“Ninety-nine percent say ‘What’s that?’ But if they know about it, I often put it on the panel. “I ask my patients if they know about kratom,” Dr Gudin added. Kratom is not nearly as widely used as opioids, and so testing every patient may not be cost-effective, but if the drug paraphernalia shops in your area “have big signs for kratom, there may be a locally high rate of use,” Dr Kain said. To keep patients safe, it may be advisable to include a test for kratom in the panel of tests a physician chooses for their patients undergoing prescription drug monitoring. “Most packets say, ‘Not for human consumption,’ which probably tells you something, that it is not necessarily safe,” Dr Gudin added. The drug is sometimes combined with tramadol, which can also cause liver damage. There have been documented cases of liver toxicity from kratom, Dr Kain noted. It’s not that I would label it a ‘bad’ drug, but it is a drug, and it needs to be studied the way all drugs are,” and manufactured consistently and safely. This is one of the dangers of walking into a ‘head shop’: you don’t know what you are getting. “Kratom leaves have different levels of different alkaloids, just as marijuana does,” he said. The problem with the drug as it is currently sold, Dr Gudin said, is that as an “herbal supplement,” there is no regulation of strength or purity. With appropriate research, Dr Gudin added, “This could be a medicine in the future.” Some patients with substance use disorder report using kratom to reduce their use of strong opioids, for instance. “To me, that was a positive development,” Dr Kain said, as Schedule 1 drugs are very difficult to do research on as potential therapeutics. The Drug Enforcement Agency originally proposed classifying it as a Schedule 1 drug, meaning it had no potential medical value and would have outlawed it, but backlash from the public convinced them to instead list it as a “drug of concern,” which kept it legal at the federal level. The leaf contains multiple plant alkaloids, the most abundant of which is mitragynine, which is similar in structure to opioids and is a mu-opioid receptor agonist, just like opioids. “In the pain management world, we hear about kratom all the time,” Dr Gudin pointed out. In the United States in recent years, it is sold as an “herbal supplement” with claims that it boosts mood and energy, and relieves pain. The leaves have traditionally been chewed as a stimulant to combat fatigue. It is an herb derived from the leaves of the kratom tree ( Mitragyna speciosa), indigenous to Southeast Asia. Kratom is still under the radar for most physicians, Dr Kain said. He spoke with Quest Diagnostics Medical Science Liaison, Jack Kain, PharmD about kratom: what it is, how it works, how it is used, and the role of testing for kratom in keeping patients safe. Legal in some states, illegal in others, this drug may have the potential to be an effective medication in the future, but is also being widely used recreationally without any control on dose or purity, “and that is cause for significant concern,” said Quest Diagnostics Senior Medical Advisor Jeff Gudin MD in a recent “Topics in Drug Testing” podcast from Quest Diagnostics. Was offered the job 48 hours later.Whether you pronounce it “CRAT-em” or “CRATE-em,” kratom has emerged recently as a drug of concern in the United States. I buttoned up my loud jeans and my noisy belt and presented my sample. I blew on the cup a few times, the colour dots started turning green. I "pee'd" in the cup just barely pass the line, set the cup on the back of the cold toilet lid while I emptied the rest of the bladder into the toilet to change colours. Had to sit for 30 minutes, when called in to test for my whizz quiz, the temp was back to 104. Put the heat pack back on and went inside. I took off the heat pack and it cooled to 100 in a few moments. I checked the temp in the parkinglot and it was 104. I recently passed a 10 panel for Concentra (dropping the name for others that search the name) and had to drive 2 hours for the test. EG its easier to cool it down if its too hot (blow on it and monitor the temp strip on the cup) than it is to warm up a cold sample. In regards to keeping it at the right temp its better to be too hot, than too cold. I've been using the product for pre-employment tests for over a decade and I can't say enough good things about it. (I'm sure you've passed, this is more of a reply to others with the same question as yours.)
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