For my time leading class I will be sharing with you all some of the work I did for my SIP over the winter. For a quick introduction to the subject please watch this 3 minute video that succinctly breaks down the issue: https://www.youtube.com/watch?v=IM35YnhaDTY&feature=share. If you do not have time to read this whole post and respond, the video will give enough background for you to think and talk about it.
The issue:
The opioid crisis has been a national story of interest in the U.S. for decades and has only been worsening. Hundreds of thousands of U.S. citizens have died in the past decade from opioid overdoses, and over 42,000 passed away in 2016 alone (Center for Disease Control [CDC], 2016). This is the story most of the nation is now all too familiar with, but many are unfamiliar with (or have been presented misleading or false information) of a more recent issue related to the crisis. The Food and Drug Administration (FDA) is attempting to eliminate public and private access to a substance that many assert to be saving countless lives. Some wonder if the agency is in fact involved in a massive, propagandized disinformation campaign against kratom. My SIP looks into what kratom is, why the FDA is determined to see that it be made against the law by the Drug Enforcement Administration (DEA), and why people in Kalamazoo continue to use the plant despite the agencies’ denunciation of it.
The DEA and FDA are prioritizing resolving the opioid epidemic, which entails passing laws against opioid analogues that are easily accessible to addicts. However, tens of thousands of kratom users, and several senators and congresspeople, have expressed concern that in addition to ignoring the root causes of the opioid epidemic, the FDA is striving to withhold the substance from those whose lives it is saving – many of whom suffer from opioid addiction. Enacting legislation that bans kratom, categorizing its users as felons, carries undeniable risk of worsening the opioid epidemic and creating “serious public health problems that do not presently exist” (Pinney Associates, 2016). However, before that issue can be addressed, we must understand the psychoactive plant.
Mitragyna speciosa, commonly referred to as kratom, is a tropical tree in the same genetic family as coffee and thousands of other flowering plants, the Rubiaceae family (BioMed Research International, 2015). It is typically used in its dried leaf, raw plant form to make tea, crushed and mixed with food, or filled into capsules. Many of the first reports of its use involve native workers in Thailand, a country where it is now illegal, chewing the leaves of the plant to get through their long and physically taxing workdays. Although indigenous to Southeast Asia, the plant has become a popular natural medicine in the U.S. (National Standard Research Collaboration, 2013). Lower doses of dried leaf kratom, e.g. .5-3 grams, yield a stimulating effect like coffee, whereas higher doses, e.g. 4 grams or more, induce mildly sedative and pain-relieving effects. Kratom also grows in a variety of strains, the most common of which are green vein, which is known to produce more stimulation, and red vein, which is typically taken by those seeking pain relief, sleep aid, or relief of opioid withdrawal.
Millions of people around the world take kratom for chronic pain; weaning off of opioids, alcohol, or other drugs; depression; anxiety; PTSD; and many other symptoms and illnesses. However, the FDA states kratom is just as dangerous as opioids; FDA Commissioner, Dr. Scott Gottlieb, recommended in November 2017 that kratom be categorized as a Schedule One drug. This came after their failed attempt to schedule the plant in 2015, which was met with such unprecedented resistance from active members of the kratom community; in the forms of petitions, emails, and phone calls to elected officials; that the law enforcement organization canceled their plan to schedule a substance for the first time. The Schedule One drug classification implies that the substances it lists are highly addictive and have no proven medical value or potential.
The FDA also claims that kratom is responsible for 36 deaths, which has been disproved by researchers, doctors, and scientists (FDA, 2017; Pinney Associates, 2017-2018). This is in my opinion the most damning evidence for the case that the FDA has ulterior motive in urging the DEA to schedule the substance in the most restrictive category. I will talk more about this Thursday, but if you are curious about this instance of government-sanctioned misinformation and misuse of medical data, here is a link to a well-written article by a journalist who helped me find the government records myself: https://www.huffingtonpost.com/entry/kratom-deaths-fda_us_5a7a3549e4b07af4e81eda8b
International shipments of kratom are increasingly being seized by U.S. Customs, even though hundreds of which are destined for states where the plant remains legal (United States Customs and Border Protection [CBP], 2015). As a local kratom vendor, this makes my job difficult when coordinating international shipments. Hundreds of thousands of pounds of kratom are not completing shipment to users and suppliers, despite the plant remaining legal in all but few states (CBP, 2015; Botanical Education Alliance, 2018). Enough is still delivered successfully to meet the demand of the legal U.S. market. However, Vendors in Indonesia and other foreign countries must fight for their right to sell to U.S. customers, diligently completing the proper documents to ensure their legal shipments are not intercepted by customs agents.
Kalamazoo is home to an active, informed, and growing community of legal kratom users, suppliers, and advocates. The community attracts supporters of legal and educated kratom use for a variety of reasons, but the most common are to avoid or quit opioids. Kalamazoo is disproportionately affected by the nationwide opioid epidemic:
"From 2015 to 2016, accidental drug-related fatalities in Kalamazoo County more than doubled from a count of 33 to 72. In other words, more people died of accidental drug overdose than motor vehicle accidents in Kalamazoo County last year. Eight out of ten of these deaths involved an opioid. In fact, the opioid-related accidental, crude death rate increased from 11 to 22 per 100,000 Kalamazoo County residents in 2016" (Kalamazoo County Health & Community Services, 2017).
The statistics for 2017 will be made available soon, but hope for more encouraging numbers is bleak in Kalamazoo. Current efforts are obviously not enough. Kratom shields millions from the trauma of the opioid crisis in small-scale communities across the U.S. If it works in these cases, implementing kratom into a large-scale, nationwide opioid recovery paradigm should be considered as a possibility.
Solutions:
This is beginning to happen in some parts of the country, although these efforts are met with objection similar to that which medical cannabis receives.
As the first of its kind, a controversial Portland program uses marijuana and kratom to treat opioid addiction: https://www.pressherald.com/2018/01/28/controversial-portland-treatment-program-uses-marijuana-and-kratom-to-treat-opioid-addiction/
The clinic discussed in the article above is basically my passion in a nutshell. Sometime down the road, perhaps if my business as a local vendor is successful, I could open a similar institution. Suboxone and methodone clinics can be found in every state, but these drugs are dangerous, fatal, and addictive, just like the drugs that cause the addiction they intend to treat. I will show you some interviews from participants in my study with experience with these clinics and why they prefer kratom.
Most folks in 12-step programs deny kratom's potential to treat addictions to opioids, alcohol, or other drugs and consider use of the substance relapse. Many recovering heroin addicts have been kicked out of treatment centers for using kratom rather than opioids like methadone or suboxone to treat their addiction, which substantially increases the recovering addict's chances of actually relapsing. Here is a decent article that discusses this issue and explains the importance of clinics like the one in Portland I would love to see emulated in Kalamazoo: http://speciosa.org/kratom-and-the-future-of-drug-rehab-centers/
As far as other solutions to this issue, the kratom community has displayed great capacity to work towards common goals. I would encourage you to check out the American Kratom Association (AKA). Their website is a goldmine of information on kratom, and educating people on the plant is part of solutions to both the opioid epidemic and kratom misinformation/ignorance. They also helped organize the efforts that encouraged the DEA to change its mind back in 2015: https://www.uspharmacist.com/article/the-dea-changes-its-mind-on-kratom. Calling and writing to representatives is a small but crucial part of the solution. It worked!
This community has some members in high places. Pinney Associates is a public policy organization specializing in abuse liability testing and abuse-deterrent drug products assessment. They have been on the front lines of producing unbiased, scientific research on kratom. They often produce results that contradict the FDA's claims shortly after they make them. Here is an article about their famous 8-factor analysis of kratom, completion of which is required by the DEA for determining whether or not a drug should be scheduled: https://medium.com/@anthonyroberts/eight-factor-analysis-on-kratom-peer-reviewed-published-in-medical-journal-d25f1c57164d
For your replies:
In your responses to my post I welcome any reactions, questions, or reflections regarding this complex issue. Here is a question to get you started: Has the growing opioid epidemic that plagues our nation and this city affected you, your family, or loved ones? You obviously do not have to share any details that you would be uncomfortable divulging, but talking about these issues and personalizing them is necessary to begin contemplating how to arrive at a future without them. That is a key lesson I learned in doing my SIP, and I will share excerpts from my Kalamazoo residing, kratom using interviewees.
I very distinctly remember the first time I was around recreational opioid use, at the winter dance my first year of high school. Several of my friends were pre-gaming the dance, and as a part of this 2 of them took Oxy that they got from one of their parents' medicine cabinet. We weren't at the dance long, and I remember part way through that they drastically changed from pretty intoxicated to worryingly sick. I remember being incredibly frightened as myself and other friends were trying to care for them at the after party, and debating whether we should contact parents or not. I'm fortunate that this is the most personal experience I have had with the opioid epidemic, and that my friends recovered without developing a habit (they didn't go near opioids again after that night). I think any substance that can help addicts reclaim their lives and avoid experiences like the one I described, or worse, would be a wonderful addition. However, I think the incredible controversy about Kratom makes any decision making about it incredibly difficult. It is incredibly hard to know who to trust, especially since support for or against it can be found at just about every section of the population in the United States.
ReplyDeleteI have a dear friend who has a loved one who struggles with drug addiction, though his drug of choice is not an opioid. What I've learned from her stories of trying to support him through multiple jail sentences and probations and attempts at rehab is that the system is actually set up to prevent him from effectively recovering from his addiction. The system is entirely punitive and exacerbates the conditions that cause him to turn to drugs in order to deal with his life. When I hear how much it costs my friend to talk on the phone with him or send him a package while he's in jail, I suspect that profit is a motive for keeping guys like him cycling through our court system.
ReplyDeleteHerbal medicine is something I know little about except to know that most indigenous cultures have a deep respect for plant-based medicine that goes beyond isolating active compounds and involves being in good relationship with the plant itself. I have also heard herbalists talk about the importance of ingesting plant medicines that are prepared properly and holistically--that sometimes when we isolate certain compounds from plants and reproduce them in labs, we miss out on the subtleties of how other compounds found within the plant work to catalyze the medicinal effects or reduce side effects.
I have similar questions to those that Rosie posed: what is the relationship of the people indigenous to places where kratom grows to this plant and how has its commodification affected them?
Two other thoughts:
1) Just thinking about how our relationship to plant medicines has been severed just as our relationship to food plants has been. And how dependent that makes us on the medical industrial complex.
2) Thinking, also, about the spiritual applications of plant medicine and how plants in some cultures are seen as helpers to guide people into different states of consciousness where wisdom and information can be gathered. I was struck at some point in the reading by the word "clean" in reference to a person free of consciousness-altering substances and wondered why we have chosen to describe drug use as "dirty." And why "dirty" has such a negative connotation anyway. I guess my point is to notice how ingesting consciousness-changing plants is seen as degrading in our culture and how our culture has produced circumstances under which people taking drugs are harmed---in contrast to cultures for whom ingesting mind-altering plants/animals/mushrooms is seen as a spiritual act that must be performed in sacred ceremony where the person/people taking the drugs are supported in coming through the experience safely.
I only know of a few distant relatives and family friends of mine who have struggled with drug addiction. The stories I’ve indirectly heard are heartbreaking, and show the personal emotional, psychological, physical, and familial destruction engendered by the opioid epidemic. I had never heard about kratom (probably on purpose because of the criticism by the FDA and DEA, and attempted coverups from rehab centers and pharmaceutical companies), so I am grateful that you are willing to share, and likely educate us about this issue. What a fascinating SIP! (I would love to hear more about your idea of opening up an rehab clinic during class, if you’re willing).
ReplyDeleteMy initial reactions when I watched the video and read the articles were of anger and sadness. Here are rehabilitation centers, pharmaceutical companies, and even federal agencies that are choosing to put their profit ahead of their clients/the general public’s wellbeing (people without whom they would be powerless) by restricting access to kratom, or by denying the seemingly clear benefits of it. The evidence (scientific, statistics, and anecdotal) seem overwhelmingly positive for the safety/effectiveness of kratom as an alternative to opiates or tool to quit opiates. Of course there is the potential for abuse, but due to the nature of kratom, that potential seems far less than comparable drugs. As Paul Kemp says in his post, “opiates are not helpful in allowing people to think through their problems…Kratom however, blocks pain, but also allows the subject to sort out their problems so they can move forward.” I enjoyed reading Kemp’s post for it’s compelling personal anecdotes. I tend to side with the accounts of people, rather than controversial institutions. It’s easy to get lost in statistics and political jargon of large agencies/corporations, but when I hear the success stories of actual ex-addicts, I am more convinced that kratom is one of many viable solutions to the opioid epidemic.
Here are some of my questions:
Why is kratom now illegal in Thailand? Is it illegal in other countries? How does the export of kratom from southeast Asian countries to the U.S. operate, and how has it impacted the people who live there and harvest it?
What do you think about recovery homes like the one in the Portland Press article? Are they a good alternative to rehab centers, but need more regulation? Which rehab centers are most responsible and effective in their treatment approaches?
Looking forward to hearing some of your interviews from Kalamazoo residents!
My personal experience with opiates has been limited to acquaintances taking pills recreationaly, and I've never been too impressed with the outcome. However, based on what I've read about the opioid crisis, it is hard to accept any other explanation other than that there is coordinated effort to get people addicted to prescription pain medication. If there's any more devious example of greed run amok, I can't think of it. However, now that it has become entrenched in the system and dug in its roots, it becomes incredibly difficult to change. I've read about rehab homes that serve as little more then holding areas, designed to milk their patients insurance of that last little bit of cash. Because the system is structured in a way to maintain addiction, it isn't surprising to me at all that there is pushback against anything that might alleviate that addiction. Kratom, and its users are simply another casualty.
ReplyDeleteHowever, the compliance of the US government in reinforcing the status quo further muddies the waters. It is deeply concerning to me that there we must now question the motivations of institutions like the FDA that were put in place to protect the consume. There is only so much responsibility we can put on our definition of a well-informed consumer.
The closest I have been to the opioid epidemic is seeing my cousin struggle with addiction to Oxy, as she was using it for back pain. Her dependency, however, did not last as long as it does for many and after about a year she was off of it. I don't want to go into too much detail on her experience, but I know that it was something she struggled with mostly because of her being prescribed it by a doctor, which offered her a sense of confidence in it that made it hard for her to think of it as not only a drug, but as a drug that can be addictive. I think this crisis very much stems from Big Pharma and the overprescribing of drugs by doctors, as a lot of medicine today has become centered around what drugs to prescribe rather than seeking other potential treatments. My cousin's experience occurred before the opioid crisis was really a thing that people talked about, which made it an even harder situation to grasp at the time, and it honestly was not until I got to college that I learned about the opioid epidemic and was really able to put the whole experience into perspective. I think it's really important to talk about this crisis and I'm really happy you're bringing this discussion to the table.
ReplyDeleteThis post is the first I have ever heard of Kratom and how it can be used to help ease people off of opioid addiction. If this is helping people manage their opioid dependencies, then I definitely think it should be made available. At this point, if Kratom and other substances, such as Marijuana, that help people manage their dependencies and ease their addictions can be classified as a schedule one drug, why haven't the opioids that make the opioid epidemic possible be classified in this way as well? I find the whole situation of the government attempting to make Kratom illegal really sketchy and it seems to only lend a hand to prolonging the opioid epidemic that is currently occurring. Perhaps this is the outcome that Big Pharma wants, as they are literally making money off of the opioid crisis, but this overlooks how many lives are lost to it and literally places corporate wealth over human health, which is sadly a common theme in our society and our class thus far.
When thinking about opioids, I immediately think of my father. My father - and many other Polynesians- has had a hereditary vulnerability for gout and has turned into chronic gout. During the beginning of his treatment, he became addicted to hydrocodone. This was apparent through my entire childhood as he would experience excruciating pain and be in the need of relief. Many times he was aware of his addiction and would wait the pain out in order to avoid taking the pills. Almost every time he would break to the pain.
ReplyDeleteI think of him and something he said once: "there is probably something in a forest somewhere for me". He may have been right with Kratom however, I wonder at what cost. when I think of Kratom, I think back to coffee and tea and their history in our globalized world. At what cost do we receive coffee in our mouths today? I wonder in what ways the move to make legal Kratom would participate in neo-colonialism as it comes from Southeast Asia. I am thinking back to the city of Jakarta. If you haven't already, I would read about it because I think it offers us a story we mustn't forget if we are to engage in Kratom cultivation. The first corporation in the world - the Dutch East India Company - comes out of this colonial space.
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ReplyDeleteLike mentioned before, this information of Kratom is new to me. The closest person who went through a heroin addiction is my cousin. She was kind of like an older sister to me. It was heartbreaking to hear how much time it is taking her to let go of these drugs. Social services had to take away her kids because of her drug use and abusive partner. I believe she had to take specific classes from her rehabilitation center to deal with her addiction. However, her rehabilitation center did not provided her to take substance like Kratom or marijuana, to help substitute her cravings for heroin. Even though she was not given these substances as a form of recovery, my uncle would not be okay with these substitutions. From my personal experience, the older generations of my family are still not okay with marijuana usage because of the misconception that a new addiction. They believe that getting on opioids or any type of addiction, is part of the suffering component of “getting better.” This is not the right mindset because instead of helping others, they are making it harder for the person to get better. Now that recreational marijuana is legal in states like California, I wonder if there will be a push for programs for people to learn how substitutions like Kratom and marijuana can help to deal with opioid addiction. Maybe there is, but it is not very talk about until you or someone you love in going through it.
My closest encounter with the fatality of heroin was my old babysitter, who died of an overdose a couple years ago. He had been clean for about a year, and seemed to be turning his life around, when he overdosed. In a letter he wrote about how being clean and sober was too difficult. I wonder if a drug like Kratom could've kept him alive and off heroin.
ReplyDeleteI've read about methadone, and how it can be as dangerous or addictive as heroin, so that doesn't seem like a very good substitute. I think the relationship of PhRMA with the government and the cost of life saving drugs is tragic. Capitalism/greed has plagued our society so much that saving people's lives is less important than making money off drugs.
I think recovery homes are probably good, more holistic treatment than what you might get at the hospital is needed when you are trying to get off such a addictive substance.
I agree with what John was saying in class about the problems from trying to get the highest high, and synthesizing/extracting from plants to get to that high. It reminds me of the poem "The Perfect High" by Shel Silverstein. https://allpoetry.com/The-Perfect-High
Overall good poem. Some of the lines will strike a drug user as cliche, but the last line sends shivers down my spine. Especially considering all this.
DeleteI do not have any direct experiences with this epidemic, but I know plenty of folks who deal with the struggle of addiction everyday. It is not something that should be taken lightly and I believe that kratum is a good solution to this as long as it is used in moderation. I know a few people who take kratum and all of them have had only positive experiences with it it terms of treating drug addiction.
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