A LETTER FROM DR. MURRAY HOLCOMB
Liberty may be defined in multiple ways, but as listed in the Merriam Webster dictionary, this understandably includes:
1. The power to do as one pleases.
2. Freedom from arbitrary control.
3. The power of choice.
The proposed ban on Kratom would seem to run head on into this cornerstone of our existence as a country and our rights as individuals. Without question, our government is charged with the protection of its citizens, but exactly what that means and at what cost is debatable. It should be remembered that the constitution is equally targeted towards the threat government poses to our rights, hence, it has been stated that individual rights are inversely proportional to government power.
In this case, the Kratom ban targets the choice made by millions of our citizens who have found relief from conditions including chronic pain, addiction, and refractory anxiety/depression. There seems to be little to support the case for significant recreational use or excessive risk. These people largely use Kratom as a person with diabetes uses insulin or a person with high blood pressure uses a beta blocker or ace inhibitor. For many, it seems to remedy longstanding symptoms which may be poorly understood and not responsive to prior therapies.
Those people that have found relief with Kratom seem generally to be well informed and accepting of the risks, especially when compared to conventional alternatives. Expense unquestionably enters into the discussion when one considers the alternative of prescription medications (although arguably presenting increased risks), as many providers operate on a cash basis only and refuse insurance.
The conditions of depression, substance abuse, addiction, and chronic pain are inexorably linked. To put these issues in perspective, >40,000 people die of suicide each year, >80,000 die of alcohol related causes, and >20,000 die each year of prescription opioid overdoses. It would seem that if Kratom can benefit users suffering from these afflictions, we should not only maintain its legal status, but find a way to increase its availability and expand research efforts. It is not unusual that the exact mechanism of action of any particular substance is incompletely understood. One need only look as far as the history of Penicillin to understand this and not reflexively pull back and deny its attributes to those benefiting. My own family’s experience is a testament to this pleading. Expense and prescription alternatives which provide suboptimal benefit with increased risk, not to mention resorting to illicit substances,makes a change in legal status almost certainly counterproductive and dangerous. The mention of Kratom’s mild opioid activity only serves to create confusion which is unfortunate.
Neuropharmacology is extremely complex, but it seems that opioid balance is of equal importance to that of serotonin, norepinephrine, and dopamine. Exercise, caffeine, and nicotine may exact their effects through a similar pathway. What defines the concept of “high” versus normal or mildly energized. That’s not entirely clear, but as a society, we’ve given people the choice to most often make these decisions for themselves barring undue risk to themselves or others.
Lastly, we should not rest until the inequity in mental health funding and availability/access has been addressed. It is nothing but confounding given the prevalence in our society.
Murray A. Holcomb, MD FACS