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Local health officials warn about natural drug

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MARTINSVILLE-It's marketed as a stimulant and pain reliever. In some places, it's also being used to help opioid addicts handle withdrawal symptoms. But now, health officials caution that people need to be careful about how they use kratom.

The U.S Federal Drug Administration recently issued a public health advisory about kratom, which is found naturally in Thailand, Malaysia, Indonesia and Papua New Guinea. It has gained popularity in the U.S. with some marketers touting it as a 'safe' treatment with broad healing properties.

"The FDA knows people are using kratom to treat conditions like pain, anxiety and depression, which are serious medical conditions that require proper diagnosis and oversight from a licensed health care provider,” the administration said in a statement. “We also know that this substance is being actively marketed and distributed for these purposes."

"Importantly, evidence shows that kratom has similar effects to narcotics like opioids, and carries similar risks of abuse, addiction and in some cases death," the advisory said, adding, "Kratom is also banned in several states, specifically Alabama, Arkansas, Indiana, Tennessee and Wisconsin and several others have pending legislation to ban it."

Kratom is not banned in Virginia, but West Piedmont Health District Director Dr. Jody Hershey says it's important to educate the public about the adverse effects the plant can have.

Hershey said undesirable effects of kratom include edginess, nervousness, vomiting (can be severe and prolonged), nausea (can be severe and prolonged), sweating, itching, constipation, delusions, lethargy, respiratory depression, tremors, aggressive or combative behavior, psychotic episodes, hallucinations and paranoia.

"Since the drug is also addictive, one of the effects can include compulsive use of the drug despite the harm that is being done to one's mental state or life," Hershey said.

Withdrawal effects of kratom are similar to those of opiates such as heroin or prescription painkillers and include: diarrhea, muscle pain, muscle tremors and jerking, restlessness and sleeplessness, severe depression, crying, episodes of panic, sudden swings of mood, and irritability, Hershey said.

He added that kratom leaves have been used for many years in Southeast Asia to relieve pain, as an anti-diarrheal medicine and as a recreational drug. The drug only began to be seen in the United States in 2012, but it is easy to obtain online, and many smoke shops, "head shops," convenience stores and gas stations sell this drug, Hershey said,

How it's used

Most users ingest kratom. Its effects come on rather quickly and can last five to seven hours, although high doses can last longer. Kratom is abused for its sedative or stimulating effects. At low dosages, kratom is a stimulant, making one more talkative, sociable and energetic, but at higher dosages, it creates lethargy and euphoria, Hershey said.

"Kratom is heavily promoted as a legal, undetectable, safe drug that can be used to come off stronger drugs,” Hershey said. “It is not yet illegal in the US (however, it is banned in some states), but the breakdown products of kratom can be detected with some drug tests. Because of its legality, the drug tends to be more popular among young people who cannot yet buy alcohol and who may be concerned about being arrested with weed (marijuana) or other drugs."

Hershey said: "Although thousands of people have taken kratom to relieve pain, we just do not know enough about the herb to deem it safe or effective. We do know that kratom has very mild pain-relieving effects and a slight stimulant effect. It brings a low risk of stopping breathing, the main risk of stronger opioids."

He added: "The opioid effects from kratom come from two potent chemicals, mitragynine and 7-hydroxymitragynine in kratom's leaf. Mitragynine is the more prominent and has very mild opioid effects, while 7-hydroxymitragynine is 13 times more potent than morphine milligram for milligram."

Hershey said kratom is thought to not to be as dangerous as heroin and fentanyl, but that doesn't mean it's safe and free of adverse effects. 

"In addition, unlike prescription drugs, the quantities of the active ingredients in unregulated kratom products can change over time or be laced with other products," Hershey said.

He noted that at this point in the United States, kratom has sent some people to emergency rooms and there have been calls to poison control centers in this country. According to the U.S. Centers for Disease Control, about 42 percent of the cases of kratom use reported between 2010 and 2015 involved non-life -threatening symptoms that required some treatment.

About 7 percent of exposures were classified as major and life-threatening, Hershey said, adding that the Drug Enforcement Administration says it knows of 15 kratom-related deaths between 2014 and 2016.

Hershey said: "Kratom has been on the DEA's list of drugs and chemicals of concern for several years. But the DEA notes that its use appears to be going up. Law enforcement agencies across the country seized more kratom in the first half of 2016 than ever before. U.S. poison control centers received 263 calls about kratom in 2015, a tenfold increase from 2010, the CDC says."

Hershey, Martinsville Police Chief Eddie Cassady, Martinsville Commonwealth's Attorney Clay Gravely, Capt. D.W. Davis of the Henry County Sheriff's Office, Henry County Commonwealth's Attorney Andrew Nester and Patrick County Sheriff Dan Smith all said they were not aware of any kratom cases in this area.

Hershey said: "We certainly don't want to see this drug become more popular, resulting in more adverse effects and deaths. It might me helpful to have more controlled, scientific research on kratom, especially given or opioid epidemic. Perhaps some of the chemicals in kratom could be used to develop better drugs for pain treatment. However, until those studies are done and kratom is approved by the FDA for medical use, its use is dangerous."

He added: "Despite the internet hype and extensive anecdotal experience, I do not think there are any high-quality studies assessing how well it actually works and the best ways to use it. Kratom has high addiction potential and is risky when combined with other psychiatric drugs or drugs of abuse. Having kratom available to purchase in nearly unlimited quantities in venues that do not restrict purchase by age is a very bad idea."

Paul Collins reports for the Martinsville Bulletin. He can be reached at paul.collins@martinsvillebulletin.com

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