A deep dive into kratom, the herb that helps with opioid withdrawal


#1

Originally published at: http://boingboing.net/2016/12/01/a-deep-dive-into-kratom-the-h.html


#2

Kratom sounds like an old god in the Conan universe.


#3

By Crom you are right!


#4

Reminder: kratom mitigates pain and addresses the symptoms of opioid withdrawal because it contains opioids. See, for instance, the 2014 book Robert B. Raffa: Kratom and Other Mitragynines: The Chemistry and Pharmacology of Opioids from a Non-Opium Source. You could get the same effect from raw opium. (Which, by the way, is Schedule II.)

Do not fall for the appeal-to-nature fallacy just because this time it’s prominently white people addicted to plant such-and-thus. Drug policy needs change, yes, but that’s because it works better to treat opioid addiction as a health problem for everybody-- rather than as a health problem when it’s white people and a crime problem when it’s everyone else.


#5

It’s an opioid in that it interacts with some (but not all) of the opioid receptors. Its effects are different from the common opium-derived opioids though, in that

  • it doesn’t produce nearly as much of a ‘high’ type reaction, per amount of pain relief provided
  • it apparently doesn’t produce as much tolerance over time
  • it doesn’t produce nearly as much respiratory depression, per amount of pain relief provided

So, while the major opioid risk factors for addiction and overdose are certainly present, but less than with other opioids.

It also allegedly leads to vomiting if you take too much, so a tendency to steadily increase doses to overcome tolerance is somewhat self-regulating. Of course, if it becomes illegal, then probably any market for it will switch from raw plant matter to white powder, so the substances in the plant that cause vomiting will be eliminated, and it will become more dangerous…


#6

Interesting claims. Do you have citations for any of them?

(Incidentally, all the opioids cause vomiting.)


#7

I hadn’t known that opioids generally caused vomiting - I’ve only needed codeine in fairly small quantities on a few occasions, so little chance to learn that.

I was mistaken about the receptors - it seems kratom interacts with all the opioid receptors.

http://www.emcdda.europa.eu/publications/drug-profiles/kratom notes “The withdrawal symptoms in humans are relatively mild and typically diminish within a week.”

https://en.wikipedia.org/wiki/Mitragyna_speciosa#Respiratory_depression mentions that e.g. “In animal studies at very high doses, mitragynine caused respiratory depression, but less than morphine or codeine.” and that the CDC’s 2016 report on Kratom exposures lists symptoms observed - nausea, drowsiness, tachycardia etc. - but not respiratory depression


#8

I really want to try the stuff because OMG NATURAL CRACK ROCK HFS!!!11!

but first… how the fuck do you pronounce it?

kraw-TOM
KRAW-tom
kray-TOM
KRAY-tom
Kraaaaa-TOM…
Etc.

I will look it up on Pronunciation Manual.


#9

I pronounce it like a crack of thunder.

Kraka-THOOOM.


#10

Dec. 1st is the deadline to register a formal comment with the DEA, if anyone’s interested.


#11

Those are something, at least, but they don’t actually serve as cites for the part pharmacologists want: better efficacy relative to the severity of negative side effects.

You shouldn’t be surprised at that characterization about withdrawal: flat-out cold turkey opioid withdrawal ALWAYS takes about a week, because that’s how long it takes the neurons to go back to producing more-or-less regular quantities of the neurotransmitters that work with the opioid receptors. (That doesn’t mean the addiction goes away-- just the gross symptoms of acute opioid withdrawal.) “Relatively mild” doesn’t help, either; again, with all the opioids, someone taking only a little of the stuff on a regular basis is going to have mild withdrawal symptoms, while someone accustomed to taking a lot is going to have severe ones. Kratom is still sold as a plant, with relatively little active ingredient in it and a lot of other things in it in addition to the opioid, so it’s tricky TO consume enough of it to have a serious opioid habit. (Modulo the purity issues, of course; if the “kratom” is actually oregano and fentanyl, that’s a whoooole 'nother ballgame.)

Similarly, while respiratory depression activity “less than morphine or codeine” is hopeful (and Wikipedia cites to the Raffa book on the point, which is at least kinda credible), that’s not uncommon; opioids that are relatively slow to bind to the receptors show less of that effect. (See Opioids and the control of respiration; the point’s discussed in the paragraph just below Figure 3.) The real question is HOW MUCH less, and to what extent it comes with the usual tradeoff: reduced effectiveness as an analgesic. (This tradeoff is why the opioids usually prescribed for pain relief, like morphine, aren’t the same as the opioids prescribed for opioid withdrawal, like methadone and buprenorphine.)

It’s not like scientists (and fellow travelers like me) just heard of kratom recently. Folks have been looking at it since the 1970s (Some observations on the pharmacology of mitragynine). Pharmacologists aren’t proud; if there was any evidence the stuff wasn’t just Yet Another Opioid, we’ve had plenty of time to take note of any weirdnesses about it.

Fortunately, there exist real compounds that have been PROVEN to be especially useful for opioid withdrawal, complete with diminished potential for abuse, notably the aforementioned methadone and buprenorphine. (Also dating from the 1970s.) Improved access to real drug treatment programs is the slow, painful, expensive way that works.


#12

and that reminds me.


#13

Kratos is a demigod in a Playstation version of the Greek mythos.


#14

Gee, I wonder if the demographic for users skews heavily white as well as middle-to-upper class. No wonder Congress actually responded.


#15

Release the Kratom!


#16

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