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Comment by mattangriffel | Hacker News Reader

Mattan here (co-founder of Ophelia). We're certainly considering any options that are scientifically backed and evidence-based. Medication-Assisted Treatment (MAT) is the standard in the medical community among addiction specialists and it's proven to be the most effective solution.

Kratom is certainly one of the solutions that people trying to overcome opioid addiction are resorting to, but it's unclear whether it's effective — not enough studies have been performed, and it's not an FDA-approved treatment for opioid use disorder. There's also some evidence to suggest that kratom actually leads to more health problems than it solves [1].

[1] https://www.mayoclinic.org/diseases-conditions/prescription-...

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Yeah, I see the issue with relying solely on anecdote.

Re: safety of kratom itself: AKA (https://www.americankratom.org/) has had independent physicians look into each reported death involving kratom in the US, and all have involved various other substances of abuse, none have been exclusively cause by kratom.

When taking powdered leaf itself, OD is pretty much impossible since you end up vomiting. There are many extracts and such on the market, but most people I know partake of (including myself) are wary about strength and clarity of said extracts.

I'd love to see more of a push for some legitimate research, I think it's something that could be very effective in this space. Good luck with licensing and I'll be sure to share the service with ones I know are currently trying to kick opiods.

Thanks for your thoughts. I'm interested to see how kratom fits into the longer-term solution. An issue right now is that its formulation is not standard, so there are different brands with different concentrations, which makes it difficult to "prescribe" as medicne. Another problem is that it's sold at smoke shops along with vape pens and paraphernalia, so people who aren't already using opioids are trying it out of curiosity and becoming accidentally dependent.

Are you implying that you think kratom should not be available otc? If so you’re completely going against your mission of helping people get off opiates. I can add to the pile of anecdotes that I personally know 10-15 people who’ve used kratom to kick serious years-long addictions to oxycontin.

This is entirely anecdotal, but I know six people who've quit either heroin or prescription/illicit oxycodone usage via Kratom.

The only real problem to Kratom is that there is no standardization to potency or means of labeling.

The percentage content of the active alkaloids in Kratom (Mitragynine and 7-Hydroxy-Mitragynine) can vary widely, with the stuff sold in gas stations and smoke shops being particularly low-potency or volatile.

The worst that will happen in the event of a Kratom overdose though, is horrendous nausea and vomiting that will make you wretch at the sight of the stuff for a good while.

Another personal anecdote, I have been a daily user for several years and had periods of weeks/months without use due to inconvenient life circumstances (traveling, too busy to buy more, etc) and never felt any ill effects from sudden cessation. Some people online report the opposite, though I suspect this might be largely psychological.

I don't know if you guys are aware of it, but two other overlooked medications for opiate withdrawal/recovery are Baclofen and Loperamide (yes, Immodium, the drugstore constipation medicine).

Immodium is active at the mu-opiod receptor but does not cross the blood-brain barrier, and so is not psychoactive. This can help to ease some of the withdrawals without risk of relapse.

Baclofen is mildly psychoactive but helps with opiate and benzodiazepine or other GABA-ergic drug withdrawals, with much less of the risk factors associated with traditional medications like methadone or buprenorphine.

I second your anecdotes, it's been great within my friend group, especially with a few that were returning from deployment with injury and oxy prescriptions. The withdrawal-type symptoms are something I've also nothing I've experienced, I'm sure it's entirely psychological.

The industry is beginning to mature, with online vendors actively getting their batches tested before sales. Seeing % alkaline contents is a very nice thing to see from them.

Like most things on the internet, Reddit has a great community for this haha. But yeah, it's been really cool to see how professional and business-like the industry has come in the past few years.

It's fairly expected for a serious operation to provide analytical data on alkaloid content and/or employ dedicated quality control personnel these days.

It's not purely psychological, especially when you get into extracts or higher potency items, but it is very minimal comparatively.

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