Facing Substance Abuse and Addiction Head On: A Three Part Series (3)

Facing Substance Abuse and Addiction Head On: A Three Part Series (3)

Dr. Hernandez has provided a three part series on opioid use disorder, alcohol use disorder, and Kratom use as well as treatment options and first steps to take.

Jul 19th, 2019

Are you or a loved one struggling with abuse and dependence on substances such as opiates or alcohol?
Have you recently experienced a hard time as a result of substance abuse such as the loss of a job or difficulty managing all of your responsibilities?

Drug and alcohol addictions are such prevalent issues and yet, can often be a taboo subject to address. People are often unsympathetic and impatient and clearly don’t understand the struggles involved. Sometimes all we need is someone who understands the complexities of the issue and an open ear to listen, and an offer to help. Dr. Hernandez, a board-certified psychiatrist here at CPCH, has created a three-part series detailing helpful information on the addiction to three common substances often experienced: opiates, alcohol, and Kratom. She has artfully explained critical information regarding the origination and use of these substances as well as information on treatment and medication management for overcoming an addiction to these substances.

The following information is provided by Dr. Hernandez who has significant experience treating mental health and substance abuse issues and knows the path to effective treatment. Have a look for yourself to see the ways that Opioid use can affect your life as well as your friends and family.
Kratom

Mitragyna speciosa, Kratom, is a tropical tree. Its leaves are used in traditional medicine in South Asia and Africa. There, people chew the leaves to reduce fatigue and decrease pain.

kratom leaves are sold as tea, powder, tablets, and liquids.

Kratom has a high potential for abuse due to as two of its main components are alkaloids with psychoactive properties. The main active alkaloids in Kratom are mitragynine and 7-hydroxymitragynine.

In animal studies, addiction was developed after receiving these two alkaloids orally for 5 days.

Mitragynine has activity in the central nervous system where it stimulates opioid receptors, just like morphine. The opioid receptors mediate analgesia, respiratory depression, and euphoria.

Kratom has also stimulant effect and has been used for centuries to decrease fatigue.

The effects of Kratom can range from euphoria and feeling relaxed to severe symptoms such as anxiety, irritability, aggression, hostility, and psychosis.

Case reports in the literature have described hyperpigmentation of the cheeks, tremor, anorexia, weight loss, polyuria, dry mouth, vomiting, jerky movements, hepatic failure, kidney, lung disease, seizure, arrhythmia (potentially fatal ventricular arrhythmia), impaired memory function, coma, and death as a result of Kratom use.

Kratom is metabolized by the liver and it can affect the metabolism and functioning of medications. It can have serious negative interactions with fentanyl, opioids, benzodiazepines as Kratom can potentiate their effects and cause respiratory depression, increasing the risk of overdose.

Many commercially available forms of Kratom have been found to be adulterated with high potency concentrations of 7-hydroxy mitragynine and mitragynine at much higher levels than in the plant.

Kratom withdrawal symptoms are almost identical to the signs and symptoms of opioid withdrawal. The severity of the withdrawal makes very difficult for kratom user to stop it or reduce its use.

The U.S. Food and Drug Administration has warned the public not to use any products labeled as containing the botanical substance kratom or its psychoactive compounds, mitragynine, and 7-hydroxy mitragynine.

Krypton is another commercially available form of kratom which contains another opioid receptor stimulator, O-desmethyl tramadol. O-Desmethyltramadol is an active metabolite of tramadol, a commonly prescribed analgesic.

The Food and Drug Administration reported multiple deaths associated to kratom use. There are multiple case reports in the literature describing fatalities associated with kratom and krypton use.

In addition, herbal supplements are not regulated by the FDA. In a recent analysis performed by the FDA on commercially available forms of kratom, high levels of nickel and lead were found. Long term exposure to these substances can cause heavy metal poisoning.

Based on the evidence available the use of Kratom is unsafe. It has a high risk of toxicity, abuse, and physical dependence.

Have you been considering treatment but don’t know where to begin? Visit our blog at https://dev.cognitive-psychiatry.com/blog for more information regarding these substances and the most specific and effective treatment methods for each substance. Give us a call at 919-636-5240 to set up an appointment. Let us help you get better, faster.

*Thanks for viewing our content on the use and abuse of Kratom! Did you catch our previous articles on Alcohol use disorder and Opioid use disorder as well? View those articles here and here.

Fluyau D1, Revadigar N2. Biochemical Benefits, Diagnosis, and Clinical Risks Evaluation of Kratom. Front Psychiatry. 2017 Apr 24;8:62. doi: 10.3389/fpsyt.2017.00062. eCollection 2017.

Meireles V1, Rosado T2. Mitragyna speciosa: Clinical, Toxicological Aspects and Analysis in Biological and Non-Biological Samples.Medicines (Basel). 2019 Mar 4;6(1). pii: E35. doi: 10.3390/medicines6010035.

1, Bolzon C1, Foster P. Kratom: a dangerous player in the opioid crisis. J Community Hosp Intern Med Perspect. 2018 Jun 12;8(3):107-110. doi: 10.1080/20009666.2018.1468693. eCollection 2018.

Lydecker AG1, Sharma A2.Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine.

Dr Andrea Hernandez-Gonzalez
Andrea Hernandez, MD, is a board-certified psychiatrist at Cognitive Psychiatry of Chapel Hill, North Carolina. Fluent in both English and Spanish, Dr. Hernandez treats adult patients with mental health and substance abuse disorders.

On February 27rd, our current electronic health system will transition to a new and advanced system to better serve you: Athena. Prior to the transition date, you will be sent a registration link to create a new patient account in Athena. If you have any immediate questions or concerns, please do not hesitate to contact your therapist, or call our office to speak to a staff member. 

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