Kratom, a legal, unregulated, opiate-like herbal supplement, is gaining popularity in recent years, especially among youth. While the plant is native to Asia, use has become more common in the United States to reduce opioid withdrawal symptoms (Veltri & Grundmann, 2019) and as a psychoactive recreational drug (McCance-Katz, 2019). Traditional screening panels do not test for the substance, rather, a special liquid chromatography or tandem mass spectrometry test is required (Eldridge, 2019). Because it is unregulated, Kratom can be purchased from smoke shops, gas stations, and online.

Kratom’s effect is unique, acting as either a stimulant or depressant, based on the dosage. In small amounts, Kratom can increase focus, physical energy, and talkativeness (Drug Enforcement Agency, 2022). In high doses, kratom creates sedative-like effects, similar to those of opiates (McCance-Katz, 2019). When consumed in very high quantities, kratom can cause hallucinations, delusions, and confusion (Drug Enforcement Agency, 2022). At any dose, the supplement can cause nausea, sweating, itching, frequent urination, and constipation (Drug Enforcement Agency, 2022).

The risk of addiction is high, as withdrawal symptoms are very commonly reported among regular users (Singh, et al, 2014). Physical symptoms include hot flashes, pain, difficulty sleeping, and decreased appetite (Singh, et al, 2014). Mental and emotional symptoms include restlessness, anger, sadness, and anxiety (Singh, et al, 2024).

The supplement is also common among polysubstance abusers, and death can result when Kratom is combined with other narcotics. While it is infrequently listed on death certificates as the sole cause, it is sometimes listed in tandem with other substances. According to the CDC, Kratom is most identified as causing death with fentanyl, heroin, and benzodiazepines (Olsen, et al, 2019).

Kratom also poses a significant risk to children. Because of a lack of research into the effects of the supplement, a few expectant mothers have turned to Kratom to curb opioid cravings during pregnancy. Exposed infants are reported to have experienced withdrawal symptoms such as jitteriness, sneezing, excessive suck, and irritability (Eldridge, et al, 2018). Though there have been few cases, it seems that children who are diagnosed with neonatal abstinence syndrome (NAS) because of kratom are able to withdraw through medication assisted treatment within a few days (Eldridge, et al, 2018).

Additionally, the number of teenagers smoking Kratom leaves or mixing the substance into drinks has increased (McCance-Katz, 2019). It is reported that youth are smoking Kratom leaves or mixing the substance into drinks. Further, research finds a correlation between the use of kratom and other substances among teens (Sharma, et al, 2022). Youth who smoke cigarettes or marijuana are about 2.5 times more likely to report kratom use than their nonsmoking counterparts (Sharma, et al, 2022). With Kratom usage on the rise in the United States, there is an increased concern among professionals that youth will continue to be more and more affected by both maternal and individual use.

There are reports of Kratom poisonings, too. Annual calls to poison control regarding Kratom concerns increased by 195 calls from 2016 to 2017 (Post, et al, 2019). Additionally, there is evidence that long-term use has a negative impact on the body, including damage to the thyroid, liver, and lungs (Alsaffar, et al, 2019).

Concern for Kratom usage in the United States is rising. However, it is not yet regulated. Congress is hesitant to place it on a schedule and most states do not want to ban it completely. Instead, many states are researching how they might go about allowing for safe use. In Ohio, HB 236, which seeks to regulate Kratom, has gained bipartisan support. The bill will require the Department of Agriculture to develop a program to regulate Kratom production and distribution (Chandler & Tucker, 2023). A license would be required to process Kratom, but not to possess, use, or sell it (Chandler & Tucker, 2023). The bill is presently in committee in the state senate, and it appears it may pass. Lawmakers believe that ensuring the safe production of the supplement will be much more beneficial to the community than banning it in its entirety (Chandler & Tucker, 2023).

To share information about Kratom, please feel free to use our infographic!

References

Alsarraf, E., Myers, J., Culbreth, S., & Fanikos, J. (2019). Kratom from head to toe—case reviews of adverse events and toxicities. Current Emergency and Hospital Medicine Reports, 7, 141-168.

Drug Enforcement Agency. (2022, November 7). Kratom. Get Smart About Drugs. https://www.getsmartaboutdrugs.gov/drugs/kratom

Tucker, M., & Chandler, K. (2022, March 14). Ohio House of Representatives Passes Bill Regulating the Processing and Sale of Kratom Products. Benesch, Friedlander, Coplan & Aronoff LLP. https://www.beneschlaw.com/resources/ohio-house-of-representatives-passes-bill-regulating-the-processing-and-sale-of-kratom-products.html

Eldridge, W. B. (2019). Kratom: An Opioid-like Herbal Supplement Pediatricians Should Know About. Journal of Pediatrics and Pediatric Medicine. https://doi.org/10.29245/2578-2940/2019/1.1142

Eldridge, W. B., Foster, C. D., & Wyble, L. (2018). Neonatal Abstinence Syndrome Due to Maternal Kratom Use. Pediatrics, 142(6). https://doi.org/10.1542/peds.2018-1839

McCance-Katz, E. (2019). Urgent and emerging issues in prevention: Marijuana, kratom, e-cigarettes [PowerPoint]. Substance Abuse and Mental Health Administration. https://www.samhsa.gov/sites/default/files/samhsas_15th_annual_prevention_day_afternoon_plenary_recording.pdf.

Olsen, E. O., O’Donnell, J. S., Mattson, C. L., Schier, J. G., & Wilson, N. O. (2019). Notes from the Field: Unintentional Drug Overdose Deaths with Kratom Detected — 27 States, July 2016–December 2017. Morbidity and Mortality Weekly Report, 68(14), 326–327. https://doi.org/10.15585/mmwr.mm6814a2

Post, S., Spiller, H. A., Chounthirath, T., & Smith, G. A. (2019). Kratom exposures reported to United States poison control centers: 2011–2017. Clinical toxicology, 57(10), 847-854.

Sharma, V., Cottler, L. B., Bares, C. B., & Lopez-Quintero, C. (2022). Kratom use among US adolescents: Analyses of the 2019 National Survey on Drug Use and Health. Journal of Adolescent Health, 70(4), 677-681.

Singh, D., Müller, C. P., & Vicknasingam, B. K. (2014). Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug and alcohol dependence, 139, 132-137.

Veltri, C. A., & Grundmann, O. (2019). Current perspectives on the impact of Kratom use. Substance Abuse and Rehabilitation, Volume 10, 23–31. https://doi.org/10.2147/sar.s164261

In the last blog post, we addressed recent demographic changes in the nation’s drug epidemic related to overdoses, highlighting that more African Americans have been dying from the opioid pandemic than ever before. However, we are not only seeing changes in who uses, but also in what is being used. Over the last couple of years, methamphetamine is seeing a huge comeback, especially in Ohio. While meth only accounted for about 3% of overdoses in Ohio only 6 years ago, this number is now up to 25% in 2021. In 2015, there were 96 fatal methamphetamine related overdoses.

By 2020, this number grew more than tenfold to 1060. Why are so many people dying as a result of meth use even though this drug is not usually known to lead to overdoses? That is because meth, just like other substances, is increasingly being laced with the synthetic opioid fentanyl.

When we asked our OhioSTART community partners who serve individuals in the child welfare system about their experiences regarding the return of methamphetamines, their reports were consistent with the quantitative data. A behavioral health supervisor stressed the danger of meth use saying that “with fentanyl being added to meth, meth becomes more dangerous as there is now a greater risk for overdose due to the addition of fentanyl.” One peer recovery supporter explained that “meth is so easily accessible and has lower fatality rates and, quite frankly, is easier to make, and is cheaper.”  She further added that “the side effects allow you to be more alert as opposed to other drugs that make you nod out or become unconscious, so it’s no wonder there’s been a surge.”

This has important policy and practice implications. For example, harm reduction approaches like fentanyl test strips or naloxone kits should receive more attention in areas that have seen a rise in methamphetamine use to prevent accidental overdoses.

Sources:

https://www.harmreductionohio.org/meth-overdose-deaths-soar-in-ohio-and-not-much-is-being-done-about-it/

Over the years, the opioid epidemic in this country has often been described as an issue that  mostly affects White and rural populations.

New evidence suggests that this is no longer an accurate depiction. A recent report by the Substance Abuse and Mental Health Services Administration (SAMHSA) provides data showing that opioid overdose deaths are skyrocketing among one specific population: non-Hispanic Black Americans.

The numbers mentioned in the report are alarming and they show that the characteristic of the epidemic is rapidly shifting. Between 2014 and 2017, fatal opioid overdoses among Black Americans that involved any opioid increased by 230%, and overdose deaths caused by synthetic opioids increased by 818%. This increase was highest for Black Americans compared to any other race/ethnic group. The report also lists adjusted opioid overdose death rates for the five US states that are affected the most, comparing rates of non-Hispanic Black Americans with the overall rate, painting a similar picture of the situation. One of the main reasons provided for this development is that other substances, such as cocaine, are increasingly being laced with the synthetic drug fentanyl.

A similar trend is emerging in Ohio. A study by Larochelle and colleagues that was published earlier this month revealed that between 2018 and 2019, the overdose death rate in Ohio for non-Hispanic Whites slightly increased from 42.0 to 45.2 per 100,000, while the rate for non-Hispanic Blacks jumped from 35.5 to 51.6 per 100,000. The SAMHSA brief leaves no doubt when it states that “regardless of how the data are represented, it is clear that Black/African Americans across the U.S. are substantially affected by the opioid crisis.”

The face of the epidemic is changing. Consequently, prevention and intervention efforts need to be adjusted to respond to this cultural shift of the epidemic.

References:

Larochelle, M. R., Slavova, S., Root, E. D., Feaster, D. J., Ward, P. J., Selk, S. C., … & Samet, J. H. (2021). Disparities in Opioid Overdose Death Trends by Race/Ethnicity, 2018–2019, From the HEALing Communities Study. American Journal of Public Health, 111(10), 1851-1854.

Substance Abuse and Mental Health Services Administration: The Opioid Crisis and the Black/African American Population: An Urgent Issue. Publication No. PEP20-05-02-001. Office of Behavioral Health Equity. Substance Abuse and Mental Health Services Administration, 2020.

Undoubtedly, substance use is an accepted behavior in today’s society. Data from a large national survey reveal that around 60% of Americans aged 12 or older used some form of substance within the last month. The most commonly consumed drugs are alcohol and tobacco followed by marijuana and prescription pain relievers. Substance use is part of mainstream society. This is the most evident for alcohol, for example the beer at a football game or the glass of wine with dinner.

Most Americans are able to consume substances without having to face any negative consequences associated with the use. Behaviors related to the consumption of alcohol and other substances are not a black or white issue but instead fall on a spectrum or continuum. Some individuals do not use at all, some consume very little, and others use regularly. So how do we know if someone’s substance use behaviors have become problematic?

Professionals such as physicians, social workers, or counselors usually look at a number of indicators to determine whether an individual’s substance use has reached a level that could be considered problematic. They ask questions such as the following: Has the person attempted to cut down on substances but failed to do so? Have responsibilities related to family or employment been neglected because of drugs or alcohol? Have friends or family members ever commented on the amount or frequency of use? Has the person ever used substances to deal with stress or uncomfortable states? Does the individual experience withdrawal symptoms when not using?

Are drugs or alcohol often on the person’s mind? A pragmatic indicator for problematic substance use is whether the alcohol or drug use has caused complications in the person’s life. For example, have there been any DUIs? Is the use causing physical or mental health problems? Is the use putting a strain on interpersonal relationships? Has the use negatively impacted work duties? If this is the case, then seeking professional help could be useful as it can be challenging to tackle addiction alone. A licensed professional will then assess the issue further.

Sources:

https://www.samhsa.gov/data/sites/default/files/reports/rpt29393/2019NSDUHFFRPDFWHTML/2019NSDUHFFR1PDFW090120.pdf

One specific part of the OhioSTART intervention is something referred to as “family treatment drug courts.” Readers might ask themselves: What are drug courts and do they work? So let’s answer the first question: What are drug courts? Drug courts are “specialized court docket programs that target criminal defendants and offenders, juvenile offenders, and parents with pending child welfare cases who have alcohol and other drug dependency problems.”

In other words, drug courts specifically target offenders that have a history of problematic substance use. The main idea behind drug courts is to divert offenders with substance use issues to treatment instead of jail. The primary goals of drug courts are to lower recidivism, reduce substance use, and help rehabilitate individuals. The drug court model is unique because of the multidisciplinary teams they employ and the comprehensive resources that they entail.

Social workers and treatment professionals work alongside the judges, prosecutors and defense attorneys that are typically seen in the courtroom setting. Drug courts are characterized by close interactions with the judge, incentives and sanctions for behaviors, monitoring through drug testing, linkage with treatment, and celebration of accomplishments through graduations.

Now let’s address the second question: Are drug courts effective? The short answer is yes, they tend to be. An analysis of around 2000 drug court graduates found that less than 20% were re-arrested within one year and less than 30% were re-arrested within two years of drug court graduation. But they are not only effective in reducing recidivism. A national study comparing drug court participants with those not enrolled in such program found that drug court enrollees entered addiction treatment faster, stayed there longer, and were more likely to be reunified with their children.

Lastly, drug courts also have an economic value. The White House highlighted this aspect when it referred to a study that found that “every $1 spent on drug courts yields more than $2 in savings in the criminal justice system alone”. All of this is not to say that drug courts are flawless or that they are 100% effective, but offering these specialized dockets to offenders with addiction histories seems to be of value.

Sources:

National Institute of Justice. (2020). Overview of drug courts. Retrieved from: https://nij.ojp.gov/topics/articles/overview-drug-courts

Office of National Drug Control Policy. (n.d.). Drug courts. Retrieved from: https://obamawhitehouse.archives.gov/ondcp/ondcp-fact-sheets/drug-courts-smart-approach-to-criminal-justice

Roman, J., Townsend, W., & Bhati, A. S. (2003). Recidivism rates for drug court graduates: Nationally based estimates.

Substance use disorders are a problem that affect more than just the individuals afflicted with them. When people are addicted to drugs or alcohol, the abuse not only creates issues in their lives, but it also causes pain, heartache, or even trauma for their loved ones. Whether it is the young child of someone addicted to crystal meth who is removed from the home, or the spouse who has witnessed her partner suffer the detrimental consequences of alcoholism, or the parents who suddenly lose their adolescent child to an opiate overdose, addiction is a disease that has a long lasting impact on the entire family unit. And while we mostly think about treatment and recovery for the individual with the substance use disorder diagnosis, we tend to forget about the loved ones. Their pain is often overlooked. When addiction rips families apart, it creates deep wounds.

External support can be helpful, in some cases even necessary, to process the damage that the substances and the behaviors associated with use have caused. Luckily, there are organizations dedicated to support loved-ones of those dealing with addiction. Al-Anon is a mutual help group that was created in the early 1950s whose mission it is to “help friends and families of alcoholics (…) by welcoming and giving comfort to families and friends of alcoholics.”  Similarly, Alateen was founded to help teens cope with the effects of parental drinking. Other organizations like Nar-Anon are dedicated to help friends and family of those abusing other substances. In addition, there are local groups around central Ohio. If you or someone you know could benefit from supportive services, check out the following website with local resources: https://www.columbus.gov/publichealth/programs/Alcohol-and-Drug-Abuse/Supportive-Services-for-Loved-Ones/

What is dual diagnosis? Dual diagnosis is the term used to describe instances in which individuals have multiple co-existing issues. In the addiction treatment field, this often refers to a person meeting the diagnosis for both a substance use disorder as well as a mental health diagnosis. A person entering treatment with an opioid use disorder and major depression would be an example of someone experiencing dual diagnosis. So how common is it? Dual diagnosis is everything but uncommon.

Results from a recent national survey (NSDUH, 2020) showed that close to 10 million U.S. adults experienced dual diagnosis in 2019. The same survey revealed that about half of all adults dealing with addiction in the U.S. also experienced mental illness. To put this in perspective, out of every ten individuals presenting to addiction treatment, five might also experience mental health symptoms. So how should dual diagnosis be addressed? Historically, substance use problems and mental health symptoms have been treated separately. However, this view is outdated.

The National Alliance on Mental Illness (2020) explains that “the best treatment for dual diagnosis is integrated intervention, when a person receives care for both their diagnosed mental illness and substance use disorder.” NAMI further states that “the idea that someone cannot treat your depression because you are also drinking is outdated — current thinking requires both issues be addressed.” If you or a loved one experiences dual diagnosis, treatment will be most effective if both the addiction and the mental health component are understood and addressed.