New Study Finds Kratom Effective for Pain, Addiction

Posted on January 25, 2022 by Pharmaciststeve

New Study Finds Kratom Effective for Pain, Addiction

https://www.paintreatmentdirectory.com/posts/new-study-finds-kratom-effective-for-pain-addiction

The controversy over kratom safety

Kratom is a Southeast Asian herb that is being used by millions of Americans to treat chronic pain, anxiety, depression and opioid withdrawal. The U.S. Drug Enforcement Agency (DEA) and the FDA have been trying to ban kratom for several years. Now, a new study by researchers at Johns Hopkins University Medical Center, sponsored by the National Institute on Drug Abuse, has found that kratom is relatively safe and effective for pain, anxiety, depression and opioid withdrawal.

The Johns Hopkins Kratom Study

The study, published online in the journal Drug and Alcohol Dependence on February 3, was an anonymous, online survey of 2798 kratom users. 59% of users reported taking kratom daily and the most common dosages were 1-3 grams.

Kratom was used by 91% of respondents for pain, 67% for anxiety and 65% for depression, “with high ratings of effectiveness”. 41% reported using kratom to stop or reduce prescription or illicit opioid use. About a third of those using kratom for opioid withdrawal reported they were abstinent from opioids for over a year due to their kratom use.

About one third of respondents said they had adverse effects from kratom such as constipation, upset stomach or lethargy. They rated their adverse effects as mostly mild in severity and lasting less than 24 hours. A very small minority, .6%, sought treatment for adverse effects.

According to researchers, 2% of respondents met the diagnostic criteria for kratom-related substance abuse disorder. When asked how troubled they felt about their kratom use, the mean rating was 3.2 on a scale of 0 to 100.

The DEA has been advocating for the classification of kratom as a Schedule I drug, a drug with high abuse potential and no known medical use. This classification would make kratom illegal. Lead researcher  Albert Garcia-Romeu, Ph.D., instructor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, says the survey findings “suggest that kratom doesn’t belong in the category of a Schedule I drug, because there seems to be relatively low rate of abuse potential, and there may be medical applications to explore, including as a possible treatment for pain and opioid use disorder.”

According to Garcia-Romeu, “Both prescription and illicit opioids carry the risk of lethal overdose as evidenced by the more than 47,000 opioid overdose deaths in the U.S. in 2017. Notably there’s been fewer than 100 kratom-related deaths reported in a comparable period, and most of these involved mixing with other drugs or in combination with preexisting health conditions.”

“There has been a bit of fearmongering,” he adds, “because kratom is opioidlike, and because of the toll of our current opioid epidemic.”

A previous kratom study showed similar results

The results of this survey are similar to the 2016 online survey of 6150 kratom users by Pain News Network and the American Kratom Association. Nine out of ten respondents said kratom was “very effective” for pain, depression, anxiety, insomnia, opioid addiction and alcoholism. Less than one percent said it didn’t help. The percentage of patients who rated kratom “very effective” for their pain condition:

  • Cancer 100%
  • Multiple Sclerosis 97%
  • Irritable bowel syndrome 94%
  • Migraine 93%
  • Fibromyalgia 93%
  • Rheumatoid arthritis 92%
  • Back pain 92%
  • Acute pain 92%
  • Lupus and other autoimmune diseases 91%
  • Osteoarthritis 90%
  • Neuropathy 90%
  • Trigeminal neuralgia 88%
  • CRPS 79%
  • Ehlers Danlos syndrome 76%

Why all the fear-mongering about kratom?

In my humble opinion, the fear-mongering isn’t out of concern for patients’ safety, it’s concern for pharmaceutical companies’ bottom line. This is a safe, effective herb that could replace opioids, NSAIDs, antidepressants, methadone, buprenorphine, benzodiazepines and more.

Kratom has been used medicinally for hundreds of years in Asia. The American Kratom Association estimates that 10-16 million people in the United States regularly use kratom.

Here are two kratom user reports:

From Melody Woolf:

For eight years I suffered terribly from fibromyalgia, arthritis, spinal stenosis, frayed meniscus, shoulder tendinitis and sciatica. This was despite taking 11 medications including prescribed dilaudid and fentanyl. I was bedridden most of the time and used a wheelchair and walker. I rarely left the house. For three years, I couldn’t even go visit my mom after she went into a nursing home. I missed out on ALL the activities my kids had at school and had no relationship with them.

Then, five years ago, I discovered kratom and it changed my life! It takes away about 75% of my pain. I now take ZERO medication and even my doctor approves of kratom. I bicycle several miles a day through a nature preserve near our home or walk two miles a day. I go out to places several times a week for dinner, coffee, etc. I went on a family camping and road trip from Michigan to Wyoming for the solar eclipse where I even did some rock climbing!

I’m now able to be there for my family. After starting kratom, I was able to see my mom often which was so important as she died March 23. I have been able to get to know my kids and establish a relationship with them. I am so lucky they all go to local colleges or I never would have gotten to know them. My daughter got married Nov 1. I danced till 11!

From Jason:

When I was 18 years old I broke my wrist and knuckles. I was given Vicodin and became addicted. I graduated to methadone and heroin. I had never used anything before but pot and alcohol occasionally. For the next seven years I was in and out of detox. All my plans went downhill. I had wanted to be a pro baseball player. I had trouble getting and keeping a job. I got a D.U.I. I watched eight of my friends die from heroin overdoses and I still couldn’t stop using.

Then one day a friend posted on Facebook about kratom, a southeast Asian herb that many were reporting is helpful for pain, anxiety and addiction. I ordered a sample pack of a red vein strain, the most calming strain of Kratom. Since I started using kratom, I have not had the urge to use opioids again.

My life is now back on track. I’ve been clean for over eight months and I’m going to school to get a machinist certificate. I use kratom to manage ongoing back pain, anxiety and depression. I take kratom twice a day and it costs me $30-$40 a month. I now feel confident about my future.

Kratom is already banned in six U.S. states

Though not every kratom user’s story is as dramatic as Melody’s and Jason’s, it’s clear that many are benefiting from kratom. Kratom is currently banned in Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin. Some cities and counties have also banned kratom. Many more states and localities are considering bans.

Help make/keep it legal

if you’d like to learn more or help make sure kratom is available nationwide, visit the website of the American Kratom Association, the main group lobbying for kratom legality.

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when are health practitioners going to have their feet held to the fire ?

Posted on January 24, 2022 by Pharmaciststeve

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Another New Covid Variant? Omicron Sub-Lineage BA.2 Under Investigation

Posted on January 23, 2022 by Pharmaciststeve

Another New Covid Variant? Omicron Sub-Lineage BA.2 Under Investigation

https://www.sentinelassam.com/health/another-new-covid-variant-omicron-sub-lineage-ba2-under-investigation-574335

New Delhi: If you thought that the world is finally about to get rid of Covid, then you were mistaken. In fact, it seems like it is far from getting over. New strains of covid, most notably the Delta variant and the Omicron variant, has popped up in some countries and subsequently spread throughout the world like wildfire. To make things worse, another new variant has been reportedly detected in the United Kingdom. Also Read – Dragon Fruits and its Health Benefits According to a report by news agency Reuters, UK Health Officials are investigating BA.2, a sub-lineage of the Omicron variant of Covid-19. The BA.2 has been designated as a variant under investigation by the UK Health Security Agency. The health officials said that this newly discovered variant could have a growth advantage. However, BA.2 is yet to be designated as a variant of concern. Experts have told Reuters that BA.2 is harder to easily differentiate from the Delta variant as this sub-lineage of the Omicron variant does not have the specific mutation seen in Omicron. Also Read – Why ‘Dolo 650’ Pills Became India’s Most Wanted Tablets During Covid Wave The UK has reported 426 cases of this new variant. Apart from the UK, most of the cases of the variant have been reported from Denmark, India, Sweden and Singapore with Denmark topping the list. Denmark reported a continuous surge in the number of new covid cases due to BA.2., with 45 per cent cases recorded in the second week of 2022, fueled by the sub-lineage of the Omicron variant. The United Kingdom Health Security Agency said that 40 countries have reported cases belonging to the BA.2 sub-lineage including the nations mentioned above. Also Read – Celiac Disease: Symptoms, Causes and Diagnosis Dr Meera Chand, incident director at the UKHSA told Reuters that new variants will continue to emerge. “It is the nature of viruses to evolve and mutate, so it’s to be expected that we will continue to see new variants emerge,” Chand added.

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The nonsense of dosing opiates to treat chronic pain

Posted on January 23, 2022 by Pharmaciststeve

Morning Mr. Steve,

I hope you’re and Barb are fairing well with the cold. It’s freezing here
After explaining to my “Pain Management“ doctor yesterday  that all I’ve tried all his recommendations in terms of injections and oral medications without success in lowering my pain. I went on to further explain it’s impossible to find a doctor in locally who wants to manage someone’s pain if someone else implanted a pain pump. I explained if my exploration  with Palliative Care doesn’t help my pain, I’ll have to fly to NY to find a compassionate doctor to control my pain. It annoyed him so much he explained his feeling of oral opiates. 
Regardless of how he feels or even hospital policy, how can it be legal to not prescribe opiates when a patient is a “pain management” doctor working with intractable pain patients? Below is his response and the oral medications he’s referring to are Cymbalta and Remeron to treat my pain. 
“With respect to oral medications, I am sorry you feel those were inadequate – we actually are following best practices according to state health dept and CDC guidelines. Opioids are really important and useful but we also have to make sure we are not creating new problems, which if you read the news you can see can cause really bad problems, and so again we go by data. I am actually less restrictive than many doctors.“
As always I love hearing your thoughts and am always extremely thankful. Stay well Sir. 
My response/recommendation to this pt:

My first thoughts is can the doc show you the DATA as to the intensity of your pain ?  Has anyone done a CYP-450 opiate metabolism test or a PGx DNA test – to see if you are a ultra fast metabolizer or which opiate YOUR SYSTEM metabolizes the best or utilizes the best ? It is well known that CRPS causes higher intensity of pain – it is known as the “suicide disease” and if you have someone with CRPS and a ultra metabolizers… they will need higher and more frequent doses of opiates to even attempt to get the pt <5 on the pain scale.

Here is four quotes from the CDC opiates guidelines:  – are these CDC guidelines being followed ?

https://www.cdc.gov/mmwr/volumes/65/rr/rr6501e1.htm

“The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function.”

“Clinicians should consider the circumstances and unique needs of each patient when providing care.”

“Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context.”

“This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.”

I would have to  dig it up, but it was well distributed back in 2016 after the CDC guidelines were published that the studies that the CDC committee used to come to their recommendations… in regards to the quality of the data used in the studies… most were rated 3-4 on a scale of 4… where “1′ is excellent and “4” is CRAP.

If your blood pressure is above what is consider a normal range of 135/85 and no amount of blood pressure meds will get it down or your high blood pressure is being ignored…  high blood pressure is called the “silent killer”…   high blood pressure will cause strokes, heart attack, eye & kidney damage. and a premature death…

Under/uncontrolled pain may cause anxiety, depression and suicide.  This chart may have been published before 2011 – but this one has been around for 10 yrs..

how many different different health issues do you have that are a separate and distinct sources of pain ?  A implanted pump will not always “hit” all the sources of pain and some sources of pain – within the body – will cause higher intensity of pain than others.. so a specific concentration of a pain med – may or may not put a “dent” in the intensity of pain from one or more pain generators.

There is no or a very high LD50 or upper dose limits for opiates and a pt that has been on them for a long time  https://en.wikipedia.org/wiki/Median_lethal_dose.. not many meds share that characteristic.

I would ask your doc… what level of pain does the CDC and state health dept guidelines suggest is an acceptable level of a pain that a pt should be expected to live or EXIST with ?

How many other chronic diseases does the state health dept and/or CDC have no target test/lab value that should be the goal in treating a pt ?

The headlines that your doc is referring to 2021 – 100,000 deaths – and that is OD’s from ALL DRUGS… it is estimated that within those numbers is 15,000 bleed out deaths from the use/abuse of NSAIDS… and 75,000 is from illegal fentanyl coming from China via Mexico

Depending on which study you wish to believe those pts that end up being addicted after getting a legal opiate prescribed is somewhere between 0.6% -2%.  So we should deny 98%+ of chronic pain pts from adequate treatment to MAYBE prevent <2% from becoming addicted ..  and probably those in that <2% are already using/abusing alcohol & Nicotine…they have a addictive personality … they will at some point find some substance that they “like the way that it makes them feel”… silences the demons in their head and/or monkeys on their backs.

That 100,000 number does not include the 100,000/yr deaths from the use/abuse of the drug alcohol and the 450,000/yr deaths from the use/abuse of the drug Nicotine

Second chart is from when the Decade of Pain law expired and was not renewed… OD’s from Pharma opiates is virtually FLAT FOR 10 YRS.. – what we don’t know, if the CDC knew and did not disclose – how many of those OD’s had a legal rx for the pharma opiate found in their toxicology –  if they would have disclosed that number – would have suggested SUICIDES…  the toxicology of the typical OD’s contains 4-7 different substances/drugs – with one typically being the drug ALCOHOL .

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Pharmacy is currently CLOSED due to staffing issues

Posted on January 21, 2022 by Pharmaciststeve

In our small county of 80K population, we have 3 independent pharmacies and I am not aware of any of them not being opened their scheduled hours…  Can’t say the same for the two chains that have the most community pharmacies in our country.

The independent pharmacy that we patronize … they tell me that they are picking up pts from the major chains – EVERY DAY – and I have not noticed the very least deterioration in their good service. Maybe they have added staffing to take care of the increased business.

Here is a website that will help pts find a independent pharmacy by zip code https://ncpa.org/pharmacy-locator

I had my own independent pharmacy for TWENTY YEARS — I know the mindset behind those who own/operate a independent pharmacy. It is very rare that someone who moves their Rxs over to a independent pharmacy tells me that they are not better than the chains they have tried…  if your med insurance mandates you use a particular pharmacy, ask for an exception to fill at a independent because of the piss-poor service/care that the chain routinely provides you. Especially if they are routinely out of your necessary meds and as such your QOL (quality of life ) is being compromised.

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Walgreen/Boots: Pharmacists Under Pressure?

Posted on January 21, 2022 by Pharmaciststeve

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HHS OIG Report Finds Many Medicare Beneficiaries Are Not Receiving Medication to Treat Opioid Use Disorder

Posted on January 21, 2022 by Pharmaciststeve

How many chronic pain pts have had a Dx added to their list of health issues by Medicare Parts B, C, and D and the Medicare pt doesn’t have a clue about it ?  How many Medicare folks are going to start getting a ‘talking to” by their PCP about them dealing with their OUD – as declared by various parts of Medicare based on some arbitrary conclusion based on some meds or psychological services that a particular Medicare folks have received ?

In the paragraph that I have IN RED …  is this just another attempt of the current administration to create some sort of perceived EQUITY in another sub-segment of our population/society?

HHS OIG Report Finds Many Medicare Beneficiaries Are Not Receiving Medication to Treat Opioid Use Disorder

HHS OIG Report Finds Many Medicare Beneficiaries Are Not Receiving Medication to Treat Opioid Use Disorder

In mid-December 2021, the United States Department of Health and Human Services Office of Inspector General (HHS OIG) released a data brief that found many Medicare beneficiaries are not receiving medication to treat their opioid use disorder.

Currently, three different medications are approved for the treatment of opioid use disorder: buprenorphine, methadone, and naltrexone. Beneficiaries can receive these drugs in either office-based settings or from opioid treatment programs. To prescribe or administer buprenorphine in office-based settings, providers must receive a waiver through the Substance Abuse and Mental Health Services Administration (SAMHSA). Methadone can only be administered and dispensed in an outpatient setting in opioid treatment programs.

In the data brief, HHS OIG states that more than 1 million Medicare beneficiaries were diagnosed with opioid use disorder in 2020 and that while opioid use disorder can be treated with medication, only 16% of those beneficiaries received medication to treat their disorder. HHS OIG found that even less (less than half) received both medication and behavioral therapy to treat their opioid use disorder.

Further, the type of treatment beneficiaries received seemed to depend on which state they live in. Beneficiaries in Florida, Texas, Kansas, and Nevada were two to three times less likely to receive medication to treat their opioid use disorder. Additionally, Asian/Pacific Islander, Hispanic, and Black beneficiaries were less likely to receive medication than White beneficiaries. Older beneficiaries and those who did not receive the Part D low-income subsidy were also less likely to receive medication to treat their opioid use disorder.

OIG analyzed claims from Medicare Parts B, C, and D to understand the extent to which beneficiaries diagnosed with opioid use disorder received medication and/or behavioral therapy to treat it through Medicare in 2020.

In conclusion, HHS OIG recommended that the Centers for Medicare and Medicaid Services (CMS) make six changes, four of which CMS agreed with and the other two it did not explicitly state agreement or disagreement with.

HHS OIG recommended that CMS conduct additional outreach to beneficiaries to increase awareness about coverage for the treatment of opioid use disorder. CMS concurred, noting that it has previously conducted “extensive outreach” to beneficiaries on the topic and will continue to do so, as appropriate. CMS also noted that it has updated its website and its Medicare & You Handbook.

HHS OIG also recommended that CMS take steps to increase the number of providers and opioid treatment programs for Medicare beneficiaries with opioid use disorder. CMS concurred, noting prior “extensive outreach” to providers and opioid treatment programs about opportunities to treat Medicare beneficiaries with opioid use disorder. CMS also said it would continue to monitor payment mechanisms and rates for office-based treatment to assess their efficacy.

HHS OIG recommended CMS collect data on the use of telehealth in opioid treatment programs, which CMS agreed with, noting that it had finalized coding changes in the CY 2022 Physician Fee Schedule that would allow it to collect data to monitor the use of telehealth in opioid treatment programs. HHS OIG also recommended CMS collect information on counseling and therapy sessions delivered via telehealth included in weekly bundled payments.

CMS also concurred with the HHS OIG recommendation to create an action plan and take steps to address disparities in the treatment of opioid use disorder. CMS noted that it has been working to identify and track drivers of disparities in the treatment of opioid use disorder. CMS also said it will use its existing equity framework to further analyze and develop opioid use disorder plans to address disparities in the treatment of opioid use disorder, amending them as needed.

When it comes to the recommendations that CMS did not make explicit agreement or disagreement on, HHS OIG recommended that the agency assist SAMHSA by providing data about the number of Medicare beneficiaries receiving buprenorphine in office-based settings and the geographic areas where Medicare beneficiaries remain underserved. However, in its response, CMS did state that it regularly works with SAMHSA and will provide data when requested to do so.

CMS also did not explicitly indicate whether it concurred with the HHS OIG recommendation to take steps to increase the utilization of behavioral therapy among beneficiaries receiving medication to treat opioid use disorder. CMS noted that it has previously undertaken extensive outreach to beneficiaries to describe the benefits available to them for the treatment of opioid use disorder. It also stated that it will continue outreach to both providers and beneficiaries to ensure awareness of all Medicare-covered services and options.

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website that shows you all sorts of stats that you never thought you would ever need to know

Posted on January 21, 2022 by Pharmaciststeve

https://www.worldometers.info/

THIS IS JUST ONE SMALL SEGMENT OF ALL SORTS OF DATA AVAILABLE FROM THIS WEBSITE – IN REAL TIME

Health
735,649Communicable disease deaths this year
28,083Seasonal flu deaths this year
430,737Deaths of children under 5 this year
2,419,037Abortions this year
17,515Deaths of mothers during birth this year
43,345,764HIV/AIDS infected people
95,262Deaths caused by HIV/AIDS this year
465,411Deaths caused by cancer this year
22,346Deaths caused by malaria this year
10,406,370,912Cigarettes smoked today
283,286Deaths caused by smoking this year
141,732Deaths caused by alcohol this year
60,768Suicides this year
$ 22,669,996,900Money spent on illegal drugs this year
76,496Road traffic accident fatalities this year

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Another pharmacist using the excuse “I’m not comfortable” as a reason to deny providing valid medical care

Posted on January 21, 2022 by Pharmaciststeve

Dear Steve,

I have been a chronic pain patient since 2006. I am 66 and disabled.
CVS is the only  drug store I can walk to as it’s close to my home. 
For over 3 years I’ve filled my C-II. there with no issue. 
It was due 1-9-22. I got a text saying out of stock and they were placing special order. I was advised to call daily to see if it came in the order.
Meanwhile my regular pharmacists have been replaced. 
They never ordered it. Today it came in. I was on hold with my insurance while she spoke to the “new” pharmacist who said she’s not comfortable filling it until she speaks to my Dr. I placed a  call to my Dr. which  revealed she never tried to call him to correct this. I’ve complained to CVS twice to no avail!
I am being discriminated of because if the type of medicine it is!  Its unfair. I’ve NEVER tried to fill early in all these years All! I take quite a bit of meds but only 2 C-II and some benzo (also for years) (I have some other mental health issues)
All scripts are now e filed so I can’t just walk out with the paper.
Additionally, I’m indigent and as this is the only pharmacy I can walk to as I’m 66, on medicare/Medicaid and don’t have a way to go from pharmacy to pharmacy, as I can’t afford a car.
This new pharmacist doesn’t know me, or my numerous conditions. Humana approved the Prior Authorization on 12/31/21 the day they got the e script. Its overdue 14 days!
I’m suffering and it’s so very wrong to be judged by the medication and also to make me suffer as I am!! I haven’t been out of bed for weeks!. any advice?
I truly need some guidance.
I live in Coral Springs, FL.
The CVS Stire # is 5084@ 3401 Coral Springs Drive, 
33065 954 346 8428.
this is my response to this pt… I try to offer pts possible solutions that they can reasonably take to resolve the issues that they are dealing with.  Just not share a healthcare horror story… to let everyone know that they are not alone..

    There are several laws that should protect pts like you.. but .. none of the bureaucrats have any interest in enforcing them… CVS has so much business that they could care less if they lose pts that take C-II’s…  The only “quick fix” is to change pharmacies … here is a website that will find independent pharmacies by zip code and distance.. https://ncpa.org/pharmacy-locator   using the CVS’ zip code that was at the bottom of your email… there are a couple of independent pharmacies <1 mile from them and a total of 13 within 5 miles and I searched for independent pharmacies that has delivery…. and since you said that you walk to CVS … they must be close to your home…

contact those on the list that the website produces… tell them that you want to transfer all your meds and ask them if they will/can sync all your meds so that they are all filled on the same day every month and if in fact that they do deliver. Syncing your  meds will help  make sure that you don’t run out of your meds and they have them in inventory when your refills are due… it is a win-win for everyone involved.

    Independent pharmacies – most likely you will be dealing with the Pharmacist owner… and they typically have very little turnover in staff… you know them and they know you.  I had my own independent pharmacy for 20 yrs – I know the mindset and we patronize a independent pharmacy for our Rx needs.

Please keep me in the loop … if/when you find a new pharmacy that will take care of you and your medications properly

Best of luck

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Medicare Quality Improvement Organization – one more way to file a complaint against a Medicare vendor

Posted on January 21, 2022 by Pharmaciststeve

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