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Comment by Centigonal | Hacker News Reader

Actually reasonable decision from the DEA under RFK. Scheduling concentrated/semi-synthetic kratom products while leaving the weaker leaf-based products alone is a good compromise to reduce harm without criminalizing kratom (which has beneficial uses for opioid recovery and maintenance therapy) in general.

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Raw leaf Kratom seems to be helpful for some with what I would consider a manageable and acceptable addiction danger. You can get hooked on it, realize there is an issues and cut back or come off it without it destroying your life. I see no reason to make it illegal. I've even seen is used by people to get off "harder" Kratom concentrates. Sorta like how we regulate beer and wine a bit differently than whiskey... same drug, same abuse potential in theory but massive abuse difference in practice.

You have anything backing up the last bit? My intuition/life experience doesn't lead me to believe an alcoholic preferring whiskey is particularly worse off than an alcoholic preferring beer, nor that whiskey is more likely to lead one to alcoholism than beer. Claude surfaced this review tending to agree with me, with the exception of acute overdose being more of a risk with the hard stuff.

https://pmc.ncbi.nlm.nih.gov/articles/PMC3888958/

I read the article and it's a bit tricky to tease out but the negative association with spirits does exist. To summarize:

1. The quantity of alcohol consumed per occasion is most strongly associated with harms.

and

2. "The more alcohol was drunk per occasion, the higher the proportion of it which was drunk in the form of spirits"

The choice of beverage and how much was drunk was more dependent on cultural, social, and other factors.

My intuition tells me it's physically more difficult to consume more alcohol from a lower-strength beverage.

My intuition tells me most people can't put down whiskey like they can beer. My guess is both of these are actual relevant things that affect behaviors, but I have no idea which is stronger.

Your intuition needs to meet a Russian. Most whiskey, unless single cask/malt, is ~ 40%, same as vodka.

Hard liquor is absorbed faster than beer which leads to a stronger rush effect. It's similar to snorting vs shooting cocaine. When the effect hits faster, the psychological association between the stimuli and the effect (sensitization) becomes stronger.

This effect has been demonstrated with rat studies using cocaine:

https://onlinelibrary.wiley.com/doi/10.1111/j.1460-9568.2005...

Why would liquor be absorbed faster than beer given the same route (drinking)?

It's easier to drink more units of alcohol faster when it's more concentrated, and not full of bubbles.

I don't think its so much that it's absorbed faster than it's just physically possible to drink 200 ml of liquor faster than it is to drink 1600ml of beer.

Let's go Polymark on this one. We have a race to alcohol poisoning.

Alice gets ∞ of the Champagne of Beers. Bob gets one bottle of EverClear.

Ready. Set. Go

I think Bob wins.

One could also be obnoxious and argue that liquor is more easily concealed, transported, etc, therefore facilitating alcoholism more effectively by allowing a larger landscape.

But HN.

Fick’s Law. The rate of absorption is proportional to the concentration gradient.

Counterpoint: https://youtu.be/TLObpcBR2yw

Or, for that matter—the whole thing where Quechua folks chew coca leaf all day, and have for eons, without obvious ill effect…

Coca : cocaine :: kratom : the stuff that just got listed, right?

Counterpoint - the Quechua who did have issues with it likely died out long before any of us would be aware of it.

It has been helpful to me and many others. Some people do develop a habit. There are multiple subs on Reddit that are pro and con kratom. Personally, its all mental. I've used Kratom on and off, sometimes weeks, sometimes months. Once I'm done with my cycle, I drop it with no WD or anything. If I was using 7-oh, that would be a different story.

I agree this is a fine compromise. Sadly the zealots in my state won’t end there. They’re going after plain leaf powders too.

If it actually has beneficial uses let a doctor prescribe it. Kratom is extremely addictive and should be illegal yesterday.

The doctors will prescribe methadone or suboxone instead most likely, both of which are *massively* more powerful and addictive than kratom.

Prescribing opioids in the US is heavily monitored and scrutinized now. Doctors (and NPs, of which my mother is one) have to document the justification, meet state law restrictions, verify the prescription drug monitoring checks with their state, and complete the EHR workflows[†] before they can send in the prescription. There are more checks after that too that the pharmacist has to complete, and the insurance company will have oversight checks they'll do as well.

Not saying people can't or won't get addicted to the drugs prescribed by doctors, but there's a lot more checks and oversight to it (these days) than there is for kratom right now.

[†] At least in my mother's case, their EHR system will also flag opioid prescriptions for review by a board.

Suboxone is regulated quite a bit differently than full agonist opioids despite being a massively powerful drug. One can get a prescription online via Telemedicine for $100 and a 3 minute visit in almost all 50 states. This was started around covid to help mitigate the opiod crisis and lower barriers to access. Suboxone is CIII instead of CII like many opioids and used to have special prescribing requirements requiring a class, patient limits, etc but those have been lifted.

It may be a lifesaving/life-changing drug for many but it is also potent enough for a single dose to put a non-tolerant user in the dirt and is abusable for non-tolerant users just as any other opiod. It has been popular as a street drug in Europe for example for decades.

Checking on Quick.md, a Telemedicine service that prescribed Suboxone it is indicated for folks who are addicted to fentanyl, heroin, opiod pharmaceuticals and kratom/7OH. If you are not opiod tolerant you can put yourself in a coma today for $100 + pharmacy fees. No need to prove dependancy with a positive drug test, no therapy, nothing.

> If you are not opiod tolerant you can put yourself in a coma today for $100 + pharmacy fees.

But how likely are you to become addicted to it? How common are long term negative life outcomes when it is involved?

There are any number of easily available chemicals that can put you in a coma, permanently injure, or kill you. That was never the concern.

This is a very overblown assertion about kratom. I've heard of people getting addicted, but no one I've known personally has ever had any issues.

I have been using kratom almost daily for about a decade, and it has been one of the most useful substances for managing my physiology in response to my environment. It's great for stress reduction, but my most common use is actually ADHD treatment (which I doubt would be "on-label" if it went through the healthcare clusterf*dge)

The ability to self-titrate is one of **the most important parts**. I know how much I need, and when I need it. With doctors or psychiatrists, you gotta schedule appointments and then try out a dosage for a while, then schedule a recheck and refine the dosage, etc etc etc. I have not had much success with prescription drugs, and I have tried many

> This is a very overblown assertion about kratom. I've heard of people getting addicted, but no one I've known personally has ever had any issues.

My brother in law has a horrible kratom addiction. He now lives in a car with no insurance.

> I have been using kratom almost daily for about a decade

Hmm...

I'm sorry for your BIL. These things can both be true, though.

> but my most common use is actually ADHD treatment

Glad it's working out for you. My partner's brother had been trying to do the same and it has completely changed him for the worse. Blown up his job, marriage, relationship with his young children, and he's damned fortunate that his siblings were raised better than me 'cause if it were my brother we'd be done already.

Adderall had always worked fine for him but we're living in a world where it's exceedingly difficult to keep a Schedule II drug prescription active and fulfilled.

Youve never heard of someone being addicted but youve been taking it nearly every day for a decade? Do you hear yourself?

Taking something regularly for extended time does not imply "addiction". Otherwise we could include in that category any number of everyday activities; it needs to entail some sort of negative consequence, in spite of which you persist.

I don't experience any significant negative side effects from my usage. And BTW I also don't have a problem going cold turkey whenever I go on vacations.

Do I hear myself?! No, but I can read what I wrote.

I don't have any personal experience with kratom, other than just recently finding out an old friend is taking it for some reason or another.

Your comment string did remind me a bit about a video that popped up on my YouTube feed like half a year ago from someone I don't watch terribly often.

https://youtu.be/TLObpcBR2yw

Let's ban weed and alcohol from recreational use too, if there was any benefit a doctor would prescribe it. /u

You cannot prescribe a schedule 1 substance (which is what the temporary schedule has placed into), and even if you could, you need FDA approval of the substance unless it is medical marijuana which recently had a specific carveout making it federally legal to non-FDA approved dispense through state licensed facilities.

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