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Comment by DickScarington | Hacker News Reader

It bothers me that in all the hype about Kratom the fact it does produce dependence is obscured.

I know a few folks who have had a terrible time getting off of Kratom. Only one of which is totally free of it.

All of their cases were similar, going from a small brew a day the first week to doing 6-10g a day within weeks.

People I know who still take it regularly remind me of addicts to other substances - claiming they can quit at any time but since they aren't having a problem they don't choose to quit.

Yet they also constantly crave Kratom and freak out when they can't get it.

Of course there are a lot of legal addictives - like a whole range of mood altering drugs like Xanax, Prozac, etc. - which are far worse long term.

That still doesn't excuse the unrelenting hype that Kratom is safe and that it isn't addictive.

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It does produce dependence if taken often enough.

However, compared to the harm caused by illicit opioids (or even prescription opioids) doesn’t this seem like a low priority?

So someone is spending $100 or $200 per month on their kratom. They aren’t committing crimes to pay for it, they aren’t overdosing and dying in the street and they aren’t getting diseases by sharing needles.

It doesn’t seem like a major health cocern.

Kind of like tobacco without the second hand smoke or lung cancer. Sure it would be better if people didn’t do it, but that’s true of a lot of things.

You would see the same level of harm reduction if other opiates were legal. My guess is that what makes kratom less harmful is the legal status.

False. Kratom (mitragyna speciosa) is unique in that it does not seem to trigger respiratory depression. So it’s not just the legal status.

However it is true that drugs like heroin (when pure) are quite safe overall - aside from the respiratory depresssion overdose scenario.

Wikipedia explicitly mentions respiratory depression as a side effect of kratom: https://en.wikipedia.org/wiki/Mitragyna_speciosa

I haven't checked their sources, though.

It may be a side effect of taking huge amounts of extract, but is not possible when consuming the leaves, as far as I know. I’ve known people who claim to take an ounce (28g) of leave per day without issue. (I take btw 2-8 grams in a day myself so I can’t speak to higher doses)

In general taking excessive amounts triggers vomiting, similar to when you eat too many psilocybin mushrooms (well, some say it’s ideal to vomit shroom-wise, but I’m not a fan). So mitragyna speciosa is incredibly safe.

Unfortunately Wikipedia’s treatment of the topic could be improved, but there is very little existing literature out there. I read one review study I was pretty happy with but I’m not on a laptop so i can’t go dig up the link unfortunately

I take a muscle relaxer that is non drowsy, yet it’s listed side effects include the same statements of drowsiness seen on all muscle relaxers. They slap the same side effects on drugs of the same class.

> They slap the same side effects on drugs of the same class

They spend billions on developing and promoting these, and they can't figure out the side effects for a specific drug? Maybe they should spend just a little bit more.

Does Kratom have other undesirable side effects? How is it on the liver? If the population present opiate users switched to Kratom, what would we see?

I've heard it causes pretty significant constipation in some cases. I guess that's undesirable.

It does cause some constipation, but it's nothing compared to that caused by even 'weak' opioids like tramadol or dihydrocodeine.

Instant end to opiate overdose deaths, for one.

Somewhat true, but that's only part of the picture. An extremely significant distinction is that, much like with cannabis, it is pretty much physically impossible to overdose to death on mitragyna speciosa by itself. It will make you feel terrible to the point of being non-functional, but it almost certainly will not kill you.

So it’s a painkiller that works as well as an opiate with a maximum dose that dwarfs the opiates. Sheesh. That alone should be enough to research its use for pain management

Back when the potential kratom ban was scaring everyone, I remember seeing a sign advertising clinical trials for those dealing with opioid addiction. The cynic in me wondered whether the trials were for some medication that mimicked kratom or any individual alkaloid

I don't think it has the same binding affinity as more powerful opiods which reduces it's addictive potential, as well the risk of overdose.

It activates mu-opioid quite strongly but not the other receptors as much (I forget their names).

Interestingly, it has a mix of opioid antagonists and agonists. I’m not sure if that specifically is why tolerance doesn’t build aggressively, or if it’s some other MoA like nmda receptor antagonism

> You would see the same level of harm reduction if other opiates were legal

We see huge harm from legal opioids which are widely mis-prescribed. They cause addiction and fail to treat the pain for which they are prescribed.

No particular opinion on kratom, but the problem historically with other drugs that produce a dependence is the dependence can exceed the amount someone can afford. The politician argument is that this will make them steal, etc

So I’d be careful with “only $x a month” as an argument.

Anyway if it is addictive it’s hard to imagine it being more addictive than oxycodone and that is totally legal and aggressively pushed by companies that know exactly how addictive it is, so mostly this goes back to the standard government motto of only making drugs legal if large companies can make a huge profit off it. Anything that can be easily grown by average consumers (like weed) doesn’t meet that requirement and so tends to be illegal.

Anecdote: about 2-3 years ago I was using about 10g/day kratom and 1gm/day caffeine to deal with chronic fatigue and muscle pain.

I was dependent on both for about 12 months just to function (without them I had a hard time getting out of bed or anything done). But the combo helped to finally get regular exercise, which helped with sleep, which helped me to heal.

The caffeine was _much_ harder to kick than the kratom. A full week of headaches and fatigue due to caffeine withdrawal.

When people talk of kratom being bad because it produces dependency, why don’t they talk of caffeine in the same way? What real negative effects does the kratom have if used long term? My experience says there is none. And all this handwringing is simply due to lack of familiarity.

1g of caffeine? That's like 25 cups of espresso. Have you had a cardiologic exam beforehand?

Its high, but it’s really not that excessive over the course of a day: https://cspinet.org/eating-healthy/ingredients-of-concern/ca...

TIL Starbucks coffee has a ton of caffeine. This explains why I'm super jittery every time I get Starbucks even though I drink (non-Starbucks) coffee every day.

So yeah, two freaking massive 20oz pours of highly caffeinated coffee will get you to around 1 gram.

But FWIW the daily recommended dose is 400mg. 1g is a ton of caffeine and way beyond what you would get to by sipping on coffee throughout the day (it's 10+ cups of drip).

I don’t know where you got 400mg/day. Last I checked it’s 160 mg/day.

https://health.gov/dietaryguidelines/2015 mentions that 400mg/day is the upper bound for moderate caffeine consumption but provides no citation.

I cannot find where the number originates, but there is at least one study @ https://www.sciencedirect.com/science/article/pii/S027869151... which explicitly claims "vidence supported consumption of ≤400 mg/day in adults is not associated with overt, adverse effects."

1g of caffeine is high, but with tolerance it doesn't seem _that_ high. I currently use 600mg/day to help with OCD[1], and it doesn't really effect me - heart rate barely moves, and I don't feel noticeably different. I've tried 1g, and it made me feel _slightly_ jittery, but that was about it.

[1] Counter-intuitive I know, but it seems to help - it makes the intrusive thoughts easier to ignore

There's no real reason to go cold turkey from caffeine. I've gotten to over 600mg/day. Not quite 1000mg though. :) Even so, when I have cut back (which I've done, multiple times) I just reduce my usage over 1-2 weeks and it's fine.

Something to consider is that your experience may not be representative of the norm.

My understanding was that kratom was more useful for harm reduction, rather than curing addiction, as it's still addictive but much less harmful than heroin.

It's similar to vaping or nicotine gum in that respect.

Nicotine gum actually uses a different metabolic pathway to uptake the nicotine which is less addictive than inhaling nicotine.

More precisely, there is a theory that nicotine becomes highly addictive in the presence of an MAOI which are naturally present in tobacco smoke, but not added to nicotine gum.

I was actually referring to inhalation vs ingestion; specifically how inhalation has a 10-20 second lag before the effects are noticeable whereas ingestion takes much longer - resulting in less behavioral reinforcement.

The MAOI theory is interesting, there are a lot of alkaloids in tobacco. Apparently nicotine uptake across alveoli membranes is very pH dependent - the ionic form won't cross the barrier. Cigarette smoke is cured at a high temp and has a low pH, pipe tobacco is cured at room temp and has a high pH. [0]

It seems that cigarettes are processed to specifically give a minimal dose per volume inhaled that quickly delivers nicotine as a way to maximize reinforcement behavior. I would be interesting to test the pH of commercial vaporization solutions.

[0]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953858/

Super interesting. Thanks for taking the time to clarify.

And so do video game addicts.

Just because something is dependence inducing doesn't mean it should be ever illegal.

If Kratom addicts start robbing convenience stores and offering blowies for Kratom cash i'll believe it.

Yeah. And even then, that would have to be a result of both addiction and the state drug war. Without the latter, the stuff is extremely affordable. I was curious if it would help with anxiety so I ordered about $8 of it, which was about 2 sandwich bags stuffed full of it! It made me feel physically nauscious for the entire morning and I took a very small amount. But I don’t think I would have been impaired driving. Drivers on opioids frighten the crap out of me.

> Drivers on opioids frighten the crap out of me

I don't mean this in an offensive way, but that's just because you're ignorant of the effects.

I suffer from chronic pain and use opioids every waking moment, but they do not impair my ability to drive safely.

Of course "being on opioids" isn't a binary thing; my medicinal dose is very different from a recreational one.

> Drivers on opioids frighten the crap out of me.

Is there any reason you personally feel that way or is it more of "opioids are strong and dangerous so I figure people driving on them is dangerous"?

We know that opioids impair ability to drive.

Of course, but it's obviously going to depend on the dose and the person's level of tolerance.

A few years ago the UK revised their regulations regarding driving while using prescribed opioids, taking an approach that essentially allows the driver to decide if they are too impaired to drive.

Actually, it looks like opioids are not associated with vehicle accidents

https://www.ncbi.nlm.nih.gov/pubmed/14650448

I'm not too sure that the data in that 2002 study is relevant today. opiate use has skyrocketed since then and it's reasonable to believe that things have changed. In my career as a paramedic, i've probably encountered more vehicle accidents where someone admitted that they have taken opiates (oxy/norco/etc) than anything. Yet it's not going to go down as a cause in many cases because while a blood test would show positive for opiates, it's difficult to pin it down. Alcohol is much easier to pin on drivers.

> If Kratom addicts start robbing convenience stores and offering blowies for Kratom cash i'll believe it

This has very little to do with the properties of a drug itself, and more to do with the demographics (poverty, unemployment, overall disenfranchisement, environmental factors like urban density and access to services) of people who use other drugs; specically, that usage of these substances often correlates with such disenfranchisement.

In other words, the people currently using Kratom may not be the same people using other drugs, and their circumstances may be different.

(Not a comment on Kratom, which I don't know much about, besides its popularity in some websites)

> Of course there are a lot of legal addictives - like a whole range of mood altering drugs like Xanax, Prozac, etc. - which are far worse long term.

Xanax is a benzo and is addictive, but Prozac is an SSRI. SSRIs are not addictive, and aren't even interesting recreationally because they don't make you feel anything good.

> SSRIs are not addictive, and aren't even interesting recreationally because they don't make you feel anything good.

And are distinctly unpleasant at higher doses.

They can be addictive though: https://en.wikipedia.org/wiki/Antidepressant_discontinuation... (at least in that they can cause withdrawal when stopped).

>going from a small brew a day the first week to doing 6-10g a day within weeks.

At small doses Kratom is somewhat of a stimulant. 6-10G is where opiate effects start kicking in, so I'd say doing 6-10G is perfectly normal for Kratom usage.

People I know who still take it regularly remind me of addicts to other substances - claiming they can quit at any time but since they aren't having a problem they don't choose to quit.

Is it worse than coffee?

Check its legal status in Malaysia and Thailand. [1]

Furthermore, some drugs such as khat, betel nut, or coca are mildly stimulating and used heavily in certain cultures throughout the world.

[1] https://en.wikipedia.org/wiki/Mitragyna_speciosa#Regulation

So because some people are idiots others should have to suffer? Kratom literally saved my life. I was hopelessly addicted to opioids and went from shooting heroin to ingesting plant matter. I agree that the opiate naive shouldn't stupidly throw themselves into opiate addiction but the idea that because some people can't handle themselves I should have to suffer is ridiculous.

I appreciate the concrete experience described in your comment, but please don't do this:

> So because some people are idiots others should have to suffer?

It degrades discussion and encourages worse from others. And since it was obviously not what the commenter was saying, it breaks the guideline which asks you to respond to charitable interpretations, not weak ones: https://news.ycombinator.com/newsguidelines.html.

Also, you've gotten into flamewars about drugs on HN before, and we had to ask you to stop. I get that you have reason to feel strongly about this topic, but that doesn't make it ok to bring sharp elbows into the conversations. If you can't be respectful, including to people who seem completely wrong, then please don't post.

Thanks dang.

I agree with this; I have witnessed Kratom aid people in quitting opioids, and when used properly as a quitting aid, it could help a great many people, should not be made illegal or placed under regulatory capture, and should be studied and brought into formal treatment. I personally keep some around in the rare instances where I would take ibuprofen or something similar.

In a similar vein, the generic drug tianeptine, prescribed for over 30 years in other countries for depression & anxiety, is now a schedule 2 controlled substance in Michigan (https://www.usnews.com/news/best-states/michigan/articles/20...), one of the major base states for the Johnson & Johnson corp, which studied the substance (https://adisinsight.springer.com/drugs/800039841) entering clinical trails for release here, but was dropped with no reasoning. Before some talking-head chimes in that tianeptine is a μ-opioid receptor, read the atypical part and addiction data in countries where it has been prescribed widely. It is the only drug which effectively treats my depression and anxiety, it is generic so large drug companies cannot make an exorbitant profit off of it, and they are keeping it from the US through media scare-tactics, like Kratom, to ensure their profitability and the reception of their patented drugs like https://en.wikipedia.org/wiki/Esketamine. We should stop them.

Tianeptine is a lot different than kratom though. I know it works really well for some people, but its abuse potential is far higher than kratom. I could never have it around, no matter how well it treats depression, because as a former opiate addict having something cheap and legal that feels pretty much the same as oxycodone (in massive doses compared to its therapeutic dose) is a recipe for disaster.

If only tianeptine could be made available in the correct (12.5mg) doses, prescribed by a doctor, maybe I could use it. But as it stands, buying powder by the gram would lead to my demise.

Thank you for that input; yes, the solution is a narrow bridge that has to balance the needs of people who use it as medicine with the potential for addiction (especially in the case of previous opiate dependency). This balancing act, though, gets severely unbalanced in the presence of profit incentives, leading to the media maximization of the addiction potential (or any negative really).

Just to be clear -- heroin is processed morphine, which comes from poppy sap. Cocaine is processed coca leaves. Nicotine is primarily extracted from tobacco leaves. Belladonna, strychnine and digitalis... just because something is made from a plant doesn't make it less of a drug or less dangerous.

The most dangerous drugs aren't really comparable, though. They tend to be processed concentrates of the plant, and in those cases the plant itself is much less harmful than the concentrate.

Consuming plant matter directly with minimal processing is quite a different thing from isolating the active ingredients as much as possible, creating dosages much higher than found in nature and simultaneously removing buffering material such as fiber and other nutrients.

Are you saying kratom is as dangerous as heroin? If not why post this?

They are saying just because it grew out of the ground doesn't mean it is safe. I found that pretty clear.

And how does that relate to what I posted? I clearly was not saying any plant is safe, I was comparing heroin and kratom.

Prozac/SSRIs are not like Xanax or even Kratom. They are very useful for withdrawal periods. Just don't take them for years at a time...

> Of course there are a lot of legal addictives - like a whole range of mood altering drugs like Xanax, Prozac, etc. - which are far worse long term.

I’m not quite sure it’s fair to lump all those drugs under addictive... Xanax is a benzodiazepine, but Prozac is an SSRI. Both can cause withdrawal symptoms if you stop too quickly, but neither are really classified as addictive.

Some of these drugs also profoundly impact people’s lives for the positive as well as actually save lives from severe depression. The constant idea that these drugs are somehow dangerous does much more harm than good to those who need it.

For some reason people have no issue with drugs like Nexium for heartburn (which can also cause dependence) but if it’s a drug that effects your brain... it’s labeled as evil.

And to clarify, addictive substances are not defined simply as something that causes withdrawal. Lots of things cause withdrawal... Tylenol can cause rebound headaches, heartburn medicine can cause intensified heartburn, etc. True addictives on the other hand also cause reward and reinforcement behavior. The strong reward stimulus effects molecular transcription factors that result in reinforcement behavior, which drives the addiction (not fear of withdrawal)

https://en.m.wikipedia.org/wiki/Addiction#Mechanisms

https://en.m.wikipedia.org/wiki/Benzodiazepine_dependence

Benzos cause dependence, and your link says this.

Dependency is different than addictive behavior.

If you read the whole page, it goes into more detail:

“Addiction, or what is sometimes referred to as psychological dependence, includes people misusing or craving the drug not to relieve withdrawal symptoms, but to experience its euphoric or intoxicating effects.”

Also if you read the link on addiction you’ll note that benzos are not listed as drugs that elicits true addictive behavior.

Can you become dependent on benzos... yes that’s possible. But people typically don’t seek out ever increasing doses to get high, which is an important distinction. And people who abuse them are often self medicating due to untreated anxiety disorders rather than to party or get high.

Stigmatizing medicine like SSRI and Benzodiazepines as addictive like opiates is misleading and harmful.

Benzodiazepines, if used under a doctors supervision and for limited duration, almost never cause dependence. Opiates on the other hand, even short term doses, can lead some individuals to become quickly addicted and start drug seeking behavior.

Doesn’t mean benzos are totally safe all the time, but it’s just not fair to compare it to opiates or Kratom.

I’m not in a position to argue the deeper details here, but superficially this thread has a tone that is pretty uncritical about benzodiazepines.

For persons scanning the conversation and absorbing the ambient folk opinions here on various substances — it is crucial to know that benzos are in fact very treacherous. You can die from them, they are highly abused, and they have a big tolerance effect as well as interactions (esp w alcohol) that can get folks in big distress or danger.

Not attempting to be uncritical of benzodiazepines, they can indeed be dangerous. Just trying to specify that they are not addictive in the same way. My understanding is that when they are abused in the sense of getting high, it’s usually in conjunction with opiates or other illicit drugs.

This is perhaps a more critical review, but still specifies the difference between physical and psychological dependence.

https://pro.psychcentral.com/benzodiazepines-are-bad-or-are-...

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