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MTM-Interview with Kurt Bravata MD..The Kratom Crisis · More Than Medicine

• 0:03
  SPEAKER_01: Welcome to More Than Medicine.
• 0:06
  SPEAKER_01: Where Jesus is more than enough for the ill the point, our culture and host of author and position, Dr.
• 0:13
  SPEAKER_01: Robert Jackson.
• 0:14
  SPEAKER_01: And the point Carlotto and Daughter Annabelle.
• 0:17
  SPEAKER_01: So it's enough because the doctor Welcome to Mortan Medicine.
• 0:24
  SPEAKER_02: I'm your host, Dr.
• 0:25
  SPEAKER_02: Robert Jackson, bringing to you biblical insights and stories from the Country Doctor's Rusty Dusty Scrapbook.
• 0:34
  SPEAKER_02: Well, today I'm privileged to have online with me Dr.
• 0:37
  SPEAKER_02: Kurt Bravada.
• 0:38
  SPEAKER_02: He's a doctor that I met just last week in at a medical conference.
• 0:42
  SPEAKER_02: He gave a very interesting lecture on kratom, which, as you know, is a very real issue both in the upstate, and as many of you know, there were two students down in Mississippi who died just last week with kratom in their bloodstream and on their toxicology.
• 1:05
  SPEAKER_02: I don't know what else may have been on their toxicology because I haven't heard, uh, but nevertheless, it is a very real issue.
• 1:13
  SPEAKER_02: So, Dr.
• 1:14
  SPEAKER_02: Bravado, welcome to More Than Medicine.
• 1:17
  SPEAKER_03: It's good to be here with you today.
• 1:19
  SPEAKER_02: Well, thank you, sir, and I thank you for your expertise.
• 1:22
  SPEAKER_02: I was very intrigued by your presentation because it answered a lot of questions that I had, and uh I think my listeners will be glad to hear what you had to say.
• 1:32
  SPEAKER_02: And I was as I was telling you a few minutes ago, just yesterday, uh a nurse came into my medical office and shared with me that she had uh well not intentionally but unintentionally became addicted to kratom that she obtained from local gas stations.
• 1:51
  SPEAKER_02: Uh she was using it to treat pain from a lupus-like illness.
• 1:56
  SPEAKER_02: Uh, but unfortunately she got a hold of the seven hydroxy um portion and uh ended up having to switch to uh suboxone to get off of the seven hydroxy purified extract of kratom.
• 2:12
  SPEAKER_02: And um now she's addicted to suboxone and she didn't see that coming in her life.
• 2:18
  SPEAKER_02: And so I I'd love for you to talk about all of that if you will.
• 2:22
  SPEAKER_02: So uh if you will, tell my listeners a little bit about yourself first, and so they'll know something about your background, and then just launch into uh a presentation similar to what you gave to us medical doctors.
• 2:37
  SPEAKER_02: Now remember, my my audience is a non-medical op uh uh audience, so don't get too technical on them, okay?
• 2:44
  SPEAKER_03: Okay, well um thanks for the opportunity to share, and I really appreciate you sharing your story.
• 2:50
  SPEAKER_03: Um, unfortunately, this is a very common story.
• 2:54
  SPEAKER_03: Um we see a lot of patients who um really didn't have any awareness of what kratom is or what seven um hydroxylene nitragenine seven OH is and and what the risks are for dependence or toxicity.
• 3:08
  SPEAKER_03: And uh unfortunately uh many of these individuals uh are exposed to Kratom, um, which is possibly recommended or offered by a friend, um, and maybe even that friend isn't fully aware of the risks of this substance.
• 3:25
  SPEAKER_03: Um, and uh you know, oftentimes it's someone you know who started it, found some um uh subjective benefit from from taking it, and then um before you know it, they're recommending it to their friends.
• 3:39
  SPEAKER_03: And you know, some people become uh some people you know use it um sporadically and and may not develop addiction, but many do.
• 3:48
  SPEAKER_03: And so we'll get into that.
• 3:50
  SPEAKER_03: Um so I am a family physician.
• 3:53
  SPEAKER_03: Um I started my family practice in southwest Missouri um in 2013 after graduating residency in uh at Bronx Lebanon Hospital in New York City.
• 4:06
  SPEAKER_03: Um I'm originally from New York, and uh um I had a lot of exposure during residency to people suffering from addictions, but at the time, um, although I was somewhat comfortable with treating patients who had addictions, um I really didn't have any training um in addiction medicine.
• 4:26
  SPEAKER_03: And uh my goal was to practice family medicine with a sub-specialty in geriatrics, and that's what I did for um over 10 years.
• 4:36
  SPEAKER_03: Um, however, about a year into my practice, um I started to notice that there were quite a number of patients that were struggling with opioid dependence and alcoholism, and um I started to seek for opportunities um to treat these patients or at least to find a place to send them for addiction treatment.
• 4:59
  SPEAKER_03: And so around 2014, I um was introduced to Vivitrol, which is an injectable opioid receptor blocker that you can use to treat uh opioids and um alcohol dependence.
• 5:13
  SPEAKER_03: And uh I started to use that for my patients.
• 5:16
  SPEAKER_03: And um, after a few years, as um our my addiction treatment within my family practice expanded, um, I recognized that there was a need for a full-fledged addiction recovery program for my hospital, which is Citizens Memorial Healthcare in um Bolivar, Missouri.
• 5:34
  SPEAKER_03: And uh my wife who is um who has um a degree in business, um she helped me develop a proposal for our hospital, and uh and uh we we um got the administration on board.
• 5:50
  SPEAKER_03: And so in 2018, we launched an addiction program with a nurse practitioner, and um we soon hired a counselor and a peer recovery specialist, and uh now um you know, a few years later, we have a full-fledged addiction recovery program with two nurse practitioners, um, a licensed clinical social worker, a peer recovery specialist, case manager, and a couple of nurses, and um we treat uh opioid dependence, uh methamphetamine abuse, um, you know, other types of stimulant use disorders, alcohol use disorder, gambling, um, even pornography and some eating disorders.
• 6:33
  SPEAKER_03: And um it was only about um three years ago, I think, that I really started becoming aware of the problem with Kratum, um, which is uh the the species name uh of this herbal is um Mitrogenus faciosa, as S-P-E-C-I-O-S-A.
• 6:53
  SPEAKER_03: So um the uh the Kratum uh plant um is uh uh native to Southeast Um Asia.
• 7:05
  SPEAKER_03: It's an evergreen plant.
• 7:07
  SPEAKER_03: And um, you know, for uh many years, you know, um, you know, centuries, um it's been used um you know as uh chew um in the chewed format um uh as uh just kind of like a chew or as uh a brood tea.
• 7:30
  SPEAKER_03: Um it's been used as an alternative to opium.
• 7:33
  SPEAKER_03: Uh traditionally it was used as a pain reliever, um it was used for energy, for focus, for anxiety, and for symptoms of opioid withdrawal.
• 7:43
  SPEAKER_03: Um, however, when it came to the United States and it started to be uh used more in developed countries, um there were uh concentrated forms of uh 7OH, which is um 7 hydroxy metrageny, which is a semi-synthetic um uh version of Kratum that is much more concentrated and um much more dangerous.
• 8:11
  SPEAKER_03: And so um 7OH is available um over the counter in many states, um, and uh it's available uh in sometimes in gas stations, in um smoke shops, um, in marijuana shops, um, and uh uh you can buy it online.
• 8:32
  SPEAKER_03: And and so what's happened is because this is not a widely known um product and and not uh regulated, um it's been available to the general public, and the general public thinks, well, oh, it's over the counter, it's natural, it's herbal, it must be safe.
• 8:50
  SPEAKER_03: Well, you know, just like what happened with marijuana, which also in its natural form has some dangers, um, it's now highly concentrated.
• 8:58
  SPEAKER_03: And so we're finding that these more concentrated forms um are roughly um ninefold more potent than morphine, um, and five to twenty two times more potent than the um metragenine found in the Kraton plant.
• 9:17
  SPEAKER_03: Um and so these um uh this this 7OH it binds to opioid receptors.
• 9:25
  SPEAKER_03: Um and uh that's the same receptor in the human nervous system that uh you know opioids like morphine, heroin, hydrocodone, oxycodone bind to.
• 9:38
  SPEAKER_03: Um but it also has um some other like serotinergic effects, meaning that it increases serotonin levels and also um some um like adrenaline boosting effects.
• 9:51
  SPEAKER_03: And so we have this kind of sedative effect, um, you know, and this kind of pain-relieving effect.
• 9:57
  SPEAKER_03: And then we also have this stimulant effect, which um, you know, for someone who is looking to for energy, you know, and at the same time to maybe treat their anxiety um or maybe treat their pain, it's very easy to get addicted to this.
• 10:13
  SPEAKER_03: And and because of its strong binding to those opioid receptors, it becomes very hard to quit because it's not just a psychological um dependence, it becomes a chemical dependence.
• 10:26
  SPEAKER_03: And um and so some people who are already opioid dependent have been using this to kind of bridge themselves in between opioid uses, and then you have people who are on the you know, kind of on the street, who are in the lifestyle of substance abuse, you know, they might tell their friends, hey, you know, craton is a good alternative for you to use to you know help your help treat your opioid withdrawal, or maybe it's even something you can use to help recover from opioids.
• 10:55
  SPEAKER_03: And what happens is these people get very addicted to it, and it's so accessible.
• 11:01
  SPEAKER_03: Um, and then before long, um, they're using it um, you know, multiple times a day, sometimes multiple times an hour, and um it becomes very expensive.
• 11:12
  SPEAKER_03: Um, and uh and then it starts to cause you know um you know agitation, irritability, uh withdrawal symptoms in between uses, um, and sometimes even like a type of psychosis.
• 11:26
  SPEAKER_03: Um, and definitely there's toxicities like liver toxicities and renal toxicities that are at risk.
• 11:31
  SPEAKER_03: So if you'd like, I can kind of also get into uh just kind of the general prevalence in the United States.
• 11:37
  SPEAKER_03: Um would you like me to go through that?
• 11:39
  SPEAKER_02: Yeah, yeah, let's talk about some of that.
• 11:41
  SPEAKER_02: My patients, my listeners would like to know that, I'm sure.
• 11:44
  SPEAKER_03: Sure.
• 11:45
  SPEAKER_03: So um, according to the National Survey on Drug Use and Health, in 2023, uh there were 1.6 million adult users in the United States, um, and the use is growing.
• 11:59
  SPEAKER_03: Um there's an estimated 1.7 to 1.9 million past users um uh in in this past year, um, ages 12 or older.
• 12:10
  SPEAKER_03: Um the prevalence has been between uh 0.68 percent to 0.7 percent um in the United States over a year period.
• 12:21
  SPEAKER_03: Um lifetime estimates in in terms of like lifetime use um uh has been anywhere between 0.9 to 6.1% of the general population, which that I think you know, 6.1% seems pretty high to me.
• 12:37
  SPEAKER_03: Um, but it's even higher in the substance use disorder population, so people who already suffer from substance use disorder, that um these people might be anywhere between 10 to 21 percent like more likely um to use uh Kratom than the general uh population.
• 12:56
  SPEAKER_03: Um so uh we see that in uh typically it's it's more in white males, so more white males use Kratom or 7OH.
• 13:07
  SPEAKER_03: Typically the age range is 26 to 49 years of age, um oftentimes employed.
• 13:13
  SPEAKER_03: And I do see this many times with my patients.
• 13:16
  SPEAKER_03: You know, these are people who were um, you know, who might be moms, um, they might be uh um working moms or um other young adults who um you know have a job and they just were trying to you know use the stimulant they could get over the counter to try to help them function better.
• 13:36
  SPEAKER_03: Um, and before you know it, it's actually interfering in their work because they're so highly addicted.
• 13:42
  SPEAKER_03: Um and so um one of the things that uh really kind of um spurred my interest in doing a talk about this, which I gave um initially as a uh medical education talk for my hospital, and then um recently at the AAPS convention, um the reason I was interested in doing a talk on it was because of the fact that one of my nurse practitioners brought up um the emerging reality that because there is new legislation coming down from the federal and the state level to try to make Kratom and 70H illegal or at least highly regulated, we're seeing a lot of municipalities at the local level um stop selling Kratom.
• 14:32
  SPEAKER_03: And so we're seeing local restrictions on Kratom use.
• 14:36
  SPEAKER_03: And because of that and the um decreased availability of the more highly potent 70H, we're seeing that um there are a lot more patients that are going into withdrawal.
• 14:48
  SPEAKER_03: And so it's something really to be aware of, especially if you know our audience um is, you know, if any among our audience are using Kratom, thinking of using Kratom, or if they know people who are using it or using 70H, it may um not be as easily available.
• 15:06
  SPEAKER_03: Um, just as an example, um in my state of Southwest Missouri, we saw that as of this as of this month, um there currently is no statewide criminal um ban on Kratom.
• 15:19
  SPEAKER_03: Um, however, um we're seeing that um the DEA has announced its intent to temporarily place um 70H and related compounds into uh Schedule I, so that's a controlled um substance group that that severely restricts its use.
• 15:37
  SPEAKER_03: Um and that the FDA has seized large quantities of 70H, particularly in Missouri, um, and uh have considered it to be um unlawfully sold um as a supplement um or as a food item.
• 15:53
  SPEAKER_03: So uh so we're seeing places like Kansas City banning 70H.
• 15:59
  SPEAKER_03: Um and so uh in Missouri's attorney general has um reached some settlements requiring major distributors to suspend sales of Kratom and 70H products throughout the state.
• 16:12
  SPEAKER_03: Um so uh let's talk a little bit more um about what Kratom withdrawal would look like.
• 16:22
  SPEAKER_03: And so it's it's exactly the same as what you would see um for uh for opioid withdrawal.
• 16:30
  SPEAKER_03: So if you were withdrawing from morphine, heroin, osicodone, hydrocodone, um, you would see some of these same symptoms.
• 16:38
  SPEAKER_03: And so that could be anxiety, sweating, shakiness, stomach upset, um, diarrhea, nausea.
• 16:46
  SPEAKER_03: You could have low blood pressure, muscle aches, restless legs, or runny nose.
• 16:51
  SPEAKER_03: So it's kind of like what you would have with a really bad flu.
• 16:54
  SPEAKER_03: Um, and it really drives continued use because no one wants to go through that, especially if if they're using it to feel better, to feel more energized.
• 17:03
  SPEAKER_03: They definitely don't want to be down and flu-like.
• 17:07
  SPEAKER_03: And so it just really motivates these people to keep using and using and using um, you know, potentially every few hours, because that's one of the things.
• 17:17
  SPEAKER_03: Withdrawal um can begin two to three hours after your last um Kratom or seven OH use.
• 17:23
  SPEAKER_03: So that's why they end up in this vicious cycle of having to use every two to three to four hours.
• 17:29
  SPEAKER_03: Um and um so it has been shown that kratom use disorder um develops in about 12 to 29 percent of users.
• 17:39
  SPEAKER_03: So so up to about 30 percent of users um do uh do have um you know develop kratom or 70H use disorder.
• 17:50
  SPEAKER_03: Um it's definitely more common for the 70H product users uh because that is much more potent.
• 17:57
  SPEAKER_03: And so there's also toxicity, like I mentioned.
• 18:00
  SPEAKER_03: So toxicities can include symptoms of agitation, elevated heart rate, you know, so like a runaway um heart rhythm.
• 18:08
  SPEAKER_03: Um some people have had seizures.
• 18:10
  SPEAKER_03: Uh, respiratory depression is possible, but not as common.
• 18:13
  SPEAKER_03: That means where you can develop shortness of breath and decreased breathing.
• 18:17
  SPEAKER_03: Um, we do see that with opioids.
• 18:20
  SPEAKER_03: Um the let me let me ask you a question.
• 18:26
  SPEAKER_02: I don't want to get you off your track.
• 18:27
  SPEAKER_02: The the toxicity, the addiction, the ill effects that we're seeing, is that peculiar to the seven hydroxy or do the lesser forms do the same thing?
• 18:39
  SPEAKER_03: Yeah, it's more so from the seven hydroxy.
• 18:42
  SPEAKER_03: Um and and and that's just because it's it's semi-synthetic and it's highly concentrated, so you have much more higher amounts of metrageny.
• 18:50
  SPEAKER_03: Um, and you know, the the um with the kratom, you would have to use a real lot of it to have uh the same um symptoms.
• 18:59
  SPEAKER_03: But the thing is, is that typically what I've seen is that people who use Kratom end up using 70H.
• 19:09
  SPEAKER_02: They keep looking for the bigger, bigger.
• 19:12
  SPEAKER_03: And so so I definitely would not um recommend that anyone who is listening to me says, oh, well, Kratom is more natural, you know, and it must be safe.
• 19:21
  SPEAKER_03: Just know if you use Kratom, you're probably gonna end up using 7-0, and and then you're gonna be in a problem because um you're you're gonna be in a tough situation because it's probably gonna become illegal in your state, and if you become dependent on it, you're not gonna have access to it, which means that even if you thought you were never gonna have to go to an addiction recovery program and be put on opioid replacement therapy, there's a good chance you might be because you're not gonna like how you feel when you withdraw from Kratom or 70H.
• 19:50
  SPEAKER_02: Yeah, is the is the concept of being a gateway drug just gonna lead to other things and more serious addictions?
• 19:57
  SPEAKER_03: Yes, and that's why from my talk I actually called it Kratom the Trojan Horse, because I really feel like it's a it was a it's a Trojan horse to uh 7-OH, and it's a Trojan horse to other types of opioids and addictions.
• 20:11
  SPEAKER_03: So um, you know, so so uh if you are struggling or you know someone that's struggling with um uh Kratom or 70H dependence, um, I want you to know if there's hope.
• 20:22
  SPEAKER_03: And um I treat this uh just about every day in my addiction practice, and um so do my nurse practitioners.
• 20:29
  SPEAKER_03: Um we're very familiar with it now.
• 20:32
  SPEAKER_03: And um, you know, like three years ago, I probably had one patient for months, and now I have you know, like one patient a day in the addiction clinic, you know, that I'm seeing for this.
• 20:42
  SPEAKER_03: Um, and I've had days where it's multiple patients who I'm seeing for it.
• 20:46
  SPEAKER_03: And um, you know, we can treat withdrawal with medications that treat the symptoms.
• 20:51
  SPEAKER_03: So um, you know, clonidine, which is a medication that has been used for blood pressure and heart rate control, um, helps to kind of lower those um blood pressure and heart rate symptoms.
• 21:03
  SPEAKER_03: Uh, we use gabapentin for restless leg.
• 21:06
  SPEAKER_03: Um, dicyclamine is a medication that has traditionally been used for irritable bowel syndrome and um stomach cramps, and we can use it for those same type of symptoms from cratum withdrawal.
• 21:18
  SPEAKER_03: Um, we use undacetron, which some of you may know is zofran for nausea.
• 21:22
  SPEAKER_03: We can use other nausea medications.
• 21:24
  SPEAKER_03: We have muscle relaxers like cyclobenzoprene that we can use for muscle cramps, um, hydroxazine.
• 21:31
  SPEAKER_03: We can use that.
• 21:32
  SPEAKER_03: That's an ananistamine, and we can use that for anxiety or insomnia.
• 21:36
  SPEAKER_03: And then often for um also for insomnia, we can use trazidone or quitiapene, which many may know as cervical.
• 21:44
  SPEAKER_03: Um, so that's just kind of treating the withdrawal symptoms.
• 21:47
  SPEAKER_03: Um, and then you know, so a primary care doctor can do that.
• 21:51
  SPEAKER_03: Uh, urgent someone in the urgent care, you know, or in your emergency room can, and and they might even be able to put you on bufenorphin, um, which you Bupenorphin is the uh medication that we typically use to treat opioid replacement therapy.
• 22:06
  SPEAKER_03: And um these days you don't have to have the bupenorfin waiver, um which formerly was called the X waiver that um since uh 2000 was required for people to um or for professionals to provide opioid replacement therapy.
• 22:23
  SPEAKER_03: Um the laws changed a few years ago, but you don't require that.
• 22:27
  SPEAKER_03: So now your family doctor, your urgent care specialist, your um emergency room doctor may be able to start a patient on bufenorphin, but then they really will need to refer these uh patients out to an addiction recovery program, an outpatient addiction recovery uh program typically, like the one that I run.
• 22:47
  SPEAKER_03: Um, and uh so there um a patient might be put on maintenance opioid replacement therapy.
• 22:54
  SPEAKER_03: And so um the re you know uh one of the concerns that people um have expressed is you know, well, isn't it substituting one drug for another?
• 23:05
  SPEAKER_03: And my answer would be yes, it's substituting a much safer, safer drug uh for a much more dangerous drug, and it's also medically regulated, so there's less of a chance of uh overdose.
• 23:18
  SPEAKER_03: And um also because you have um you know medically prescribed and insurance-covered access to this medication, um, you're not gonna have this vicious cycle of withdrawal and then going out on the street or wherever you're going, you know, to constantly have to purchase um new fixes.
• 23:36
  SPEAKER_03: Um and so what we do is our goal is um, particularly with 70H and Kratom, um, is to hopefully get these patients off of buprenorphin.
• 23:47
  SPEAKER_03: And so we'll put them on it for a while.
• 23:49
  SPEAKER_03: One of the great things is that with Kratom or 7OH dependence, you don't typically have to use as much buprenorphine.
• 23:56
  SPEAKER_03: You know, with our with our opioid-dependent patients, we typically are using um anywhere from uh 12 uh to sometimes even as high as 32 milligrams of butenorphin a day.
• 24:10
  SPEAKER_03: Um, and oftentimes for uh Kratom or sedinal age dependents, uh, we're able to use uh somewhere or anywhere from like two to four um to maybe eight um milligrams a day.
• 24:23
  SPEAKER_03: And uh these patients tend to do really well.
• 24:26
  SPEAKER_03: And then over a period of time, you know, we have this as we develop this relationship with this patient, we talk to them and we say, you know, what are your goals here?
• 24:35
  SPEAKER_03: Um, you know, are you thinking that you might be ready to taper down?
• 24:39
  SPEAKER_03: And when they feel ready, um, we will do that and we'll see after a few weeks how they're feeling and if their kratom or 70H cravings are coming back.
• 24:49
  SPEAKER_03: We also try to get them into group support, we assign them a peer recovery specialist, we um get them into counseling if they're agreeable to do that.
• 24:57
  SPEAKER_03: We do frequent drug screens to help keep them accountable.
• 25:01
  SPEAKER_03: And um, you know, if they if they don't like to use the sublingual bupinorphin, um, or for some reason we feel like they're not being compliant with that, we have the option to use the injectable form, which is long-acting.
• 25:13
  SPEAKER_03: And so we can use um either there's weekly dosing um and there's monthly dosing of these injectables.
• 25:21
  SPEAKER_03: Um, and then um, which I haven't yet talked about, there is um a drug uh which is also used in addiction treatment for opioid dependence and alcohol dependence, and it's called naltrexone.
• 25:36
  SPEAKER_03: Naltrexone is available um as an oral form, uh, which is once daily, and it's available as a once-monthly um intramuscular injectable.
• 25:46
  SPEAKER_03: And so with that medication, it has no psychotrophic effects, it's only an opioid receptor blocker.
• 25:52
  SPEAKER_03: And so when we taper these patients off of their bufinorphan, we can put them on maltrexone, either the once-daily oral form or the once-monthly injectable, and that helps bridge them, you know, for weeks or months until they feel that they're ready to not be on anything.
• 26:11
  SPEAKER_03: And uh, we always recommend that they try to stay as closely involved with addiction recovery um as possible, you know, continue to come back for visits, and you know, we just even the drug screens can help keep someone accountable.
• 26:24
  SPEAKER_03: Um, but one thing to know about drug screens is that your standard drug screen does not test for uh 7OH or um or Kratom.
• 26:36
  SPEAKER_03: And so uh you have to um well, specifically the um rapid point-of-care drug screens, which are the uh you know urine um immunoassay drug screens, they don't test for it at all.
• 26:49
  SPEAKER_03: And so the send out drug screens very rarely include metragenine as uh a substance that they test for.
• 26:57
  SPEAKER_03: And so you have to ask your lab, like lab core or whoever you're using, there's millennium labs, there's um you know, four um, oh, what's some of the other ones?
• 27:08
  SPEAKER_03: Um anyway, there's there's quite a few labs that you can use.
• 27:12
  SPEAKER_03: Um, and uh ethos is one of them.
• 27:15
  SPEAKER_03: And so you can call your lab vendor and say, can you please test for 70H or metrageny?
• 27:24
  SPEAKER_03: And they can do that, and that allows you to help, you know, see if these patients are continuing to use, or it allows you in your family practice, your urgent care, or your emergency room to um see if someone's using in the first place.
• 27:38
  SPEAKER_03: Um I got you.
• 27:39
  SPEAKER_03: I got you.
• 27:40
  SPEAKER_03: That's good to know.
• 27:41
  SPEAKER_03: Yeah, so so that's pretty much um pretty much the story.
• 27:45
  SPEAKER_03: Um, you know, I just would recommend that you know doctors um start testing for this more, that employers start considering the possibility that um this might be something that's being used by employees, um, and that law enforcement be aware of it because this is something that can cause intoxication or toxicities.
• 28:07
  SPEAKER_03: Um definitely our our our emergency, you know, first responders, they need to be aware of it.
• 28:14
  SPEAKER_02: Well, a year and a half a year and a half ago, I I'd never even heard of Kratom, but in the last year and a half it is a constant issue in my family practice.
• 28:24
  SPEAKER_02: And you're you're right, it's a it's a burgeoning issue for family doctors, first responders, emergency rooms, and uh and I and I keep getting reports back from uh emergency room uh who are taking care of my patients that they are in fact uh intoxicated with kratom.
• 28:46
  SPEAKER_02: And so it's it's a bigger issue than people realize.
• 28:50
  SPEAKER_03: Absolutely.
• 28:53
  SPEAKER_03: So yeah, so I I um I did uh I recently wrote a book.
• 28:59
  SPEAKER_03: It's called Live Free or Diet, a holistic guide to finding faith, freedom, and abundant life.
• 29:07
  SPEAKER_03: I included in that book uh some information about uh addiction recovery, um, and also specifically about freedom and 7-OH and uh other forms of opioid dependence, um, and and you know, stimulant use disorder, alcohol use disorder.
• 29:25
  SPEAKER_03: Um, and you know, these are things that um they have.
• 29:29
  SPEAKER_03: There definitely is a moral um issue, there definitely is a behavioral issue, there definitely is a spiritual issue, um, but there absolutely is a chemical dependence issue.
• 29:41
  SPEAKER_03: And if we don't address all of those, um it's very difficult to treat the whole patient or fully address uh the uh substance dependence problem.
• 29:50
  SPEAKER_03: And so we have to treat the whole person, and uh that's what I'm about.
• 29:55
  SPEAKER_02: Where can people get a hold of your book?
• 29:57
  SPEAKER_03: Uh yeah, so again, uh my book is Live Free or Diet.
• 30:00
  SPEAKER_03: Um, and if you just search Live Free or Diet um uh or my name, uh Dr.
• 30:05
  SPEAKER_03: Kurt K-U-R-T Bravata, V-R-A-V-A-T-A, uh, you can find that on Amazon.
• 30:11
  SPEAKER_03: Um, you also can find it um on the uh the website for my book, which is livefree or dietbook.com.
• 30:20
  SPEAKER_03: Um, I do have an audio book, which I narrated myself, and so that's available um under LiveFree or Diet or under my name on Audible.
• 30:30
  SPEAKER_03: Um it you can get it at local um bookstores through their online books, uh bookstore, like Barnes and Nobles has it in the online bookstore.
• 30:39
  SPEAKER_03: I think ChristianBooks.com and some of the other Christian online vendors have it.
• 30:45
  SPEAKER_03: Um uh it's it's definitely not a money grab because I haven't even made back what it cost me to publish it.
• 30:51
  SPEAKER_03: And the book's been out for um the book's been out for almost two years now.
• 30:56
  SPEAKER_03: Um, but um, and that's why I went ahead and did the audiobook myself because I wasn't planning on spending any more money on it.
• 31:03
  SPEAKER_03: But you know, it's not about that, it's really just about putting tools in the hands of uh patients, but also in the hands of medical professionals.
• 31:11
  SPEAKER_03: You know, this book, I I really wanted to write a book that um was all about body, mind, spirit, holistic, comprehensive health and wellness, and that addressed it from a spiritual, um, psychosocial, philosophical, and medical standpoint.
• 31:29
  SPEAKER_03: And um got, you know, I get into all the supplements and you know, med, you know, some of the medications that can be used, and you know, all the behavioral interventions and all the things that we can do to improve our health and wellness from a body-mind spirit perspective.
• 31:44
  SPEAKER_03: And so I appreciate the opportunity to talk about that and um and to be on your podcast.
• 31:48
  SPEAKER_03: This is really great.
• 31:50
  SPEAKER_03: It was a pleasure to meet you the other day, and what a wonderful conference and such great speakers, and it was really enjoyable.
• 31:57
  SPEAKER_02: It was a good conference, a lot of good speakers, and and your presentation was one of the highlights.
• 32:02
  SPEAKER_02: I want you to know that.
• 32:03
  SPEAKER_02: All right, look, I'm gonna I'm gonna invite you back.
• 32:06
  SPEAKER_02: Uh he talked about Alpha Gal, which some of my listeners will will know a little bit about that, and when I invite you back, they're gonna know a lot about that.
• 32:17
  SPEAKER_03: So that would be great.
• 32:18
  SPEAKER_03: We'd love that.
• 32:19
  SPEAKER_02: All right, our time is up.
• 32:20
  SPEAKER_02: Uh, thank you, Dr.
• 32:21
  SPEAKER_02: Bravada.
• 32:22
  SPEAKER_02: Kurt Bravada is our guest today, and I appreciate him coming and sharing his expertise.
• 32:28
  SPEAKER_02: You're listening to More Than Medicine.
• 32:29
  SPEAKER_02: I'm your host, Dr.
• 32:30
  SPEAKER_02: Robert Jackson.
• 32:32
  SPEAKER_02: We'll be back again next week.
• 32:33
  SPEAKER_02: Until then, remember, Jesus loves you, your doctor loves you.
• 32:38
  SPEAKER_02: Until next week, I pray that the Lord will bless you real good.
• 32:44
  SPEAKER_00: Thank you for listening to this edition of More Than Medicine.
• 32:47
  SPEAKER_00: For more information about the Jackson Family Ministry or to schedule a speaking engagement, go to our Facebook page, Instagram, or webpage at JacksonFamily Ministry.com.
• 32:58
  SPEAKER_00: Also, don't forget to check out Dr.
• 33:00
  SPEAKER_00: Jackson's books that are available on Amazon.
• 33:04
  SPEAKER_00: The Family Doctor's People, the truth about life, and the first book and the Family Doctors People.
• 33:10
  SPEAKER_00: It's Truth A Doctors Beauty, what people need about.