6 ms·

I wonder if/when we’ll see clinics offering kratom as an alternative treatment for pain management and opioid withdrawal. There’s heaps of anecdotal evidence of

I wonder if/when we’ll see clinics offering kratom as an alternative treatment for pain management and opioid withdrawal. There’s heaps of anecdotal evidence of its effectiveness for helping people to get clean, but we’re lacking research to corroborate it, and I can imagine people are hesitant to start such research in case the FDA succeeds in banning it—on the basis of what seems to me junk science and fearmongering, I might add, but we’ll see. More to the point—a typical dose of kratom is less than $1; it’s hard to abuse since taking too much will just make you dizzy/nauseated/anxious, a mistake most users only make once; it doesn’t cause respiratory depression (doesn’t recruit β-arrestin2) so it (EDIT: probably, although we don’t know for certain) won’t kill you if you overdose; and if you’re in withdrawal, it will take you from “not fine” to “fine” within an hour without getting you particularly high or keeping you dependent like methadone/suboxone. There are certainly downsides—e.g., it’s moderately addictive itself and can interfere with testosterone like any opioid—but its potential utility in fighting the opioid addiction epidemic is clear. If I had my way, it’d be guaranteed to remain legal and available over the counter to people over 18, thoroughly studied for side effects and drug interactions, and recommended/prescribed as an alternative PRN treatment for withdrawal symptoms—and other conditions like anxiety, if you don’t want to get hooked on benzos. I know this: it saved multiple people in my life from opioid abuse, and myself from alcohol. That’s got to be worth something.

marcoperaza 8y ago
>it’s hard to abuse since taking too much will just make you dizzy/nauseated/anxious, a mistake most users only make once; it doesn’t cause respiratory depression (doesn’t recruit β-arrestin2) so it won’t kill you if you overdose; This is dangerous misinformation. It is known to cause seizures, psychosis, and liver toxicity, and some medical authorities say it does cause respiratory depression. It has been linked to several deaths. As with any drug, more research is needed, e.g. to isolate the effects from those of other drugs that users commonly take with it. But no one should be encouraged to put this stuff in their body.
- brogrammer5 8y ago
  Yes it can cause those things...in combination with other drugs but where is the evidence that it causes those symptoms on its own? Many drugs become deadly in combinations that are otherwise harmless on their own.
- evincarofautumn 8y ago
  You’re right—I’m absolutely not suggesting people go out and take it willy-nilly. I’m saying we have anecdotal evidence that it could be effective in a clinical setting, because people (including myself) are currently going out and taking it willy-nilly. Personally I would like it to remain available OTC but I’d be fine if it ended up scheduled for prescription only. It’s my understanding that there are no records of deaths that were clearly caused by kratom alone—but there are a few dozen cases that the FDA has published where someone has died with kratom in their system, usually alongside other drugs such as opiates, alcohol, benzos, or steroids—but also (and here’s where I call “junk science”) from a fall and a gunshot wound. We currently don’t know to what extent it interacts with other drugs—it’s a bad idea to take it with anything else that affects your breathing, or an MAOI. As for the “won’t kill you” claim: β-arrestin2 recruitment is responsible for the main deleterious side effects of traditional opiates, including respiratory depression, constipation, and tolerance buildup. These are reduced but not eliminated when taking kratom, similar to how morphine behaves in knockout mice lacking this protein. It could still certainly kill you, although the best estimate we have right now is “you’d have to take an awful lot of it”—probably via extracts, unless you want to eat a few pounds of leaves. Mitragynine and 7-OH-mitra are metabolised by the liver, and yes, there are some reports of liver toxicity. I have heard of seizures in cases where someone was already detoxing and susceptible. I had not heard of kratom-induced psychosis—do you have a citation handy?
  - marcoperaza 8y ago
    Wikipedia is citing the psychosis claim to: Warner ML, Kaufman NC, Grundmann O (2016). "The pharmacology and toxicology of kratom: from traditional herb to drug of abuse". Int. J. Legal Med. (Review). 130 (1): 127–38. doi:10.1007/s00414-015-1279-y. PMID 26511390.
- 8y ago
Nasrudith 8y ago
Reminds me of one radical proposal for dealing with addiction - anything is legal with a prescription if it is medically justified. To give an extreme yet logical example they could deal with a heroin addicted patient by a combination of therapy and evaluation of root causes while giving a tapering course of pharmaceutical grade to wean them off if they think that is the best option.

marcoperaza 8y ago

>it’s hard to abuse since taking too much will just make you dizzy/nauseated/anxious, a mistake most users only make once; it doesn’t cause respiratory depression (doesn’t recruit β-arrestin2) so it won’t kill you if you overdose; This is dangerous misinformation. It is known to cause seizures, psychosis, and liver toxicity, and some medical authorities say it does cause respiratory depression. It has been linked to several deaths. As with any drug, more research is needed, e.g. to isolate the effects from those of other drugs that users commonly take with it. But no one should be encouraged to put this stuff in their body.

brogrammer5 8y ago
Yes it can cause those things...in combination with other drugs but where is the evidence that it causes those symptoms on its own? Many drugs become deadly in combinations that are otherwise harmless on their own.
evincarofautumn 8y ago
You’re right—I’m absolutely not suggesting people go out and take it willy-nilly. I’m saying we have anecdotal evidence that it could be effective in a clinical setting, because people (including myself) are currently going out and taking it willy-nilly. Personally I would like it to remain available OTC but I’d be fine if it ended up scheduled for prescription only. It’s my understanding that there are no records of deaths that were clearly caused by kratom alone—but there are a few dozen cases that the FDA has published where someone has died with kratom in their system, usually alongside other drugs such as opiates, alcohol, benzos, or steroids—but also (and here’s where I call “junk science”) from a fall and a gunshot wound. We currently don’t know to what extent it interacts with other drugs—it’s a bad idea to take it with anything else that affects your breathing, or an MAOI. As for the “won’t kill you” claim: β-arrestin2 recruitment is responsible for the main deleterious side effects of traditional opiates, including respiratory depression, constipation, and tolerance buildup. These are reduced but not eliminated when taking kratom, similar to how morphine behaves in knockout mice lacking this protein. It could still certainly kill you, although the best estimate we have right now is “you’d have to take an awful lot of it”—probably via extracts, unless you want to eat a few pounds of leaves. Mitragynine and 7-OH-mitra are metabolised by the liver, and yes, there are some reports of liver toxicity. I have heard of seizures in cases where someone was already detoxing and susceptible. I had not heard of kratom-induced psychosis—do you have a citation handy?
- marcoperaza 8y ago
  Wikipedia is citing the psychosis claim to: Warner ML, Kaufman NC, Grundmann O (2016). "The pharmacology and toxicology of kratom: from traditional herb to drug of abuse". Int. J. Legal Med. (Review). 130 (1): 127–38. doi:10.1007/s00414-015-1279-y. PMID 26511390.
8y ago

Nasrudith 8y ago

Reminds me of one radical proposal for dealing with addiction - anything is legal with a prescription if it is medically justified. To give an extreme yet logical example they could deal with a heroin addicted patient by a combination of therapy and evaluation of root causes while giving a tapering course of pharmaceutical grade to wean them off if they think that is the best option.