Kratom Abuse: Overcoming Opioid Effects

Recently, I have received a number of calls from prospective patients who have become addicted to Kratom. Kratom is a complex drug containing more than 40 chemicals extracted from an evergreen tree in Southeast Asia known as Mitragyna Speciosa. After reading about its wonder-drug effects, it is easy to see how someone might give it a try – and then get into some serious trouble.

In low doses, Kratom acts as a stimulant. In higher doses, the opioid effects become predominant and soon there is physical dependence. Someone who uses Kratom regularly and stops will experience an opioid withdrawal syndrome including irritability, nausea, high blood pressure and insomnia. At least one death has been attributed to Kratom as well as hundreds of ER visits nationwide.

In my view, the big problem here is not simply the drug itself, but the way it is perceived. Unlike heroin, which almost everyone you ask (including addicts) will tell you is dangerous and bad, Kratom has enjoyed a more benign reputation. Moreover, as the stimulant effects predominate in low doses, a new user doesn’t feel the opioid effects present when one takes more of the drug and tolerance develops. Once that realization occurs, it is too late. The Kratom user is “hooked”.

Unfortunately, many members of the medical community have not yet appreciated the significance or popularity of this drug and have not educated themselves about it. Many treatment programs do not offer treatment for Kratom addiction leaving someone physically dependent on the drug to self-detox – a potentially dangerous and very uncomfortable experience.
Over the past year I have detoxed several patients from Kratom using a combination of drugs including low-dose Suboxone. These detoxes have been free of complications and the patients have remained relatively comfortable. Moreover, with appropriate after-care opiate cravings can be controlled and the patient can feel normal once again.

If you or a loved one finds themselves addicted to Kratom give me a call as it is likely I can help.

Overcoming Addiction And Rebuilding Your Life – You Can Do This

Sheila (not her real name) is one of my patients.  With her permission I am sharing her story because I bet it resonates.

Sheila is now a happy and healthy mom and wife with a satisfying and lucrative career who has rediscovered her interest in art and is quite the social butterfly. She hasn’t had a drink or used drugs in many years and has helped others get into treatment and maintain sobriety.  Although she always acknowledges her past she knows that she has risen above it.  She realizes that each day of healthy living is a gift and she appreciates that more than ever – having spent years in a cycle of drug use and depression for much of her early adult life.

Sheila grew up in the suburbs, the middle daughter of upper class parents.  Her early childhood was pretty idyllic – with lots of opportunity to pursue art, which was her passion. At age 13, just as she entered puberty Sheila was visiting cousins and was sexually abused by her uncle.  That’s when everything changed.

Already feeling awkward about her body (teenage Sheila was attractive, but shy), she soon developed an eating disorder and began to isolate herself.  She no longer found joy in life and lost contact with many of her friends.  A trip to grandma’s medicine cabinet for some Percocet started a downward spiral that stopped 5 years later when, after a near overdose, her mom convinced her to see me.

Sheila was terribly afraid of experiencing withdrawal symptoms so we decided to do an extended opiate detox – one that would last a full 3 weeks rather than the more standard 1 week protocol practiced at most detox facilities.

24 hours after her last use of prescription opiates Sheila took her first dose of Suboxone. We completed the induction phase of treatment over a 4 hour period and she was so comfortable she did not need most of the other medications I prescribed for symptom control (including Clonidine for withdrawal symptoms and Zofran for nausea). Over the next 3 weeks I gradually lowered her dose and she remained comfortable for the whole process.

Although Sheila completed detox with no complications she did have some symptoms of depression for the next few months. I used a combination of anti-depressant medications to treat her symptoms and her mood returned to normal. A year later, she was medication free and symptom free – leading a happy and sober life and rediscovering her artistic interests

Like so many other stories, this one had a happy ending.  Sure there were bumps along the way but Sheila found love in others when she once again began to love herself.

The Stages Of Change

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This model of addictive behavior is illustrative because it predicts what types of intervention may be useful when approaching an addicted person. Pick the right one and the patient may be open to your suggestions. Pick the wrong one (based on an incorrect assessment of an individual’s readiness for change) and you will alienate them further.

The five stages are…

Precontemplation – also known as denial. People in this stage are not thinking seriously about change and are unlikely to be open to help. They will defend their current behaviors and often become agitated if you challenge their opinions with regard to drug use. The best approach here is often watchful waiting (as painful as that may be), looking for an opportunity that will move the addict to the next stage. This may happen organically (a close friend or family member may die of addiction) causing a period of lucid reflection or they may be forced to acknowledge the problem if they lose a job as a result of drug use or are arrested for a DUI.

Contemplation  – this stage provides the golden opportunity for an intervention. The addict has become aware of the personal consequences of his/her addiction and is willing to at least consider a change of behavior. In this change stage, the individual is weighing the benefits and drawbacks of treating his/her drug or alcohol dependence.

Although one may be tempted to “rush in” when an opening appears, it is important to listen to the addict express his/her ambivalence. Often, we can tip the scales towards treatment during this phase by addressing the addict’s specific concerns and misperceptions. The addict may say “If I detox than I have to go into a hospital for a month and I can’t afford to miss work for that long” to which I might reply “Actually we can detox you at home and you can be back at work within a week”.

Preparation – This is an overlooked but very important stage. The more one prepares for detox and recovery, the better the outcome. Preparation includes both psychological preparation as well as more mundane logistical considerations.

During this phase, the addict should seek support from people they trust and tell them about the changes they are going to make, with the help of a support team that will include a physician, a recovery coach as well as other friends or family members if possible.

Also at this time, the addicted individual who is planning to detox at home will likely have to make some preparations regarding work and childcare. Generally, a one week absence from work is optimal. In addition, although having children around during the process can be motivating, the addict should not be the primary caregiver during this time.

Action – All the other stages lead to this one – when the patient is actually being detoxed and withdrawal symptoms are being controlled with a variety of medications. Although the first day or two of treatment focuses on medical detox, patients are generally comfortable enough to begin the process of recovery with the help of a Recovery Coach who will provide much of the initial support as the addict re-acclimates to a sober lifestyle

Maintenance – This is the most overlooked stage of recovery. Although detox is certainly a triumph, once accomplished the next goal is to achieve a sustained recovery. Support systems during this phase are completely individualized and may require a Recovery Coach (for those who find do not find AA or NA to be suitable) and regular physician visits (especially if the patient is receiving ongoing treatment for mental health conditions such as depression or anxiety).

The Neurobiology of Addiction

Our goal at ‘Detox At Home NY’ is to give you the promise of a new life – one free of drugs and full of a sense of well-being. What we do is to help you embark on the Road Of Recovery, a lifelong journey that will allow you to once again experience REAL joy – not a chemically induced euphoria.

So what happens inside the brain with drug use? Put simply, the drugs of abuse hijack systems already in place to regulate emotion. Dopamine, for example, is the “feel good” chemical. Our brains make dopamine and set up a reward system to encourage behaviors that are advantageous for the continuation of the species. Such behaviors include drinking water, eating food and engaging in sexual activity.

Hypothetically speaking, drinking water may release 1 unit of dopamine, eating may release 2 units and sex may release 4 units. The release of that dopamine results in a feeling of pleasure. Oxycodone and heroin hijack this system. Where sex might release 4 units of dopamine, oxycodone or heroin will release 40 units, resulting in a powerful but temporary euphoria.

With this understanding it is easy to see how drugs can take over one’s life. What interest does one have in normal activities if a pill can provide a euphoria that is 10 times as intense as the pleasure experienced from sex. Over time, the addict loses interest in food, drink, sex and just about anything else that once brought pleasure. The “new normal” becomes a drug or alcohol induced euphoria and nothing else can compare.

Of course, once he/she realizes this, he/she is caught in a vicious cycle – having to use drugs or drink alcohol simply to avoid withdrawal symptoms and severe depression. Over time, the risk of overdose becomes greater and the mortality rate climbs. This year in the U.S. we have lost more young people to addiction than to any other cause.

At ‘Detox At Home NY’ we are reaching out a helping hand to addicted individuals, to their families and their friends. The lucky ones find their way into treatment, either by realizing how much they need it in that lucid moment of insight, or through the interventions of those who love them.