plants. When consumed, the bacteria in and on the plant can infect a new host, including a human.

The symptoms of salmonella infection include diarrhea, fever, abdominal cramps. Typically, people recover without treatment after 4-7 days. But it can also be severe and require hospitalization – especially in immune system compromised individuals. It can even kill. People with lupus should try to avoid putting themselves at risk for salmonella.

Because salmonella survives on the inside and outside of the plant, even thorough washing does not lessen the risks. Cooking the plant reduces the risks somewhat, but the disease can be deadly, making it best to avoid potentially contaminated foods. Plants have no external signs of salmonella contamination.

Should People with Lupus Take Kratom?

Kratom is not FDA approved and the agency restricted its use and sale in 2018. However, it is legal in the U.S. overall. Some states have banned it while others may restrict it. There is a debate going about rating it a “schedule 1” drug, at the same level as heroin, marijuana, LSD, and ecstasy:

“Schedule I drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse.”

 The FDA considers kratom to have “no approved therapeutic uses” as of 2018, and the general consensus is that the risks outweigh the benefits and that it will not pass FDA approval.

Although people with lupus are not recommended to try kratom, if you choose to try it out, be careful with where you buy it or who you source it from. Make sure that you use a well-regarded supplier. Due to the nature of the herb, growth practices vary and may use different levels of chemicals and result in various levels of quality. Online reviews can help you find a suitable source if you choose to go this route. 

Do not try kratom if it is banned in your state or country. Do not take kratom with other substances or medications – the effects can be unpredictable. And always speak about new additions to your health plan with your lupus treatment team.