Opioid-like herb has yet to be researched extensively
Transcript
Host Amber Smith: =Upstate Medical University in Syracuse, New York, invites you to be The Informed Patient, 我们的播客邀请了来自纽约中部唯一的学术医疗中心的专家. I'm your host, Amber Smith.
在美国,越来越多的过量死亡与一种草药物质有关,人们可能会用它来缓解疼痛和焦虑. It's called kratom. And to learn more about it, I'm talking with Dr. Willie Eggleston, a toxicologist from the Upstate New York Poison Center.
Welcome back to "The Informed Patient," Dr. Eggleston.
Willie Eggleston, PharmD: Thanks for having me back.
Host Amber Smith: 与处方药和非法街头毒品相比,人们可能会求助于帮助缓解慢性疼痛, kratom is a lot easier to obtain. What can you tell us about it?
Willie Eggleston, PharmD: Kratom is an herbal supplement. It's a product that's derived from a plant. The plant is mostly grown in parts of Southeast Asia, like Vietnam, and generally the plant makes its way over into the U.S. That plant is dried and then turned into a powder. 使用它的人要么用它的粉末来泡茶,然后喝, or the powder is put into empty capsules, so it can be taken more like a pill that you would take for a disease. 你几乎可以在网上任何地方买到,也可以在卖kratom用品的商店买到.
Host Amber Smith: Is there any age limit, or can anyone buy it?
Willie Eggleston, PharmD: Currently in the United States, federally, it's an unregulated product. So there's no rules or regulations around kratom, including that technically it's not a legal product to have in the U.S.
It's just that that's not typically something that's enforced. 有些州和县有年龄限制,18岁或21岁以下的人不可能购买, but it varies from region to region.
Host Amber Smith: Now, some states have banned it, though, right?
Willie Eggleston, PharmD: Yes, there are states that have outright banned it.
We don't know how effective that is, when the state next door has not done so, or you can buy it online. But some states have banned the product entirely.
Host Amber Smith: How expensive is it?
Willie Eggleston, PharmD: It really depends on where you're purchasing it and what type you're purchasing, but, generally speaking, it's not something I would consider like a really expensive product. It's not something that you're paying hundreds and hundreds of dollars for. 这是一种价格合理的产品,你可以为正常供应支付25到100美元.
Host Amber Smith: Now, do you get calls about kratom at the Upstate New York Poison Center?
Willie Eggleston, PharmD: We do. It's not a big group of our calls, but, generally speaking, over the last few years, we get anywhere from 20 to 25 calls a year related to kratom use. And usually what it is, is either someone with questions wanting to know what the heck is this, and is it safe or something that I should be using, or what we've been seeing more of, is folks who are using the product, they don't realize that, like other opioid drugs, it has addictive properties, and they're in withdrawal when they've stopped using it.
Host Amber Smith: So it is here in Central New York in some capacity?
Willie Eggleston, PharmD: Oh, absolutely. 你可以走进纽约市中心的一家商店,相当容易地买到kratom产品.
Host Amber Smith: So it's considered an herbal product. Does that fall under the FDA (Food and Drug Administration) or the USDA (U.S. Department of Agriculture) or the DEA (Drug Enforcement Administration) or ... who regulates this?
Willie Eggleston, PharmD: Yeah, 草药产品是一个很不幸的术语,通常被用来形容它,因为它是一个术语,我们用来形容它来自一种植物, but it does not mean that it's regulated as a dietary supplement, the way our other dietary supplements that we buy over the counter are in the U.S.
So, for example, if you go to buy your multivitamins at the grocery store or local pharmacy, those are regulated as a dietary supplement. Kratom doesn't have any status in the U.S. under the FDA, and so it's not regulated as a dietary supplement. It just exists as an unregulated product, 所以基本上没有人对它制定规则,除非某个州制定了一些规则.
Host Amber Smith: So would it be seen the same as a candy bar?
Willie Eggleston, PharmD: It's not considered a food, either. It's completely unregulated, which can be a confusing proposition for folks, that you want to put it in some sort of bucket, but right now it doesn't exist in a bucket.
但我认为,人们担心的是它的销售方式和营销方式. 我想大多数人会自己得出结论认为它是一种膳食补充剂, you know, it is like the melatonin or the vitamins that you go and buy at your pharmacy, because it comes from a plant, and it's generally viewed there as safe.
But I did want to be clear: Unlike vitamins and unlike melatonin, the FDA has not said that this is a dietary supplement, FDA还没有说目前普遍认为它是安全的.
Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith.
I'm talking with Dr. Willie Eggleston. He's a toxicologist from the Upstate New York Poison Center, and he's also a clinical assistant professor of emergency medicine at Upstate..
So how does kratom work? What does it do in the body? You told me people will either make it into a tea, or it might be in a capsule. So once they ingest it or eat it, what does it do?
Willie Eggleston, PharmD: 这种植物本身含有几种不同的化合物,可以以不同的方式影响身体, 但最重要的是要注意它确实有一种化合物,它在体内的作用就像阿片类药物一样. So that compound is called mitragynine, and it works in the same receptors in your brain that opioids act with. 所以人们会用它来治疗慢性疼痛或长期疼痛问题. And they will also report using it if they are stopping an opioid, and they're having withdrawal symptoms to try to manage those withdrawal symptoms.
But just like an opioid, 它也有可能导致阿片类药物使用障碍或成瘾的风险. And when you stop it after a long period of use, 如果你在长期使用阿片类药物后停止使用,你会经历一些相同的戒断症状.
Host Amber Smith: So do you have to be careful if you're already taking a prescription opioid? Is it safe to add this to that?
Willie Eggleston, PharmD: I would definitely recommend against adding it to that.
We know that a prescription opioid on its own has an increased risk for side effects, like slowed breathing, that can be very dangerous and potentially life threatening.
当你在此基础上添加另一种阿片类药物时,这可能会增加风险.
So just to be clear, when we're talking about opioids like fentanyl, which is an opioid people use illicitly, I think most of us realize that's a very dangerous drug. It has a high risk for overdose, a high risk for slowed breathing.
Prescription opioids at the appropriate dose still have that risk. It's just less. 克拉通仍然有这种风险,但它似乎比处方阿片类药物还要小. But when you mix those things together, it's just a recipe for a bad outcome.
Host Amber Smith: So would kratom make a person high, or does it just relieve anxiety?
Willie Eggleston, PharmD: Like any other opiate, it can make you high. When you talk with folks who are using opiates for the sensation they get when, say, they use fentanyl, the high is very different with kratom. It's not the same head rush, it's not something they would seek out, right? They're going to seek out fentanyl first. They're going to seek out prescription opioids second. And they're going to seek out kratom last. And they're probably not, honestly, going to be able to get enough of a high to make it useful, so they're really just using it for withdrawal in that case.
But if it's someone who's never used an opioid in their life, and they don't have a tolerance, and they take a bunch of kratom, 它们肯定会给你带来与另一种阿片类药物相同的快感. It's just not quite as strong.
Host Amber Smith: 我想这是一个有点棘手的问题:如果你只服用这一种东西,那么服用它安全吗? And if so, if you do take it, does it work? Is there any evidence that it reduces pain or anxiety?
Willie Eggleston, PharmD: So, to answer your first question, I think that the risks with kratom use on its own are low, but they're not zero.
We do know that it has some side effects. It can cause injury to the liver. It can cause, as I mentioned earlier, addiction and potentially withdrawal. And in really high doses, just like an opioid, it potentially could slow someone's breathing to a dangerously low level.
And then because of the other compounds that are there in the plant, 我们还发现了其他与阿片类药物不一致的副作用, things like increased heart rate or, in severe cases, maybe even like a seizure. And so, for those reasons, 因为我们目前还没有很多关于潜在副作用的信息, and because it's unregulated, 所以它所说的剂量不大可能不是它的实际剂量, there's a lot of inherent risks with using the product.
As far as does it work? We just don't know. 很有可能在未来的某个时候,这对患有疼痛或患有阿片类药物使用障碍或成瘾的患者来说是一个合理的选择. But no one has done those trials, that research, to figure out does it actually work.
That's the take-home point I have for folks who are curious about it, 它确实比处方阿片类药物更安全吗. 但至于其他副作用,我们真的不知道,我们也不知道它是否有效.
Host Amber Smith: So how addictive is it? Is it as addictive as a prescription opioid?
Willie Eggleston, PharmD: That's another one we don't know because the research hasn't happened yet. From anecdotal experience in talking with patients who are stopping kratom, 他们确实描述了戒断症状比他们停止海洛因或芬太尼等药物的戒断症状更轻微.
但这并不一定能给我们很多关于这个产品潜在上瘾程度的信息. Certainly, it's not as safe as other dietary supplements like vitamins and melatonin, where we know that those side effects are mild to nonexistent, and we know there's not a risk for addiction or withdrawal.
Host Amber Smith: So when you hear about people who have taken kratom, is it usually mixed with other drugs or alcohol, or is it usually people just taking a high dose of it, where they would end up calling the poison center, maybe?
Willie Eggleston, PharmD: So, 对于那些用它来控制疼痛或戒断或上瘾的人来说, in my experience, those individuals are using it on its own. They're not mixing it with other substances. And in those cases, the common question that we get is about the withdrawal when they stop the product.
Now, there are also cases of folks who do mix the drug with other substances, 在这些情况下,他们更有可能是用kratom作为一种获得快感的手段, as opposed to using it for chronic pain or treatment of a substance use disorder.
And in those cases where you are mixing it, we do know there's risks. 当你看到各州报告的阿片类药物过量死亡的总人数时, about 2% of those have kratom involved.
It's along with other substances a lot of the time, like fentanyl or other sedatives, but it's certainly involved in that process.
Host Amber Smith: What happens if someone takes too much and overdoses? What does that look like, and what do you do to help that person?
Willie Eggleston, PharmD: 对于那些服用了太多克拉托姆并出现过量症状的人, we can see mild opioid effects, like they're being sleepy or, difficult to wake up. At very large levels, potentially slowed breathing.
But then because of the other compounds in the plant, we do also commonly see things like increased heart rate, anxiety, seizures. In fact, we see seizures more frequently than we see slowed breathing, 因此,植物中其他化合物的刺激作用可以在决定某人如何因中毒而进入医院方面发挥作用.
Host Amber Smith: Would naloxone be used for someone who overdoses on this?
Willie Eggleston, PharmD: If someone is having symptoms of slowed breathing from the opioid effects of kratom, 目前我们掌握的信息表明纳洛酮的效果很好. It will reverse the effects and allow that person's breathing to go back to normal.
It's just not something we have to do very frequently, because it doesn't seem that that's a big risk factor with kratom, like it is with other substances like fentanyl.
Host Amber Smith: We probably don't know the answer to this, 但我们是否知道使用克拉托姆的人的身体会有长期的影响?
Willie Eggleston, PharmD: We don't have a full picture at this point, but the two that we do know are, the longer you're using the product, 你就越有可能患上阿片类药物使用障碍或成瘾, and to develop a withdrawal when you stop the product. And in cases where patients have developed liver injury, it has been in people using the product for longer periods of time.
Aside from those two risk factors, at this point, 我们真的没有任何数据表明有其他潜在的长期并发症.
Host Amber Smith: So that liver toxicity, can that be a real serious problem for someone?
Willie Eggleston, PharmD: Oh, it definitely can, 这需要在医院呆很长时间来接受治疗,并确保你的化验值恢复正常.
But it's not something that we're seeing every other day. It's a less common side effect that we see with long-term use.
Host Amber Smith: Well, that's good to know. I appreciate you making time for this interview, Dr. Eggleston.
Willie Eggleston, PharmD: Of course. 我很感谢你们邀请我,我希望大家今天对克瑞托姆有了更多的了解.
Host Amber Smith: 我的客人是毒理学家威利·埃格尔斯顿他来自纽约州推荐最近最火的赌博软件毒物中心和纽约州推荐最近最火的赌博软件大学医院急诊科.
"The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe.
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