
A Rare E.R. that Treats Opioid Addiction on Demand - CaliforniaKarl
https://www.nytimes.com/2018/08/18/health/opioid-addiction-treatment.html
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evincarofautumn
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.

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marcoperaza
> _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.

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evincarofautumn
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?

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marcoperaza
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._

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hackermailman
We have the same types of Suboxone clinics here plus a mobile clinic, so they
come to you to get clean [https://www.theglobeandmail.com/news/british-
columbia/a-bc-c...](https://www.theglobeandmail.com/news/british-
columbia/a-bc-clinic-is-showing-how-quick-treatment-can-get-patients-
offopioids/article33815291/)

Interesting France has been doing this since the mid 90s.

