Addiction Medicine Made Easy | Fighting back against addiction
Addiction is killing us. Over 100,000 Americans died of drug overdose in the last year, and over 100,000 Americans died from alcohol use in the last year. We need to include addiction medicine as a part of everyone's practice! We take topics in addiction medicine and break them down into digestible nuggets and clinical pearls that you can use at the bedside. We are trying to create an army of health care providers all over the world who want to fight back against addiction - and we hope you will join us.*This podcast was previously the Addiction in Emergency Medicine and Acute Care podcast*
Addiction Medicine Made Easy | Fighting back against addiction
Kratom: What Someone Who Uses it (and Loves it) Thinks About it
This episode explores the complexities surrounding kratom, featuring insights from Matthew Lowe of the Global Kratom Coalition (GKC). We discuss the dual nature of kratom, its benefits and risks, the importance of consumer education, and the ongoing push for industry regulation to protect users.
We discuss
• An overview of kratom's rising popularity and consumer demographics
• The role of word-of-mouth and the internet in kratom discovery
• Importance of accurate labeling and consumer education
• Differences between kratom leaf, extracts, and synthetic products
• Discussion on addiction potential and withdrawal symptoms
• The Kratom Consumer Protection Acts and their significance
• Ethical considerations within the kratom industry
• Call for enhanced regulation and responsible marketing practices
To contact Dr. Grover: ammadeeasy@fastmail.com
Welcome to the Addiction Medicine Made Easy Podcast. Hey there, I'm Dr Casey Grover, an addiction medicine doctor based on California's Central Coast. For 14 years I worked in the emergency department, seeing countless patients struggling with addiction. Now I'm on the other side of the fight, helping people rebuild their lives when drugs and alcohol take control. This podcast is my way of cutting through the confusion and making addiction treatment easier to understand. My goal to leave you with real knowledge you can use, whether it's to help your patients, your loved ones or even yourself. Thanks for tuning in. Let's get started.
Speaker 1:This episode is going to be on kratom. Now, I know, I know, I know I've covered this topic a lot recently, but give me a break. It's a great topic and there is so much to learn and most healthcare providers don't know much about Kratom. Today's episode is going to be different than anything I have done before on this podcast. We are going to be talking to someone who is an insider in the Kratom industry.
Speaker 1:I connected with Matthew Lowe from the Global Kratom Coalition and I thought that it would be really informative to speak with someone who uses Kratom and advocates for Kratom use. So we set up a time to record this episode and I have to say I learned a ton in making this episode, both in terms of the perspective of the Kratom industry someone who uses Kratom but also how Kratom products are changing. Now, just to be clear for me as a doctor, I do not recommend anyone use Kratom, but I thought the perspective was helpful and this episode helped me in my practice. The week after I recorded it, I had a new patient visit with a patient who was trying to get off of Kratom but felt like none of the doctors she had worked with knew much about Kratom or knew how to help her, and I was so glad to be able to work with her. Well, let's get started. Let's just start with telling me who you are and what you do.
Speaker 2:Thanks very much for having me, dr Grover. I really appreciate it. I've appreciated the work that you've been doing to shine a spotlight on Kratom and ask a lot of the questions that I think need to be asked and need to be answered. Ask a lot of the questions that I think need to be asked and need to be answered. Consumer education is everything.
Speaker 2:But yeah, I'm Matthew Lowe, I'm the executive director of the Global Kratom Coalition. The Global Kratom Coalition is an advocacy group advocating for Kratom, but I think what's unique about the Global Kratom Coalition is we try to look at things very clearly, very rationally, and take everyone's lived experience into account, with the messaging we put forward, the science we do and the regulations that we want to see passed. You know, kratom, we believe, is a wonderful substance and I think, if you use responsibly, it can add a tremendous amount of benefit to people's lives. But, as you've expressed and many others have, there are people that struggle with Kratom and we want to make sure that we're addressing all corners of the room to come up with solutions that really work. We want to maintain access, but we want to ensure that consumers are well-educated and are walking into the Kratom journey with their eyes wide open.
Speaker 1:So let's start with how does someone find Kratom? I mean, most people I talk to haven't heard of it and a very small minority of my patients use it, but it's out there. As I told you, I walked into a shop and bought some just to see what it was like, and I've chatted with some other addiction doctors, you know, and the process of going to the doctor and getting medicine and getting a prescription and going to the pharmacy and waiting in line and dealing with insurance buying Kratom is totally different. So I understand, once someone finds it it can be a really convenient experience. But how do people find it in the first place?
Speaker 2:It's a good question. So I think something that a lot of people don't know is there are 24 million Kratom consumers in the United States and that's just been verified through a recent survey that we did and those results will be published. But that's a big number of people. It's 9% of the population and that is growing rapidly, right? You take that five years ago and it was probably 12 million people, so it's really starting to break through. Where it was traditionally an online and smoke shop orientated product, you're starting to see it in many more places.
Speaker 2:So how do people find out about kratom? I think it's a lot of word of mouth. A A lot of the people that I've spoken to, it's recommended from a friend or anything like that. The internet is a place that I think catches a lot of people as well, and then just forums and the like. But you're absolutely right you either know about Kratom or you know nothing at all, and I think one of the biggest challenges is when you're trying to find information on Kratom. It can be quite challenging because you're finding lots of information out there that is either very technical from a scientific perspective and you can't make head or tails of it, or you're getting two very different stories on what Kratom is, and that's something that us at the global kratom coalition, through our kratom consumer advisory council, are trying to to change.
Speaker 2:You've got this divide. Either people think kratom is this wonderful substance that can do no harm, and then another side you've got people that say, well, kratom is, you know, the scourge of the united states. America needs to be banned entirely. And, like with most things, the truth is somewhere in the middle, particularly in the. There's a scourge of the United States. America needs to be banned entirely. And, like with most things, the truth is somewhere in the middle, particularly in the context of the United States, where innovation in the kratom market has expanded aggressively over the short while, and we'll talk about it as we get into this call.
Speaker 2:But not all kratom is equal. So there's a big difference between consuming the leaf versus an extract, versus a synthetic isolate, and that is a big point of education that we're trying to get across is what are you actually consuming, how should you consume it and what should you be cautious of? And when it comes to caution, it's very subjective. People's experience with substances, and I think a lot of your tendencies and past history can inform the consumption choices you make, and also what medications are you taking, etc. These are complex things that need to be understood when taking any substance. So, yeah, again, I think the internet is a big resource for introducing people to Kratom. I think word of mouth is significant, and then it's just now that you're seeing expanding into stores that aren't smoke shops and have a certain smaller clientele. More people are getting introduced to it, and that's the same with many substances, right, you see THC drinks and mushrooms and whatnot. People are looking for alternatives, and often you find those alternatives when you go shopping.
Speaker 1:I've been in contact with the folks that do the Kratom Sobriety Podcast. They have some very interesting stories they tell about when people really lose control of their lives because of Kratom, and they sent me an email that it's being sold at Walmart. Is that true?
Speaker 2:That's news to me. I would be very surprised if that was the case. They have an online marketplace for Walmart. Potentially it's there.
Speaker 1:I'm going to follow that up with. We've talked about Kratom has many different relationships with a person, good or bad. How do people get good information about it? You mentioned the internet's a resource, but the internet's a vast depth of knowledge, both biased, non-biased. Talk to me about how somebody who wants to use Kratom could actually get good information. Because where I went I walked into the smoke shop and I pretended to not be a doctor and I asked the person working I'm interested in Kratom and she handed me kind of a pamphlet from a company called Katz Kratom. But what I know medically is a lot of what they were purporting doesn't necessarily link up with what the substance actually does. And I asked what if I have pain? And she didn't really know. So is there any good resource you would point people to who are interested in using it?
Speaker 2:Yeah. So I mean, that's a great question and I would say that there are resources out there, your typical resources like Mayo Clinic and WebMD. To be quite frank, they don't do a great job of explaining what Kratom is. It's all very kind of alarmist and you can see it's been written by ChatGP Key in many instances. But it's something that we talk about a lot is how do we better inform consumers? So the first hurdle or first line of protection for consumers is the label.
Speaker 2:The product label itself is the first line of protection, and a lot of work's been done in the Kratom industry to develop labels that are appropriate for the substance and, I think, appropriate for a dietary ingredient, but also appropriate for Kratom, because Kratom is not vitamin C, let's not fool ourselves. It holds more risk than vitamin C and, as such, there needs to be more information available to a consumer on what's actually in the product. How many alkaloids am I consuming, what is the suggested serving size and how many servings should I have in a day? There should be appropriate warnings on the packaging. The label is just vital. It should warn against using the product if pregnant and breastfeeding. That should not be done with Kratom. I think it should say on the product that this product may be habit forming. I've seen some more responsible Kratom companies go as far as to say if you've had a problem with a substance in the past, you should take caution when using this product, which I think is a very, very good thing to put forward. Beyond that, a labeling address of where the place is manufactured. So if you do have an adverse event, you've actually got some recall. But the first line of defense is the label. If you are picking up a creative product that doesn't have appropriate label, doesn't tell you how you should use the product, doesn't tell you how much you should take in a day, I would be staying away from that product.
Speaker 2:Second to that, doctors are a resource for this, but there isn't nearly enough communication and education in the medical sphere, something that we are trying to change. So University of Florida themselves have stood up a pharmacist CME program which can be done online. It launched last week. I would suggest that anyone that's a pharmacist should go onto that program and do the CME course. At the GKC we are setting up CMEs for healthcare practitioners. We're doing one at Tulane in Louisiana on the 31st of January and next year we're hoping to roll that out to as many universities as possible. Again, we're not trying to whitewash an issue. We're getting the best scientists to talk about what they know about Kratom and how they should be advising people that are using Kratom and want more information.
Speaker 2:And then, from a consumer perspective, I think there's a lack of authoritative, very clear, very concise information that's available and again, the GKC is trying to change that. We're setting up a web series at the moment of very short, three to four minute videos that explain what is the label, what should you be looking for? How should you use these products? What's the difference between leaf, between extract, between a 708 isolate? Is there a difference between green vein, white vein, red vein, etc. The answer is there's not. There is a lot more information that needs to be put out into the world.
Speaker 2:I don't think you should be getting your advice from a smoke shop itself. Rely on the label, like with anything. Try to read as much as you possibly can across the spectrum to get a very clear indication of what it is that you're taking. And then, most importantly, listen to your body. I think that too often than not, we don't listen to our body and we over-consume things. You see it with alcohol, you see it with caffeine. You see it with many different things. Food, ultra-processed food, is a big deal. For that we don't listen to our bodies. You're not going to have an adverse event from taking Kratom one time. It's a long-term use that you need to be conscious of your consumption habits.
Speaker 1:So, for context, I have the picture here of the Kratom I bought, and it has a warning label that individuals should consult their physician and you shouldn't use if you're under 21, and you shouldn't mix it with alcohol or medications and should be out of the reach of children, and that you should not use it if pregnant. For comparison, though, I'm going to read you warning labels from alcohol and cigarettes. So this is from the back of a bottle of Malbec Government warning. According to the Surgeon General, women should not drink alcoholic beverages during pregnancy, and consumption of alcoholic beverages impairs your ability to drive a car or operate machinery and may cause health problems. Ironically, it doesn't mention that alcohol is addictive.
Speaker 1:And then on tobacco, there's a giant label that says warning this product contains nicotine. Nicotine's an addictive chemical, so there's even variability among the other legal substances, but I think for me as a doctor, what I need patients to know about Kratom is that regular use leads to dependence and then withdrawal, because that's really where my patients have struggled is they don't know what they're feeling Like. Why am I feeling so bad? And one of my patients he's doing fairly well right now asked me to go to his smoke shop at 10 am and bring business cards because people don't understand the withdrawal syndrome. So how do you think that could be effectively put on the warning label?
Speaker 2:Well, I think the advice that this product can be habit-forming is vital, and I think what the good thing about Kratom is is you look at cigarettes and you look at alcohol. They've been around in the US consumed for hundreds of years and it's taken them a long time to get to this position of appropriate warnings, people understanding the substance. I mean, it wasn't too long ago where people your doctor was smoking, right, you were smoking on planes, etc. So things change over time as we understand things. I think that the kratom industry itself has kind of stood up because the FDA is sitting in a bit of a gray area at this point in time. 13 states have passed KCPAs and it's been incumbent on many of the industry to step up and say, well, what is appropriate for this product? And the good actors in the space are really pushing things in the right direction and moving things further and further as we gain more understanding of this product that we're selling. But then, of course, they are the people that aren't keeping up with that and they are more than they should be and they are really behind in terms of what should be on those labels. You know, I understand that people do struggle with Kratom and a big part of the work that we're doing is trying to leverage the information we have from the John Hopkins surveys that have been done on Kratom and addiction, on kratom use disorder, which has shown that the prevalence of developing a kratom use disorder is like a 70 30 split. So 30 percent of those people will develop a kratom use disorder and then when it moves into the severity of that kratom use disorder, it's between mild and moderate.
Speaker 2:But let's's not I don't want to overweight this. That doesn't mean that everyone's experience is mild or moderate. Most people experience mild to moderate but there are people that experience severe symptoms of Kratom use disorder. Typically those symptoms are physical, absolutely right. You build a tolerance, you get physical withdrawal. We don't see social impairment, we don't see risky behavior that comes from kratom use and I'm talking about the leaf generally, because the majority of that data was on the leaf. So it is a physical withdrawal.
Speaker 2:On that scale it looks quite similar to caffeine. I'm not saying it is exactly like caffeine, but that's the way that it expresses itself. But that's not to say that there are people that have a far worse experience with it. But I think there is, and there needs to be, a greater understanding that you are walking into a substance that has these habit-forming properties, and I certainly think that if you've had a problem with substances in the past, you should tread very, very lightly when walking into your Kratom journey, because it is rewarding. It rewards you, it makes you feel good, it helps you get things done. I mean, this is the most amazing thing about Kratom is that you take Kratom just like you would use a cup of coffee, but it really helps you get things done and that's a good feeling and those feelings you want it more and more and more. So you really need to self-moderate when you're consuming these substances.
Speaker 1:What is a KCPA? You mentioned that term.
Speaker 2:Oh sorry, kcpa is the Kratom Consumer Protection Act. So you know, in the absence of federal regulation, the states have taken it upon themselves to regulate Kratom. So a piece of legislation has been passed in 13 states called the Kratom Consumer Protection Act, and that puts in guardrails for the industry. That ultimately should protect consumers. So it mandates what a label should look like. It ensures that it's not sold to people under the age of 21. It ensures that people are manufacturing these products appropriately. It ensures in some states that there's a registry. So any product that's sold in the state needs to be registered with the state. That's very important because, number one, you can then check that people are testing their products, it's not contaminated with heavy metals or salmonella. You check the label so you make sure that it's labeled appropriately and in theory, the retailers should be looking at the registry and only selling those products that are registered with the state.
Speaker 2:I think that that is a good model, but you need enforcement of that model. So I want to see a world in which you can walk into any convenience store, any smoke shop in America, and you as a consumer, don't have to guess if that product is a good product or a bad product. You can be sure that it's a good product. And how do you know it's a good product? Well, it's in line with the KCPA. It's past that registration and the stores that are selling those products are only selling those products that are being registered. That is not the case at this point in time, but if the Global Kratom Coalition is successful, that's what we'd want to see.
Speaker 1:Yeah, I was just thinking about cannabis in California. So California legalized cannabis in 2016. And I voted for it Because, yes, I mean, humans have been using cannabis for thousands of years. I wanted people to at least know what they were getting. Now, interestingly, the market went a little bit sideways and the potency of cannabis is just obscene. I have a photo on my phone.
Speaker 1:I went to a cannabis dispensary to take photos because I was doing some lectures at schools and I found one cannabis product that's 43% THC and that's just. I mean, at least it's on there. And I think for me in my clinic, I ask my patients, what do you use? And they'll say, oh, I use cannabis. And I'll ask what percentage? Many of them don't know and they'll say, doc, it's just pot. And I'm like, well, no, no, no, but what's the percentage? It's not your father's pot, it is true. That is true. And what's interesting? So cannabis is?
Speaker 1:Obviously it's a unique industry here in California, but the person who works at a dispensary is called a bud tender, and what's interesting is it kind of lies in this gray area between medical and recreational, and I did a podcast episode on who works as a bud tender. Sometimes they're cannabis enthusiasts. Sometimes they're pharmacists, sometimes they're nurses, sometimes they're a person with lived experience with cannabis. And when you actually look at what drives their recommendations to consumers, it varies from some legitimate research on some of the unusual seizure syndromes that can be treated with CBD to we got to get this stuff sold. Let's tell everyone it's really good.
Speaker 1:And Kratom seems to be got to get this stuff sold. Let's tell everyone it's really good. And kratom seems to be in this gray area as well. People view it as medicinal, but it also can be recreational. I don't think anyone views alcohol or nicotine as medicinal, it's just recreational. When I went into a cannabis dispensary I didn't really have time they were so busy to ask any questions. I mean, I feel like in an ideal world. If we're saying Kratom can be useful for some medical issues, it would be nice for people to have a medical resource that they could ask. I'm curious as to what your thoughts are on that.
Speaker 2:Yeah, I think that Kratom in its native form. You see much lower risk in Kratom in its native form, right? Just leaf kratom. I think we've got to understand that. Number one is traditionally it was consumed as a tea or chewed as a leaf for energy and focus Long hot days in the sun. And you're using it for energy. And in the United States it's sold as a dietary supplement, right? So it's not coming from marijuana, which was a scheduled substance into being a legalized substance. It's sitting in a dietary supplement space with a gray area from the FDA. They tried to get it scheduled. They weren't able to do that because it didn't fit the paradigm in which a product should be scheduled.
Speaker 2:I think when you start to look at the synthetic high concentration 708 products that come onto the market there, you're looking at an unapproved new drug, right? You're looking at a substance that is number one it's got 100 times more 708, which is 7-hydroxymetragynine. It's a metabolite of kratom. So when you pull a kratom leaf off the tree, it doesn't have any 7-hydroxymetragynine. It's a metabolite of kratom. So when you pull a kratom leaf off the tree, it doesn't have any 7-hydroxymetragynine in it. 7-hydroxymetragynine is a pure opioid, right? When you dry that leaf that 7-OH becomes apparent, but in tiny, tiny, tiny amounts. When a consumer consumes that leaf, they don't really get much of an impact from the 7-hydroxy. It's mainly the mitragynine, the speciocillotine, the speciocyanine that is doing all the work. It's the symphony or crystal of 50 different alkaloids that are giving it its effect. However, when you take 7-hydroxy mitragynine, you amp it up by 100 times and you amp it up by 100 times. You use a process of heat light and pool shock to create a chemical reaction and suddenly you've got this highly potent opioid. That isn't just 7-hydroxymetogynine. It's got multiple unknown substances in it that aren't found in nature. Suddenly you've made a drug and that should not be being sold in gas stations and smoke shops and the like. If you look at the leaf, on the other hand, it's got hundreds of years of safe use. It's been used in the United States for probably close to 50 to 60 years without any major concerns. You're dealing with two very different substances.
Speaker 2:I believe the kratom in its native form is a dietary ingredient that can be consumed safely with the right guidelines around it, and I don't think it needs to be restricted from a route to market perspective. I believe you can mitigate a lot of the risk through labeling, through registrations and through ensuring that you've got good actors in the marketplace Bigger, better, stronger, faster exactly like the pot situation puts us in a way worse position when you're constantly wanting to make products stronger. I think that is not good for the consumer. Moderation is key and as soon as you start pushing it over a certain limit, I think that's when things start to become a little bit shaky. So you know, we've got this, this saying that not all kratom is equal, and one of the things I I try to do, and it's quite difficult because it's so entrenched.
Speaker 2:But you know, someone says, while I use kratom, I'll say well, what do you mean? You use kratom? What kratom do you use? Is it the leaf leaf? Is it a powdered extract? Is it an extract? Is it full spectrum? Does it have all the 50 alkaloids in it? Is it an isolate of mitragynine? Has it been spiked with specioacillitine or is it a synthetic isolate? These are very, very, very different things and my view is safe kratom is full spectrum kratom.
Speaker 2:The rest we know less and less about and as you move away from raw leaf kratom or natural whole leaf kratom, which we know a lot. Even the FDA has done their own clinical trial. The further we move away from that, the less we know, and the less we know, the more risk. Know, the more risk there is. That's not to say that stevin hydroxymetrogynine might not be this wonderful substance. Right, that is going to be an opioid replacement. That might be the case, and I'd love that to be the case.
Speaker 2:That kratom was able to create a medicine that was very effective, but right now we don't know. What I definitely know is that a bunch of kitchen chemists couldn't be selling that substance. That's what I do know. So yeah, it's a tricky thing, but I think the first question you need to be asking yourself as a consumer is what cravedom am I using? And I would suggest sticking with the leaf. Certainly, if you are a naive user, starting with the leaf, there's nothing wrong with extracts, but moderate your usage. Don't pick up an extract shot that has got 1,200 milligrams of kratom extract in it and 650 milligrams of total alkaloid. You're consuming, then, 10 times the amount that would have been consumed traditionally, and that's not going to end well for you.
Speaker 1:So one of the things I do when I go to speak to high schools is actually put up pictures of labels of different forms of alcohol, just to show the kids like you're going to be offered alcohol. I need you actually to know what you're getting. I did the same with cannabis, I did the same with tobacco, and what I love about this podcast is I get to learn things that as a doctor, I never thought I'd know. So I have a medical degree, obviously, and a lot of what you just said about the different forms, even despite my interest in kratom, was over my head. So can you give me just a brief overview of the different forms of kratom and then how it's evolved from leaf to extract? And in my mind I think of that like coca, coca, tea, cocaine, crack. So can you walk me through that?
Speaker 2:Yeah, it's fascinating. I mean, the more people I speak to about it, the more we realize we're not alone. This has all been seen before. It's all been seen before the evolution of the substance. You take cocoa leaf, which is a wonderful leaf, it's a truly special leaf but you can't get it in the United States because people made crack out of it. The baby got thrown out with the bathwater and I really don't want that to happen with kratom. So to understand kratom fully in its different forms forms, you need to take it all the way back to southeast asia. In southeast asia it's either picked from the tree and chewed, or it's brewed into a tea, or it's dried and people consume it that way. In the united states it came over first as a leaf, a dried leaf that is crushed into a powder sold in packages. People are either brewing a tea out of that powder or they are taking a spoonful of the powder and they're ingesting it with water. Again, a different experience, right? Because brewing a tea and drinking what is effectively an aqueous extract is a different experience to taking the whole leaf and putting it into your stomach and letting your body work it through. There's already a different experience that you're going to have there.
Speaker 2:Then in 2013, the first Kratom extract was put onto the market. Now an extract is just using a process to pull out the active components of Kratom to put them into a format that allows you to do a lot more with it right, put it into different product formats, et cetera. But what it also allows you to do is to make stronger products, because you can pack a lot more of the alkaloids into a smaller container. The leaf has got the 50 different alkaloids. It's filled with fiber. It's a very fiber-rich product. If you're taking the raw leaf, you can't really consume that much of it. It's very hard to consume too much because of its self-mitigating properties. With an extract it's more bioavailable, etc. But let's be clear I'm not saying an extract's bad. I'm just saying that you can make a more potent product. So there's products on the market that are extract products that understand that they want to give people an experience that's in line with traditional use and they have low amounts of alkaloids in those products. But there's other products you can get in smoke shops that have got crazy amounts of alkaloids in it.
Speaker 2:You need to know what you're picking up, because in some cases you've got a little eight milliliter shot. That is supposed to be four servings, right, but it's eight milliliters. Everyone's drinking it in one go. So you need to be four servings, right, but it's eight milliliters, it's everyone's drinking it in one go. So you need to be cautious of these types of things. You need to read the label, you need to understand what you're getting into.
Speaker 2:So those are the extracts, and the extracts typically have the full spectrum of the 50 alkaloids in them. You're normally going to see them either in tablets or shot format. Then you've and this is more recent, you've got individuals that have learned how to isolate and amp up, not through synthetic processes, but creating mitragynine isolates. So mitragynine is the most abundant alkaloid in kratom. It's anywhere between 50% and 60% of the total leaf from an alkaloid content perspective. Between 50 and 60% of the total leaf from an alkaloid content perspective. They've worked out how to turn a kratom extract into a 95% mitragynine extract. So effectively you're having a single alkaloid product, which is going to be a different experience from a full spectrum alkaloid, because all of these alkaloids I mean it's full spectrum extract because they all play with each other to mitigate, to enhance and to give it an effect. So that is something entirely different. Typically you're getting those in either strips or you're getting them in in pill format and then so we've gone leaf, we've gone extracts, we've got gone to isolates and then and this is only 18 months in you've got products that are typically called 70h or seven ohms or seven, and these are products that are actually coming from the hemp industry. So individuals have worked out that you can take a mitragynine extract, a very high purified mitragynine extract. You can put light, heat and chemicals into it and it can turn that mitragynine into 7-hydroxymitragynine, but in abundance.
Speaker 2:These products are being sold in smoke shops, typically in pill format, sometimes in shot format. They're always called 7-hydroxymitragynine, but often called Kratom. Are being sold in smoke shops, typically in pill format, sometimes in shot format. They're always called 7-hydroxymetragynine, but often called Kratom. We must be very clear these are not Kratom. They have a tiny, tiny, tiny part of alkaloid that is in dried leaf Kratom and nothing else. That's Kratom. And then they've got other unknown new chemicals in it that we've got no idea what they do.
Speaker 2:These products are very potent. They are full opioid. They bind fully to the opioid receptors and we just don't know enough about these products for them to be being sold in gas stations and convenience shops and the like. It's my view, based on the fact that there are novel compounds in them. They are 100 times stronger than anything that's been consumed by humans before. In terms of 7-hydroxymetragynine, they're 3 to 22 times more potent than morphine and, lastly, because they are being sold and marketed for pain relief and opioid use disorder. These are novel drugs. They are new drugs that need to go through the NDA process. I would love all your listeners to be aware and understand that if you're walking into a smoke shop particularly if you're a naive consumer and you say I want to try Creighton and he hands you 70H, say no and ask for the leave you 70H, say no and ask for the leave.
Speaker 1:Wow, this is part of why I was looking forward to this conversation. That's really concerning. I mean I almost feel like you should be given naloxone if you buy one of those extracts. If you're saying it's more potent than morphine, is that a full agonist at the opioid receptor?
Speaker 2:Yeah, 7-hydroxymetragynine is a full opioid agonist and that's not to. I want to be very careful to not throw 7-hydroxymetragynine under the bus. It's a wonderful molecule. It's just in very, very small amounts in kratom leaf, and there's a reason why. In the Kratom Consumer Protection Acts that have been passed in 13 states, a very important provision is in each or in eight of those 13 states, and that states that no Kratom product can be sold that is synthetic and no Kratom product can be sold that has 7-hydroxymetragynine at more than 2% of the alkaloid fraction. And it's for this exact reason. A very clear indicator that a Kratom product has been adulterated or manipulated is if it's got more 7-hydroxy than 2%. These products are 98% 7-hydroxymetragamy. So we are working incredibly hard to ensure that the regulators and the AGs in each of these states are taking action against these products. We wanted people to know. Number one, they're not Kratom and number two, we want the authorities to ensure that consumers can't access them in those states where they're prohibited. They're prohibited for a very good reason.
Speaker 2:Now I know that there's work being done on a medical level on 7-hydroxymetragynine as a potential opioid replacement. That is a long process. It needs to go through a significant amount of research. You need to be approved by the FDA. That's great. We shouldn't be kitchen chemists creating compounds that we know nothing about and putting them onto the market and, even worse, conflating them with Kratom, because that's very concerning for a consumer. I would hate a naive consumer's first experience of Kratom and I put it in inverted commas to be with a 7-hydroxy-metragynine product or to be with 7. And that's what people are calling it. They don't call it 7-OH, they don't call it Kratom. People that are consuming it. They call it 7.
Speaker 1:So I need to be asking the same question to my patients who use Kratom that I'm asking my cannabis patients. I ask them tell me about the cannabis that you use. I need to be asking tell me about the Kratom that you use.
Speaker 2:There's such variety here important things and we're going to be creating more and more. There's some great sciences be done on this, but the problem with the science is it's for the scientists. How do we, how do we distill that and make it for the consumers so that they can understand better? And we're doing a lot of work on that at the moment too, you know, because it's one thing to say. Well, you know, be careful with medication when you take it. Well, what medication, what medication should I be concerned about when I take it? So we're doing a a lot of work on how we educate around that.
Speaker 1:Do you think the average Kratom user knows what you just told me about? Or they're just going to their local shop or a website and buying it.
Speaker 2:I would say no, and that's why it's lovely speaking to people like you and the media, et cetera, to make people aware that there is this difference. It's important for consumer protection, but it's also important for the longevity of this industry. It's so, so, so important for consumers that don't want to lose access, for the industry that wants to continue to operate, to be responsible. Label properly. Don't put out products that are too strong. Don't manipulate Kratom. Kratom is good enough as it currently is. Don't turn it into these obscene derivatives that are so far from Kratom they can't even be called Kratom anymore. It just goes down the wrong path.
Speaker 2:And you see that with marijuana and we spoke about it earlier it's not your father's pot, you know. It's really, really, really potent and it's just a different thing. It's a different thing entirely, but it seems that's kind of the way of the world. We need to make everyone aware and then, through the industry itself and, you know, get everyone to see the the bigger picture, which is we want kratom to stay, we want kratom to be accessible. You know, in 2016, the FDA was the biggest threat to Kratom. I think that's changed. I don't think. I think the FDA is moving to a point of acceptance with Kratom. They've done a single ascending dose trial on Kratom. It's the industry itself that worries me the most. It's profit over sensibility that concerns me.
Speaker 1:Yes, understood, because I was going to ask ethically, how does somebody in the industry feel about Kratom? I mean, I think about Budweiser. Right, they make beer. Beer can be used responsibly and it can ruin people's lives. Same thing with Philip Morris and tobacco, and I think those are big profit-focused companies. You look at opioids and the Sackler family and Purdue Pharma are now a four-letter word in America. I mean my patients, the stupid Sacklers. They're taking the Sackler's name off museums and universities in the United States. They've been so vilified. How does the creative industry think about itself ethically?
Speaker 2:Yeah. So I think just let's not leave the food companies out of this either, please. Ultra processed food. Well said, we are learning our lessons as we move along and we've seen what's happened in history, and the things that we're putting onto the shelf are having these deleterious downstream effects on humans. I mean, I think about what my parents used to serve me 20 years ago. I wouldn't give that to my kids now, but it wasn't their fault. They just didn't know. That was what was on the shelf Cocoa pops, and what do you guys have there? Lucky charms.
Speaker 1:Lucky charms.
Speaker 2:That was just what people consumed. I think there are, like in any industry there's the good actors and the bad actors. I think the good actors take responsibility to consumers incredibly seriously. You've seen a huge evolution in terms of the type of products that are on the market, the strength of the products that are on the market, the labeling, the way that they are selling the products. No disease claims. The good actors are not saying that this product is for X, y and Z disease claim. They're moving away from all of that. They're relying on its mood enhancement, its focus. They're putting out products that are low serving size, not particularly strong, that can actually act as what they're telling you it's for, which is something for focus, something for energy, something that supports long-term, safe use of the substance. Then there's other actors in the space that are just there for the money and they are chasing that hardcore user that's looking to consume more and more and more and more, and that's a zero-sum game, unfortunately.
Speaker 2:So you've got this push and pull in the industry and we're trying to through our best through self-regulation, but importantly and this is super, super important self-regulation only goes so far. You actually have to have real regulation. I want states to step up and go. We've put a stake in the ground. We've got the Crater and Consumer Protection Act. Now we actually want this law to work, because the law is useless unless it's being enforced. It doesn't mean anything unless it's being enforced. So a big push from our side is getting these rules enforced, and we believe that our member companies and the consumers that we support believe that this is the way to go to bring this industry to order and to protect consumers.
Speaker 1:It's interesting that you mentioned food. My daughter's high school actually asked me to do a lecture on food and nutrition and addictive food. And yes, they have these taste labs where they will actually try to engineer food to what's called the bliss point. It's the ratio of fat, sugar and salt that is the most intensely pleasurable and I was joking, lay's potato chips doesn't even lie about it. Their tagline is you can't eat just one. I mean food industry don't get me started. They openly admit that their product's addictive.
Speaker 1:So when I was giving the lecture to my daughter's school, I literally there's a fun joke about somebody snorting lays because they're so addictive. So but yes, you're right, I mean and I think outside of my role as a doctor, I think about my role as a parent and the world is full of vices and some of them can be very destructive and others aren't so bad for people. And I think to your point, giving people the opportunity to know what they're up against. I mean, that's always what I lecture to students about is, when you go to college, there's going to be alcohol everywhere. I need you to have some baseline knowledge.
Speaker 2:Yeah. So I mean a couple of things on that. Back to the food situation. I mean, you think about it and this is quite stark for me when I come to the US. I'm South African, I don't know if you could tell from my accent, but when I spend time in the US, the thing that gets me the most is the coffee culture. It's just so different.
Speaker 2:Coffee in Europe or coffee here, is either espresso or double espresso with a bit of milk, small cups. It's a coffee experience In the US. It's like what size do you want? Do you want medium? Do you want grande? Whatever? You can eventually get a liter thing. But then what do you want in it? All the syrups.
Speaker 2:So you've got coffee shops that have expanded on every corner because they're selling sugar, they're selling caffeine, but they're mainly selling sugar, which is just a fascinating thing that I noticed when I'm there. So a big part of what we're also doing is we age gating. So no one under the age of 21. I think the great thing about Kratom from a children's use perspective is it tastes awful. Right, it really does not taste great. It's not a good experience and in leaf form it's not really something kids will chase.
Speaker 2:But obviously if you move along the spectrum it changes. And we put into legislation and we're trying to do it everywhere is no advertising to children, no products that are candy-flavored or in the shape of a teddy bear or whatever it may be. So a big part of what we're trying to do is ensure that the way these products are not only sold but are marketed, are for adults. These are adults' products, unlike what you're seeing in the hemp industry, which hemp turned into intoxicating hemp, and you can walk into these shops and you'll have a bag of Skittles that looks like a bag of Skittles but it's actually Delta-9 Skittles.
Speaker 1:I mean.
Speaker 2:I don't even want to make that mistake, but if a nine-year-old or a 10-year-old or a five-year-old makes that mistake, that's a life-altering mistake.
Speaker 1:I've seen that in the emergency department, yes, and our hospital. If somebody comes in with a stroke, you page overhead code stroke and I call it the code cannabis. An older person doesn't know what they're getting, gets cannabis is confused. The paramedics get called and they come in. They don't know if it's a stroke and it ends up being cannabis. One question on that I did find one brand when I was researching this called Kraken Kratom and their website did sell little gummies.
Speaker 2:I'm assuming that's an extract then? Yeah, so it'll be an extract that's put into those gummies. So gummies are a common place in the dietary supplement space. I think the jury's out on whether Kratom should be in a gummy or not. They are becoming quite popular. Again. It's super important that they're not in any format that could be appealing to a kid. Is a gummy necessarily appealing to a kid? I don't know the answer to that at this stage. It's something that we do talk about and we're wrestling with at this point in time. But what I can tell you is that colorful packaging with kids' faces on it, things that are appealing to kids, should not be on the market.
Speaker 1:or, you know, it becomes very blurry very quickly when you start to move into confectionery effectively I wish that vaping alcohol and cannabis would, would have that perspective because you at least in the us, if you go through the liquor while you have swedish fish flavored vodka and one of my patients who vapes really loves the watermelon flavor and just those flavors and colors are so stimulating for kids.
Speaker 2:Totally. I mean yeah to to. To enjoy smoking, you've got to work really hard at it. To enjoy vaping, you don't, because it tastes so good. These things change and addictions become easier. Look, I'm a believer that everyone needs some kind of substance or some kind of stimulation. Everyone's got something to quell their stress. Some are healthy things that they do and some are unhealthy things that they do. People should have choice. Life is stressful.
Speaker 2:I can tell you from a creatin perspective and I'm a creatin user myself. It's been a game changer for me in terms of my ability to be productive, to get things done, to manage my life, to ensure that I've got enough energy for a workout or a full day's work and time with the family. I've managed to control my Kratom use. I don't see it as a problem. I haven't experienced any problems with it yet, but that's just me. I haven't really abused any substances besides nicotine. I've got a real problem with that. That's my experience. It's not everyone's experience and yeah, it's been great, but I have heard some people that have had terrible experiences with Kratom. No-transcript.
Speaker 1:I have to say this has been an absolutely fascinating conversation.
Speaker 2:As we get ready to wrap up, leave me with some final thoughts on what an ideal regulatory labeling role for Kratom would be. The corner of the room is for the FDA to stand up and regulate Kratom appropriately. They tried to get it scheduled in 2016. That didn't work out. They now say it's an unapproved new dietary ingredient. They don't nuance that. Not all kratom is equal, so it's just the wild west out there.
Speaker 2:The states have stood up to do something. We believe that the regulations that are in place are good. They don't go far enough. We've spoken a bit about the labeling. I think that there should be an age restriction of 21 in every single state. I believe that you should have the warnings that we've spoken about on every single label in every single state. I believe that, 100%, you should know exactly how to consume that product. What is a serving? How many servings should I consume in a day? But I think take the regulation out of it and what's actually in the bill. The thing that I want to solve the most is enforcement, even if it's just an age limit or a labeling standard. Our industry is taking it seriously. Our industry is taking it seriously. Our retail is taking it seriously. It's our responsibility to ensure that we are following the rules so the consumers have as much information as they can to consume responsibly.
Speaker 2:Freedom of choice and access is only true freedom if you're fully educated, if you really understand what you're taking. Otherwise it's meaningless. So we can't just say, oh, access, freedom of choice. That choice needs to be informed and that information starts with the label. It starts with the label and if I can get any message across to anyone, it would be vendors and retailers label your product appropriately. The GKC has gone as far as to create a resource for vendors, manufacturers, businesses on what a label should look like. What warning should you have in that label? That's on our website and we'll develop that out as we move forward. And then again to the consumers read your label, take what is suggested to you. As soon as you start moving beyond that, there's a reason why there's a suggested serving on a package. It's based on what they deem as an appropriate use of that product. When you start to move away from that, that's where people start to get into trouble.
Speaker 1:I have to say I have learned an enormous amount, and today's Friday I'll be in clinic. Next week I'm actually hoping I get to see one of my patients who uses Kratom, because I feel so much more informed after having this discussion with you.
Speaker 2:Well, thank you so much, and thank you for your interest in the subject and for the work that you do, and let's stay in touch. I'd love to hear what you find out in the clinic Sounds good.
Speaker 1:Before we wrap up, a huge thank you to the Montage Health Foundation for backing my mission to create fun, engaging education on addiction, and a shout out to the nonprofit Central Coast Overdose Prevention for teaming up with me on this podcast. Our partnership helps me get the word out about how to treat addiction and prevent overdoses To those healthcare providers out there treating patients with addiction. You're doing life-saving work and thank you for what you do For everyone else tuning in. Thank you for taking the time to learn about addiction. It's a fight we cannot win without awareness and action. There's still so much we can do to improve how addiction is treated. Together we can make it happen. Thanks for listening and remember treating addiction saves lives.