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Kratom is a new drug, recently introduced to American markets. Its usage has stirred a debate between ardent followers and stalwart opposition about whether it’s a new, all-natural dietary supplement and possible painkiller, or just another opioid to add to the pile. Here’s an FAQ to shed some light on the substance.
What is kratom?
Mitragyna speciosa. This Southeast Asian tree and close relative of the coffee plant has long been a controversial plant in its
native land. Some locals use it as traditional medicine, some farmworkers use it as a stimulant before a long day in the fields, others mix it into alcoholic cocktails for recreation. Its leaves contain compounds that produce mind-altering effects, making the plant a source for painkillers and recreational drug use. People in America have found many uses for it in the past six years, ranging from dietary supplement to coffee substitute, from opioid withdrawal medicine to recreational substance.
What are the effects of kratom?
Kratom’s chemical makeup affects the brain in ways similar to stimulants and opioids. The plant contains two compounds that interact with opioid receptors in the brain. These chemicals can cause mild stimulation in small doses, alleviate pain in medium doses, and induce euphoria in large doses. Individuals who use kratom as a stimulant experience increased alertness and energy.
Its health and behavioral effects, which can range from mild to severe, include:
Loss of appetite
Does kratom make you “high?”
Kratom affects the brain by altering its chemistry. Similar to opioids, it can produce a euphoric effect, or “high.” The compounds in opioids cause a flood of the brain’s neurotransmitters, which regulate moods and influence decisions. They cause a person to feel euphoric and reduce the sensations of anxiety and pain. Kratom interacts with the body in a similar way but its effects vary on the dosage taken. These effects of kratom come on quickly and typically last five to seven hours.
Can you overdose on kratom?
While there is no official medicinal research, overdose from kratom is highly unlikely, unless it is taken in anomalously large amounts or mixed with other substances. While kratom hasn’t been linked to overdose, there have been deaths reported by the FDA, where it is possible that kratom reacted negatively with other opioid and alcoholic substances, inducing a fatal overdose.
Is kratom addictive?
As with other drugs that produce opioid-related effects, kratom can be addictive. With continued use, it can also cause physical dependence, leading to withdrawal symptoms if the user stops taking it. These symptoms include hostility, irritability, insomnia, muscle aches, jerky movements and aggression. People seeking to beat kratom addiction have found behavioral therapy helpful.
Is kratom legal?
Kratom only started circulating widely in the US in the last six years. Currently, it is a legal substance in the US on a federal level. It is often marketed as a dietary supplement and sold in powder or tablet form in tobacco and head shops.
However, some states have banned the substance or are currently working to ban it. The FDA and DEA came close to placing kratom on the list of Schedule 1 drugs (which includes heroin and LSD), but withdrew the decision after massive public outcry, specifically from recovering opioid addicts who used kratom to ease withdrawal symptoms. The future of the drug’s legality is still up in the air.
Thousands of people are unnecessarily dying because we misinterpret how those struggling with addiction think, according to a philosopher, German Lopez.
After a year of reporting on the crisis, Lopez claims the stigma against addiction “is the single biggest reason America is failing in its response to the opioid epidemic,” and to overcome that stigma, we need to first understand it.
In 2016, 42,300 people died of an opioid overdose. Yet treatment programs, medically assisted treatment (MAT), and harm reduction policies (like needle exchanges and supervised injection sites) exist. Lopez argues that the success of these programs has been inhibited by the perception that addiction is a moral failing, along with the myth that helping a person suffering is somehow enabling them, rather than helping them find sobriety.
Cursed By Stigma?
A recent Vox report featured a felony treatment court judge referring to MAT as a “crutch.” That same judge went on to say that, according to the former health and human services secretary, Tom Price, the person is “just substituting one opioid for another.” In Indiana, county commissioner Rodney Fish blocked a needle exchange program, quoting the bible in his reasoning.
While advocacy groups and people speaking openly about recovery have helped change the perception of addiction, there are still many who believe it is a matter of choice – that we have the power of choice to take the drugs over the negative consequences. In choosing drugs, we’re viewed as having weak character or poor judgement.
It is this kind of stigma that Lopez claims is doing the real damage. Philosophically, he believes this is caused by the misguided belief that people always do what they think is best, and that their actions reflect their values and beliefs. Yet, when people take drugs and develop substance use disorder, the power of choice has gone. They are motivated much less by their morals and values and more by their need to fulfill a physical addiction.
The Flawed Philosophy of Addiction
Lopez argues that this flawed philosophy of addiction is what shapes our treatment of it, whether we’re aware of that or not. This is evident in the idea that someone has to hit a rock bottom – to experience the grave consequences of their choices – before they can find recovery.
Another example of that philosophy is that MAT and needle exchange programs are viewed as a means of enabling, mitigating the issues, and leaving the underlying problems unresolved. If that were the case, then why are more and more people finding recovery before they get to deaths door?
Could we adopt a more sympathetic view of substance use disorder? Lopez argues we can. In doing so, he suggests that we need to change our perception of addiction. For example, we must recognize that powerful drugs have the power to hijack rational choice in favor of pleasure.
It is by understanding these scientific facts, as opposed to unfounded judgments, that we might start viewing addiction as a disease instead of a moral failing…and improve our chances of beating this epidemic.
Gavin’s family knows he needs help. Gavin knows he needs help. At 16, he is on a destructive path of addiction that will soon lead to overdose and death if he doesn’t change direction – fast. But the thought of rehab is frightening – to both Gavin and his parents.
What goes on in there? What will happen to him? Is it even worth the time, effort, and money?
These are common questions among parents and teenagers. The thought of your child going to rehab can be intimidating, especially for teens. Knowing what to expect and how it can benefit your teen can help. Here’s the scoop…
What Goes on in There?
Each treatment center may vary on the details, but teens can generally expect the following activities and therapies while in rehab:
Daily therapy sessions
Consistent medical check-ups
Regular meals and snacks
Supervised free time with peers also in recovery
A strict routine and structure (possibly with tiered levels, with increasing amounts of freedom based on success)
What Are Some Benefits of Teen Rehab?
A teen recovery program can provide multiple benefits to teens and their families. A few list-toppers include:
New environment: When a teen enters rehab, they enter a fresh environment. They are removed from the normal pressures of their lives, including their usual triggers to use drugs. They can focus solely on their recovery. The time away gives them a fresh start, fresh perspective and fresh opportunities.
Breathing room: When a teen is struggling with addiction, the entire family is affected. When the teen enters rehab, it gives the entire family a much-needed break. The daily storm of life quiets. Parents can step back and take a deep breath. The physical distance between family members can help start a healing process.
Open learning: Teens are often more flexible and more open to new ideas than adults. They have not lived a life filled with drug use. They are still open to change. They are often able to absorb new information better and learn more quickly than adults. When put in an environment that guides them to learn healthier patterns of behavior, many teens do quite well.
Healthy structure: While in rehab, the teen will adhere to a strict schedule. Most kids thrive on routine. They know what to expect each day, so life doesn’t feel out of control. This structure helps teens develop healthy routines and focus on establishing and maintaining their sobriety.
Family support: Teen rehab typically includes family therapy. This can prove helpful during the teen’s stay, as well as when it’s time for the teen to come home. Final sessions cover how the teen should transition back into family life and what rules are appropriate for parents to establish. Family support can prove invaluable to creating a healthy environment at home.
Brian just spent the last 10 hours in the shower. Why? It was the only way he knew to get the pain and nausea caused by cannabis overuse to stop.
Brian is one of an estimated 2.7 million Americans who suffer from bouts of cannabinoid hyperemesis syndrome (CHS). This condition causes vomiting and pain in heavy marijuana users. It used to be a rare condition, but the recent changes in marijuana laws have resulted in a flare-up in the number cases.
Dr. Eric Lavonas, director of emergency medicine at Denver Health and spokesman for the American College of Emergency Physicians, reports, “CHS went from being something we didn’t know about and never talked about to a very common problem over the last five years.”
A Misdiagnosed Mary Jane
Many marijuana users develop the syndrome after years of smoking pot, so they don’t make the connection to their habit. Yet, the pain and nausea are too severe to ignore. Patients can also become dehydrated, which can lead to kidney damage.
Often misdiagnosed, CHS is frequently mistaken for a psychiatric or anxiety-related syndrome. Appendicitis and bowel obstructions are also commonly suspected. Many CHS sufferers spend thousands of dollars on testing, and even surgery, in attempts to discover the cause of the symptoms. After multiple trips to doctors and emergency rooms, patients eventually receive the right diagnosis: “You’re smoking too much pot.”
Dr. Joseph Habboushe, assistant professor of emergency at N.Y.U. Langone/Bellevue Medical Center, notes, “I know patients who have lost their jobs, gone bankrupt from repeatedly seeking medical care, and have been misdiagnosed for years. Marijuana is probably safer than a lot of other things out there, but the discussion about it has been so politicized and the focus has been on the potential benefits, without looking rigorously at what the potential downside might be. No medication is free from side effects.”
Is There a Cure?
CHS symptoms generally don’t respond to drug treatment. Anecdotal evidence exists for the “hot shower cure.” Patients have reported that taking hot showers is the only way to relieve the pain and nausea – some reporting that they stay in the shower for hours at a time.
There is a silver lining. CHS is curable, and the cure doesn’t require a shot, expensive treatment or surgery. Simply quit using marijuana. Yep – stop smoking marijuana and – voila! No more CHS.
But, getting people to stop using pot can be a challenge. Many have heard for years that marijuana helps relieve nausea, so they have a hard time believing the drug is truly the cause of their symptoms. Others simply don’t want to quit or find it difficult due to addiction.
These obstacles make it likely that many will continue to suffer from CHS. And, as legalization continues to spread, doctors suspect the number of CHS cases will continue to rise.
They were all set to expand their counseling services into a full residential treatment facility. The county originally bought the building with plans to demolish it, but the team worked hard to restore it to its’ former beauty.
The services provided at their recovery residence were already making a great impact on the lives of many local women struggling with substance abuse. County officials conducted an abundance of inspections, searching for zoning code violations that weren’t present. And then…they received a cease and desist order. NIMBY (Not in My Back Yard) strikes again!
The NIMBY attitude is impeding recovery efforts across the nation. In Virginia, the McShin Foundation faces these obstacles and more as it tries to reach under-served populations with peer-based services. Despite the organization’s documented success, they don’t have the full support of many facets of the community.
Why? The foundation is being hindered by the same detrimental attitude that stunts the growth of recovery services across the nation. Too many officials and pessimistic influencers say, “Yes, please offer recovery options for our town…but not in my back yard.”
This kind of judgmental opinion makes recovery expansion nearly impossible in most areas.
Getting to the Root of Stigma
This critical view stems from the persistent, negative stigma attached to chemical dependency. No one wants to admit substance abuse is an issue in their neighborhood. No one wants to admit it’s an issue in their own family. Many want all mention of addiction, including any services offered, to be kept far from home. They want the recovery resources to be available for others, in other locations, but NIMBY!
That is, of course, until it’s their kid or family member who needs help. Then, recovery resources nearby would be great. Miraculously their attitude shifts to, “Hey, why aren’t there more services in my area? We need help here!” Until this tipping point is reached, many people remain in the damaging cycle of stigmatizing substance abuse.
One facet of this harmful stigma is fear. A frequent stereotype is that any locale which offers recovery services will be overrun with drug use. Crime will skyrocket. Property values will plummet. Children will no longer be safe. Community members fear these outcomes for their neighborhoods.
Yet, if the people of the community don’t get the help they need, aren’t these conditions even more likely? It becomes a circular dance, with fear taking the lead and stumbling around the dance floor. Out of step with what could benefit the city, decision-makers guided by this fear make expanding recovery services difficult.
Facing the Facts
NIMBY continues to be an issue everywhere, despite evidence disproving many noted concerns.
Results from a University of Maryland School of Medicine study show crime rates in the immediate vicinities of methadone treatment centers are the same as those in surrounding neighborhoods, and crime rates in proximity to treatment centers are actually “lower than that of convenience stores with the same demographics.”
The NIMBY attitude offers further incongruity among county boards and policy makers. The board of supervisors who are influential in decisions affecting the McShin Foundation offer an example. Their official statement reads, “The county recognizes that addiction is a serious issue and that the establishment of counseling and treatment centers is important.” So, it’s important, but not so important to make expansion of these centers less difficult? Again, we enter a circular NIMBY dance that gets programs nowhere.
Any Solutions in Sight?
To overcome NIMBY obstacles and help those dealing with chemical dependency, community members and policy makers need to do the following:
De-stigmatize recovery services
Admit substance abuse exists in their town, neighborhood or family
Stop shaming those struggling with addiction
Dispel fears surrounding recovery services
The current opioid epidemic leaves few untouched by its’ destructive wake and expansion of recovery services is desperately needed across the country.
To defeat the NIMBY attitude, we may need to implement a similar strategy to that of some urban designers. Howard Blackson III, an urban designer, recommends a balanced approach that weighs “individual NIMBY reactions with the collective need of citizens to access the city.” In other words, we can’t ignore that NIMBY attitudes exist, but we can’t let them inhibit the growth of programs essential to the health and well-being of a city and its members at large.
What happens when over 100 Americans a day die from opioid-related substance abuse? Policies change. The outcry becomes so loud it can’t be ignored, and everyone – including retailers – is forced to stand up and take notice of the opioid epidemic.
The latest addition to nation-wide policy changes is taking place at the Walmart pharmacy counter. The influential retailer announced that store pharmacies will now impose a limit on opioid prescriptions. Their policy will cap new opioid prescriptions for acute pain at a seven-day supply, with dosages limited to 50 MME per day (morphine milligram equivalents).
This change isn’t taking place out of the blue. The policy complies with state laws that enforce the same limits. CVS pharmacy recently made a similar decision, limiting their opioid prescriptions to seven-day supplies as of February of this year. Medicare is changing its coverage to limit opioid acute-pain prescriptions as well.
New Limits Hit Hot Button
While the policy change won’t affect everyone, many are concerned it will affect the wrong ones.
The goal of these limits is to prevent abuse and addiction. The logic follows that patients who have access to fewer pills will take them for shorter time periods and will be less likely to become hooked. Additionally, fewer leftover pills will be in circulation. These leftovers have proven to be a direct source of addiction and overdose. Roughly two-thirds of teens who abuse drugs report that home medicine cabinets act as their convenient drug supply. By reducing the number of pills initially provided to patients, the hope is to cure this epidemic from the front end.
Despite major retailers jumping on-board this plan, many have reservations. The concern is that these policies will only hurt patients who truly need the medication. Some claim that those who rely on opioids for daily functioning and use them as prescribed will be the ones who suffer. They point to studies that show only 25% of people who abuse opioids begin with opioids prescribed by their doctor.
Still, if the policy saves those 25% from addiction, wouldn’t it be worth the change? For most, the jury is still out.
Walmart plans to follow up this policy with another in 2020 that requires e-prescriptions for controlled substances. Why? Electronic prescriptions are harder to alter, more difficult to copy and less prone to mistakes.
In January, the retailer also announced a new effort to help with safe disposal of leftover opioids. They will provide free packets of a powder that make disposal easy. Patients can simply pour the powder, DisposeRX, into their prescription bottles and add warm water, and the substance turns into a biodegradable gel that patients can throw away.
These changes are part of Walmart’s ongoing efforts to “be part of the solution to our nation’s opioid epidemic.”
The CDC estimates more than 62,000 Americans lost their lives to drug overdose in 2017. The emotional cost to individuals and families across the nation is impossible to quantify.
The financial toll, however, can be estimated. The current opioid crisis is taking enormous amounts of money away from individuals, local governments, healthcare providers, and federal programs.
A recent report from Altarum, a nonprofit health research institute, reveals some alarming numbers. Totaling the costs since 2001, Altarum reports the opioid epidemic has a current price tag of one trillion dollars. The total from 2017 alone is over $115 billion.
In recent years, this sum has grown exponentially and if things don’t change, Altarum estimates our country will lose another $500 billion over the next three years to this epidemic.
Who’s Paying This Bill?
In short – we all foot the bill. From Steve the construction worker to good ole’ Uncle Sam, the opioid crisis is snatching money out of everyone’s pocket. If we break down the total, this cost is borne in three main tiers:
Individuals: Lost wages due to substance abuse and overdose make up a significant portion of the cost.
Private sector: Businesses suffer from lost productivity and health care costs.
Governments: Agencies at local, state and federal levels miss out on tax revenue and spend funds for social services, education, health care and criminal justice.
Multiple sources contribute to this expanding sum. However, lost earnings potential and health care costs make up a significant portion of this staggering amount.
Lost earnings: The average age of an overdose victim is 41. Using this figure as a base, Altarum estimates each overdose victim costs the nation $800,000 in lost wages and productivity. This loss affects business operations as well as tax revenues. The private sector misses out on the contributions each individual would’ve made, and the government misses out on the taxes.
Health care costs: The opioid crisis has racked up a total of $215.7 billion in health care related costs from 2001 to 2017. This total is largely made up of emergency room visits, Naloxone administration, and treatment of other complications related to overdose. Recently, a large portion of this cost has fallen to Medicaid.
What Can We Learn?
Are these statistics helpful? Hopefully, yes. Knowing the details about the financial burden of the opioid epidemic could help identify solutions. Once we know the overall scope of the problem and the areas of people it’s affecting most, we can target these sectors with appropriate interventions.
They’ve been discussed, proposed, shot down, and encouraged in various parts of the country. Many wonder if these sites help curb the financial, criminal, and healthcare costs of the current opioid crisis in America.
Well…ready or not, here they come.
What is an SIS?
The first two supervised injection sites (SIS) in the U.S. are scheduled to open in San Francisco by summer of 2018. The project got the green light after years of persistent efforts by the city’s activists and a unanimous vote by the local health commission.
Laura Thomas, California state director for Drug Policy Alliance, explains, “There are over 120 of these around the world at this point, and they all operate on the same basic idea. You show up; you check in; you use your drugs; you hang out for a while, interact with the staff and then go on your way.”
The supervised injection sites or “safe” sites will be able to serve an estimated 22,000 of the city’s IV drug users by offering services such as:
A safe place for people to use drugs
Access to hygiene supplies
Access to needle disposal boxes
Access to medically trained staff
Various staff members will be on site 24/7 to provide drug counseling and/or medical assistance in case of an emergency. Advocates hope the site will keep dirty needles off the streets and reduce the number of fatal overdoses in the city (currently about 100 per year).
All in Favor: Yay or Nay?
Of course, intravenous drug use is still against the law in San Francisco, so these sites will be privately funded, rather than government subsidized. Legislative efforts are currently underway in an attempt to protect those associated with the site from arrest, but they’ve yet to pass. Project developers say the danger of incarceration probably won’t stop the sites from opening.
These “safe” sites are extremely controversial, so the city may experience push-back from non-supporters. Although, a recent poll of 500 registered San Francisco voters revealed 67 percent of respondents were in favor of the project.
However, one undetermined factor could affect the level of support in the future: locations for the sites haven’t been identified. Once these are determined and announced, will the idea be just as popular? One has to wonder if a case of NIMBY (not in my back yard) might thwart site developers’ efforts.
Lawrence Muir – also known as Chip – the acting chief of staff and general counsel for the Office of National Drug Control Policy, was fired suddenly for unknown reasons, according to CNN.
This abrupt dismissal is the latest development in the Trump administration’s rather confusing approach to the opioid crisis.
Is Trump’s Dedication Questionable?
Muir’s departure comes at a time that the future of the agency is uncertain, despite President Donald Trump’s vow to make the opioid epidemic one of his administration’s top priorities. The Trump administration’s failure to propose a strategy has led many to question their commitment. Finally in October, he took a first step by declaring the opioid crisis a national public health emergency.
Trump’s announcement came after what seemed like years of pleading, campaigning, and lobbying from activists groups, public officials, families of those lost to overdose, and healthcare professionals. He stated, “We can be the generation that ends the opioid epidemic.” Yet it took months before we saw action.
Before being fired, Muir was a political appointee with unfettered access to key White House meetings about the opioid epidemic. He’d been attempting to obtain a congressional reauthorization for the drug czar office – which has been slowly deteriorating over the years. Currently the agency has around 70 employees, but many staff members have reported feeling “concerned” about their future.
A source told CNN, “They’re either shutting us down or reducing us to atrophy, where we amount to zero,”. A counsellor at the White House, Kellyanne Conway, will still be involved in the administration’s efforts to deal with the crisis.
Too Little, Too Late?
However, this latest development has caused public concern about whether President Trump intends to put the full weight of the office he holds into tackling the opioid crisis. We’ve seen quadruple the number in deaths from overdose since 1999. Between 2000 and 2015, 50,000 Americans died of drug overdoses. In 2016, the number shot up to 64,000.
The acting Health and Human Services Secretary, Eric Hargan, announced in November President Trump will donate his third quarter salary to the Department of Health and Human Services in an effort to tackle the opioid epidemic. His donation will be used for a public awareness campaign – warning people about the dangers and risks of opioid dependency. Is it enough?
Let us know what you think about the issue. Sound off in the comments section below!
Several years ago, when I was first trying to get sober, I went on a terrible drinking binge. A really, really terrible one.
I drank around the clock for two solid weeks. I stopped eating. I reached for a beer as soon as I woke up and drank until I passed out. All I did was sit on the couch and drink while tears poured out of my eyes.
I was terrified of going to the hospital – I’d had some pretty bad experiences there – but I was even more frightened of brain damage caused by alcohol poisoning and too little food. So, I finally called a friend and asked him to take me to the emergency room.
It was one of the best decisions I ever made – one that literally saved my life.
Face Down Your Fears
The definition of alcohol poisoning is “the ingestion of a lethal or potentially lethal amount of alcohol.” Drinking too much too quickly can affect your breathing, heart rate, body temperature, and gag reflex. Without medical intervention, alcohol poisoning lead to coma and death.
If you’re drinking copious amounts of alcohol like I was, your chances of alcohol poisoning are high. Going to the hospital is a scary thought, but choosing not to go could lead to your death. While I can’t remove all your fears, I can help to shed some light on what happens when you go to the emergency room.
Let’s take a look at three things you can likely expect once you get there:
#1 – You will undergo a medical evaluation and a doctor will take steps to stabilize you.
When you’ve been drinking a great deal, especially if you haven’t been eating very much, your body’s probably malnourished and dehydrated. Doctors will likely perform lab tests to check for any deficiencies, then give you IV fluids and other nutrients as needed. When I was in the emergency room, I remember my physician asking if I’d been taking a thiamine supplement. I thought it was an odd question at the time, but I later learned chronic alcoholism is linked to the development of Wernicke–Korsakoff Syndrome (WKS). WKS is caused by a severe acute deficiency of thiamine (vitamin B1) and can result in an inability to make new memories, permanent brain damage, and numerous other mental and physical effects.
#2 – You could be assessed by a mental health professional.
If available on staff, a mental health professional may be called in to speak with you. He or she will likely ask if you feel suicidal or if you feel like hurting yourself or others. It’s important to be honest. No one is judging you; these people are professionals and it’s their job to help you. When I was in the hospital, I could honestly say that I didn’t want to harm myself – I was there because I wanted to live!
#3 – Your doctor may recommended that you to check into medical detox.
Most hospitals have some kind of detox unit where patients are able to medically (and safely) cleanse their bodies of alcohol. Once there, medical staff will administer medications like Librium to lower your anxiety and minimize your risk of seizure. If you’ve been drinking a lot and for a long time, you probably already know it’s incredibly dangerous to go “cold turkey.”
Most medical detox programs offer different levels of therapy. The one I went to frankly didn’t provide much one-on-one counseling, but they assured my medical safety as I detoxed off of alcohol. I kept telling myself I’d much rather be uncomfortable for a little while than to be dead. So don’t give up! You can do this.
Before You Go to the Hospital…
Before you go to the emergency room, make sure to let your significant other, parents, roommates, or neighbors know you’ll be gone for a few days. That way they can take care of any day-to-day needs things like notifying your job or pet care, and you can focus on healing.
It’s a scary move to make, but it’s the right one for your health. And remember, nothing matters more than saving your own life!