Several months ago a 26-year-old man from Northern Virginia came to the office for an Accelerated Opioid Detox.

He had been using heroin for about two years after being on oxycodone for surgeries he’d had shortly after high school. Jim had graduated from a good HVAC program and was a reliable employee. He loved working with his hands. He was just blowing all his money on heroin.

He was scheduled for a 3-day rapid detox because he was using under 2 grams of heroin. Usually, if someone is using over 1.5 or 2 grams of heroin daily, or if there might be some fentanyl involved, we will have them come in for 4 to 5 days.

A Comfortable Heroin Detox?

The first day of a patient's detox off heroin at The Coleman Institute is usually pretty comfortable. We give patients a very small dose of naltrexone with several other medications to minimize any symptoms they may experience. That's why it was a little unusual when Rene, Jim's girlfriend and support person, called us saying that Jim was having strong signs of withdrawal.

"He's having diarrhea and has vomited a couple times. He has really bad body aches and says he feels like he needs to beat on his legs to stop the pain."

Well, of course, those are the classic signs of acute opiate withdrawal, but why was Jim having such a violent reaction when most people generally sleep through their first day with the Coleman Institutes detoxification protocol?

UNDERSTANDING ACCELERATED OPIOID DETOX



We had Rene bring Jim back to the office and after further conversation with him, the answer emerged. Jim had neglected to mention that—and we had neglected to ask if - he had been using kratom to help withdraw from opiates. He had purchased the kratom about a week prior to coming to our facility. He told us it really seemed to help his withdrawal symptoms all last week.

Why Did Choose to Use Kratom During Heroin Detox?

We totally get it.

It’s becoming more well known that kratom, with opiate-like qualities, can ease some of the symptoms one experiences going cold-turkey off heroin, fentanyl, or other opioid pain relievers. In Jim’s case, however, this only compounded his problem. As we delivered naltrexone to remove the opiates already present on his opioid receptors, Jim was loading them up again with kratom, exacerbating his withdrawal symptoms.

It was a little like playing Whack-A-Mole…as we pushed the heroin off, freeing his receptors, the kratom was right there, ready to take a position on an empty receptor. Instead of just the original 1.5 grams of heroin we could easily and comfortably handle during a three- day accelerated opioid detox, Jim’s use of kratom was making it more difficult and actually ended up adding more time to the process.


Does Kratom Take Away Opioid Withdrawal?

Yes, it would make sense that kratom would help with an opioid withdrawal, and at one time, researchers thought it might be a good alternative for opioids, or at least helpful for withdrawal. But, if you think about it, for a person withdrawing off heroin, heroin will help with the opioid withdrawal. So will oxycodone, fentanyl, Percocet, etc.

The problem is, you are simply perpetuating the situation.

"Kratom: Unsafe and ineffective," an article on the Mayo Clinic website, describes multiple problems and safety concerns when it comes to kratom, including death. Some of the serious outcomes of using kratom were seizures, high blood pressure, and multiple side effects, including:
  • Weight loss
  • Dry mouth
  • Chills, nausea and vomiting
  • Changes in urine and constipation
  • Liver damage
  • Muscle pain
Kratom also affects the mind and nervous system:
  • Dizziness
  • Drowsiness
  • Hallucinations and delusion
  • Depression and delusion
  • Breathing suppression
  • Seizure, coma and death
I was surprised to hear that substances made from kratom may be contaminated with salmonella bacteria. Again, from the Mayo Clinic article, “As of April 2018, more than 130 people in 38 states became ill with Salmonella after taking kratom. Salmonella poisoning may be fatal, and the U.S. Food and Drug Administration has linked more than 35 deaths to Salmonella-tainted kratom. Salmonella contamination has no obvious signs, so the best way to avoid becoming ill is to avoid products that may contain it.”

How Does Kratom Affect An Opioid Detox?

So, after cracking the kratom quandary, Jim’s detox proceeded with much more ease and comfort. We were able to give him a little extra comfort medication and extended his detox for another day. He ultimately did very well, and it is now a standard part of our protocol to question our patients about using kratom.

Jim’s ultimate goal was to go on long-acting naltrexone, which is an opiate blocker and does not cause any physical dependency. Providing Medically Assisted Treatment (MAT) with naltrexone has been our specialty at TCI for close to 20 years. However, all the opiates must be out of the system before a person starts on the naltrexone….including kratom.

NALTREXONE FOR OPIATES FAQs



More Questions About Using Kratom to Detox off Heroin?

It can be very confusing to know the ins and outs of various treatments and what substances should and shouldn’t be used to help a patient detox off opiates like heroin, morphine and codeine, and opioids such as Percocet®, Vicodin® Roxicet®, Dilaudid®, etc. If you have any questions or concerns about kratom or other addictive substances, please schedule a callback below.

Joan R. Shepherd, FNP


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