from youarewithinthenorms.com
NORMAN J CLEMENT RPH., DDS, NORMAN L. CLEMENT PHARM-TECH, MALACHI F. MACKANDAL PHARMD, BELINDA BROWN-PARKER, IN THE SPIRIT OF JOSEPH SOLVO ESQ., INC., SPIRIT OF REV. IN THE SPIRIT OF WALTER R. CLEMENT BS., MS, MBA. HARVEY JENKINS, MD, PH.D., IN THE SPIRIT OF C.T. VIVIAN, JELANI ZIMBABWE CLEMENT, BS., M.B.A., IN THE SPIRIT OF THE HON. PATRICE LUMUMBA, IN THE SPIRIT OF ERLIN CLEMENT SR., EVELYN J. CLEMENT, WALTER F. WRENN III., MD., JULIE KILLINGSWORTH, RENEE BLARE, RPH, DR. TERENCE SASAKI, MD LESLY POMPY MD., CHRISTOPHER RUSSO, MD., NANCY SEEFELDT, WILLIE GUINYARD BS., JOSEPH WEBSTER MD., MBA, BEVERLY C. PRINCE MD., FACS., NEIL ARNAND, MD., RICHARD KAUL, MD., IN THE SPIRIT OF LEROY BAYLOR, JAY K. JOSHI MD., MBA, AISHA GARDNER, ADRIENNE EDMUNDSON, ESTER HYATT PH.D., WALTER L. SMITH BS., IN THE SPIRIT OF BRAHM FISHER ESQ., MICHELE ALEXANDER MD., CUDJOE WILDING BS, MARTIN NJOKU, BS., RPH., IN THE SPIRIT OF DEBRA LYNN SHEPHERD, BERES E. MUSCHETT, STRATEGIC ADVISORS
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THE DISCUSSION
“Kratom in Crisis: Realities, Risks, and Community Challenges” is a video from “The Virtual Psychiatrist” YouTube channel, featuring Drs. Muhamad Aly Rifai and Norman Clement, who explore the complexities of kratom, a tropical tree native to Southeast Asia with active compounds that interact with opioid, serotonin, dopamine, and adrenergic systems.
The discussion highlights its widespread use in the US for chronic pain, mood issues, and opioid withdrawal, noting its accessibility through smoke shops and online retailers.
“..A vaguely written law can be applied both ways..”
norman j. clement rph, dds
The doctors also discuss the significant risks associated with kratom, including dependence, withdrawal, liver toxicity, seizures, and potential exacerbation of psychiatric conditions, especially with unregulated products and polysubstance use. They emphasize the lack of FDA approval and standardized medical protocols, advocating for more research, regulation, and public as well as medical community education.
Introduction to Kratom: Origins, Accessibility, and Active Compounds
Kratom (Mitragyna speciosa) is a tropical tree native to Southeast Asia, traditionally used by farmers to combat fatigue and boost productivity. In the US, it has seen a rapid spread and is now widely available in various forms (teas, capsules, powders) in smoke shops, online, and even gas stations, making it highly accessible.
Chemistry
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Molecular structure: Mitragynine
Molecular formula: C23H30N2O4
Molecular weight: 398.50 g/mol
- Active Compounds: The primary active compounds are mitragynine and 7-hydroxymitragynine. These alkaloids interact with opioid receptors but also affect serotonin, dopamine, and adrenergic systems, leading to a “weird mix of stimulant effects at low doses and opioid-like sedation at higher doses.”
- Demographics and Reasons for Use: US users are often “middle-aged, often men and a lot of them have private insurance and a decent income.” The main reasons for use include:
- Chronic pain
- Mood issues
- Managing withdrawal from prescription or illicit opioids (“People are desperate for alternatives and Kratom’s legal status and easy access make it appealing.”)
- Self-treatment due to lack of access to traditional healthcare or wariness of the system.
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How do the effects of kratom vary depending on the dosage?
Kratom’s effects are dose-dependent due to its active compounds, mitragynine and 7-hydroxy mitragynine, which interact with opioid, serotonin, dopamine, and adrenergic systems.
At low doses (1-5 grams), it tends to produce stimulant-like effects, increasing energy, alertness, and sometimes mild euphoria. At higher doses (5-15 grams), it acts more like an opioid, leading to sedation, pain relief, and a sense of calm.
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REFERENCES:
Unraveling Media’s False Opioid Narrative
This briefing document summarizes key themes and arguments from the provided sources, focusing on the critique of the dominant “opioid crisis” narrative and advocating for a re-evaluation of pain management, addiction treatment, and drug policy.
Tackling the 7-OH SO-CALLED Opioid Crisis?!?
What is kratom and what are its traditional and current uses?
Kratom, or Mitragyna speciosa, is a tropical tree native to Southeast Asia. Traditionally, farmers in countries like Thailand and Malaysia have used it to combat fatigue and boost productivity. In the U.S., it’s now widely available in various forms such as teas, capsules, and powders, often found in smoke shops, online, and even gas stations. Users commonly report taking it for chronic pain, mood issues, and, significantly, to manage withdrawal symptoms from prescription or illicit opioids, especially those who may lack access to traditional healthcare.
How do the effects of kratom vary depending on the dosage?
Kratom’s effects are dose-dependent due to its active compounds, mitragynine and 7-hydroxy mitragynine, which interact with opioid, serotonin, dopamine, and adrenergic systems. At low doses (1-5 grams), it tends to produce stimulant-like effects, increasing energy, alertness, and sometimes mild euphoria. At higher doses (5-15 grams), it acts more like an opioid, leading to sedation, pain relief, and a sense of calm.
What are the main risks and adverse effects associated with kratom use?
Regular, high-dose kratom use carries risks of dependence and withdrawal, with symptoms similar to opioid withdrawal, including restlessness, anxiety, sweats, nausea, chills, irritability, and insomnia. Adverse events can include liver toxicity, seizures, and in some cases, death, particularly when mixed with other substances. A significant concern is the lack of regulation for kratom products, leading to potential contamination (e.g., with salmonella) or adulteration with other substances, meaning users often don’t know what they’re consuming.
Can kratom affect mental health, and why is it a diagnostic challenge?
Yes, there’s growing evidence that kratom can worsen psychiatric conditions, particularly in vulnerable individuals, potentially triggering psychosis, mania, or full-blown mood episodes. This is due to its interaction with serotonin and dopamine systems. A major diagnostic challenge is that kratom metabolites do not appear on routine drug screens, making it difficult for clinicians to identify its role in a patient’s symptoms unless they specifically ask about supplement use. This can lead to misdiagnosis or delayed treatment, especially in communities with limited mental health care access.
How has the COVID-19 pandemic influenced kratom use?
During the COVID-19 pandemic, some individuals reported increasing kratom use to self-medicate for pain, anxiety, or opioid withdrawal, often due to amplified existing barriers to healthcare access, job loss, or financial stress. Interestingly, increased kratom use was less likely to be reported as “for the worse” compared to increased alcohol or tobacco use, with many users perceiving it as neutral or even positive. For some, it became a “stop-gap” measure when other support options were unavailable.
What is the current legal and regulatory status of kratom in the U.S.?
Kratom’s legal status is inconsistent across the U.S., being banned in a few states (e.g., Alabama, Arkansas, Indiana, Vermont, Wisconsin) but remaining legal in most others. The FDA has not approved it for any medical use, and the DEA lists it as a “drug of concern.” There is no federal ban, and products on the market are largely unregulated, lacking quality control and consistent labeling.
Why is there a debate surrounding kratom’s potential as a harm reduction tool versus a public health threat?
The debate stems from its complex pharmacology and user experiences. Proponents argue it could serve as a harm reduction tool, particularly for individuals seeking to transition away from more dangerous opioids, given its legal status and accessibility. Conversely, critics view it as an emerging public health threat due to the risks of toxicity, dependence, and psychiatric complications, compounded by the lack of regulation and scientific evidence on its safety and efficacy. There is insufficient large-scale, well-designed clinical trial data to definitively settle this debate.
What are the critical needs for addressing the complexities of kratom use?
Addressing the complexities of kratom use requires several key actions. Firstly, there’s a critical need for rigorous, large-scale clinical trials to establish its safety and efficacy. Secondly, improved regulation, quality control, and standardized labeling for kratom products are essential to ensure consumer safety and transparency. Thirdly, public awareness campaigns are needed to educate users about the potential risks, especially for vulnerable populations or those with underlying conditions. Finally, healthcare providers require better education about kratom to improve diagnostic capabilities, provide informed guidance, and manage potential complications or withdrawal symptoms effectively.
