Cannabis use as a tool in the harm reduction of opioid use: A Canadian perspective

While greater quality research is needed to gain a better understanding of the possible benefits of cannabis in improving pain management and mitigating opioid harms, we anticipate that the loosened legal restrictions for research that have accompanied the legalisation of cannabis in Canada will open the door for generating empirical evidence. More in-depth research is needed to accurately measure dose reductions, improvements in symptoms and pain, and to establish the underlying reasons visitors to High Hopes use cannabis as a substitute for opioids. While there are limitations to this study – namely, the small sample size, the short period over which data was collected, the problems with self-report and the possibility of recall eco sober house boston bias – this preliminary research nevertheless offers some important insights about the potential role of cannabis in reducing opioid harms among a vulnerable population. While we are unable to draw causal explanations for opioid substitution or definite conclusions about the benefits of cannabis in reducing opioid harms, what we did learn from this preliminary study was that cannabis was viewed as an important adjunct therapy by a population that experiences higher rates of mental illness, trauma, physical comorbidities, and overdose. In another study, a small population of chronic pain patients in Michigan reported reductions in opioid use by 64%, as well as decreased medication side effects and an improved quality of life.

In addition, kratom dependence and withdrawal are generally weaker and more readily self-managed relative to opioids. Use of opioids such as methadone and buprenorphine should be judicious in people seeking help to manage their kratom use disorder and/or withdrawal. If they formerly or are perhaps still using opioids, then the possibility of treatment with buprenorphine or methadone may be more helpful and appropriate if kratom is not satisfactory.

The evidence shows that millions of people in the US purchase and use kratom products for improving health and are preferred to FDA approved medicines because for them, kratom products are more effective, accessible, and tolerable. It is important to note that the benefits documented in published surveys do not constitute the basis for therapeutic claims and no kratom product or kratom alkaloid is approved for therapeutic use in the US. The FDA and other federal agencies state that there is no proven therapeutic use for kratom despite evidence that millions of people in the US and many more in SEA use kratom primarily for therapeutic, beneficial use. That evidence includes peer reviewed surveys and field studies in the US and SEA, clinical and preclinical studies showing that MG’s mechanisms of action are consistent with such effects. Moreover, several animal models used to predict efficacy for treating opioid use disorder, opioid withdrawal and pain demonstrated efficacy. In the first half-year of the COVID-19 pandemic, there was uncertainty about kratom supply by vendors and consumers, however, overall US supply was not affected.

The CSA eight factors evaluate pharmacological actions in the brain or central nervous system that may lead to dependence, substance use disorders, or addictions (American Psychiatric Association, 2013; National Institute on Drug Abuse, 2019; World Health Organization, 1994; O’Brien et al., 2011). Abuse potential assessments determine whether substances and medicinal products should be controlled by the CSA , and if so the restrictiveness or level of control. Substances are only placed in Schedule I when there is no FDA approved therapeutic use and sufficient abuse potential to merit control.

  • With investments in social services and mental health and an openness to experimenting with out of the box solutions, we will be better equipped to get ahead of this public health crisis.
  • Abuse potential assessments determine whether substances and medicinal products should be controlled by the CSA , and if so the restrictiveness or level of control.
  • This includes the old and new Drug Abuse Warning Network, Monitoring the Future, National Survey on Drug Use and Health, RADARS®, or the Treatment Evaluation Data Set.
  • JH was the primary scientist/investigator, and lead the identification of articles, writing, and analysis.
  • Opioids are central nervous system depressants and when taken in a quantity that exceeds what the body can handle, they can depress breathing and precipitate heart failure.

Dating back to at least the late nineteenth century, individuals in Asian Countries have taken the matcha-green material as a discomfort treatment and mood enhancer. Despite its current marketing as a cure-all or even a replacement for painkillers, several healthcare experts concur that it is dangerous.

Why genetics makes some people more vulnerable to opioid addiction – and protects others

These topics include current events, true crime, science, mysteries, conspiracy theories, and of course aliens. In addition to exploring the benefits of alternative therapies such as cannabis, we must also address the contamination of the drug supply. Recently, many progressive organisations have been calling for programs that supply pharmaceutical-grade opioids to people at higher risk for overdose from fentanyl and fentanyl analogues. The government of Canada has responded to these calls by approving injectable hydromorphone as a treatment modality for people with opioid use disorder. While this is an excellent first step to ensuring that people who have an opioid use disorder have a safe supply of medication, there is still much work to be done to ensure that a safe supply – along with mental health and treatment supports – are available to all individuals at risk of the harms of fentanyl and its analogues.

Patterns and reasons for use and demographics were investigated in 142 current and 62 former opioid polydrug users in Malaysia (Singh et al., 2020c). The alkaloid content of a kratom street sample was primarily MG, followed by paynantheine, speciociliatine, speciogynine, and “low levels” of 7-OH-MG. There were no significant differences in demographic characteristics between current and former opioid polydrug users except with respect to marital status, with current kratom users having a higher odds ratio of being single. While both current and former opioid users reported using kratom to ameliorate opioid withdrawal, current users had significantly higher likelihood of using kratom for that purpose; however, former opioid users were more likely to use kratom for mood elevating effects.

  • As the nation grapples with its opioid addiction epidemic, one solution for many with chronic joint pain and back pain could be physical therapy.
  • Nonetheless, the findings are encouraging and should facilitate the conduct of more comprehensive follow-up studies.
  • The purpose of this review is to provide an update of our 2018 article on the abuse potential of kratom.
  • In December, 2021, the World Health Organization Expert Committee on Drug Dependence concluded “there is insufficient evidence to recommend a critical review of kratom mitragynine and 7-hydroxymitragynine” but should be kept under surveillance .
  • This subject has been the focus of a growing number of articles published in academic journals, which have become the subject of much debate.

The main reasons for kratom use are pain relief (48%), anxiety, “PTSD” or depression (22%), increase energy or focus (10%), and “help cut down on opioid use and/or relieve withdrawal” (10%) (Coe et al., 2019). Side effects were generally minor, e.g., stomach upset, rarely required medical attention and rates and severity of “bad reactions” were generally similar to those reported by Grundmann . As mentioned in Table 2, the NSDUH and RADARS surveys may greatly underestimate the US prevalence and incidence of kratom use, with estimates of past year kratom use of 1,790,00–2,040,000.3 (U.S. Department of health and Human Services, 2020; Schimmel et al., 2021).

Kratom Abuse Potential 2021: An Updated Eight Factor Analysis

Furthermore, Thailand has lately reassessed the legal recognition of several illicit drugs; thus, kratom may no longer be prohibited. Countries, municipalities, and towns that do not now prohibit it may make that https://sober-home.org/ choice at any time as the narcotic is much more generally recognized. Furthermore, the principal constituent in kratom varies significantly from species to species, causing its impacts unpredictably variable.

Advances in analytical methods are accelerating our understanding of the effects of numerous kratom alkaloids including liquid chromatography–tandem mass spectrometry assays that quantify kratom alkaloids in kratom leaf extracts and commercial products (Sharma et al., 2019). Kratom is commonly consumed to enhance occupational performance and as a coffee substitute for energy at low doses. Suhaimi, Hassan, Mansor and Müller reported changes in brain electroencephalogram activity after acute and chronic MG exposure in rats, with strong effects on some measures at high doses, supporting the importance of more research on brain function and potential cognitive effects (Suhaimi et al., 2021). Consistent with Vicknasingam et al. ’s clinical findings, oral LKT administration to mice produced dose-related antinociceptive effects at doses that did not alter locomotion or produce CPP; there were brief, non-life threatening decreases in respiration (Behnood-Rod et al., 2020).

is kratom illegal in michigan

The US has the most comprehensive survey data to address the need for temporary or “emergency” placement of substances into CSA Schedule I. Yet none of the major surveillance systems identified such a public health threat. This includes the old and new Drug Abuse Warning Network, Monitoring the Future, National Survey on Drug Use and Health, RADARS®, or the Treatment Evaluation Data Set. DEA’s National Forensic Laboratory Information System mentioned kratom reports from 2010–2016 but none thereafter because the signal remained low. Safety assessments in pharmacokinetic and pharmacodynamic studies confirm that kratom based extracts and individual alkaloids at far higher doses than consumed by humans do not appear to carry substantial mortality risk, with one analysis suggesting a mortality risk at least 1000 times less than illicit opioids (Henningfield et al., 2019).

Substances with approved therapeutic uses and sufficient abuse potential must be placed in Schedules II–V. By law, an eight-factor analysis (8-FA) provides the primary pharmacological and public health basis for drug scheduling (Food and Drug Administration, 2017a; Belouin and Henningfield, 2018; Johnson et al., 2018). This assessment focuses on kratom and its alkaloids, in particular mitragynine , the primary alkaloid in kratom present in sufficient amounts to account for its effects. This episode covers the Rockefeller family dynasty and how they came to control almost every industry and government around the world. We also dive into conspiracy theories linked to the family as well as their connection to the Rothschild family. We created this podcast with the sole purpose of opening minds and sharing information about a wide range of topics that often doesn’t get mentioned by the mainstream media.

What Is the Legality Status of Kratom Around the US And UK?

President Donald Trump displays a presidential memorandum he signed, declaring the opioid crisis a public health emergency in the East Room of the White House, Oct. 26, 2017, in Washington. Dependence and withdrawal were addressed in a systematic review of kratom use for mental health reasons that concluded “Kratom dependence is a risk for some people, though the dependence syndrome appears to be mild in its psychosocial and physiological effects eco sober house price relative to that of opioids … kratom use does not appear to result in significant respiratory depression” . A major category of kratom use globally was to self-manage substance use disorders, consistent with the findings discussed in Factor 1 that demonstrated low abuse and physical dependence potential, and that MG administration reduced morphine and heroin self-administration, and withdrawal signs (Hemby et al., 2019; Harun et al., 2021b).

Such efforts are actively in progress characterizing a variety of indole and oxindole alkaloids, determining their chemical structures, and binding affinities for opioid and other receptors (Chear et al., 2021). One approach to the synthesis of novel MG analogs produced several partial MOR agonists with low G-protein activation (Chakraborty et al., 2021b). These analogs demonstrated robust analgesic effects but low respiratory depressant, locomotor, and conditioned place preference suggesting lower adverse effects including abuse potential.

Nonetheless, the findings are encouraging and should facilitate the conduct of more comprehensive follow-up studies. New kratom pharmacokinetics studies in rats, mice and dogs document plasma MG, 7-OH-MG, and other alkaloids and minor metabolites over 12 h or more, with accompanying safety assessments. Six new clinical studies following long-term kratom use provide safety data on health, and organ and brain function were also conducted. Combinations of kratom alkaloids may inhibit cell proliferation and migration of nasopharyngeal carcinoma cells suggesting alkaloid or new analogs as potential cancer treatments (Domnic et al., 2021b).

The most important public health benefits with respect to mortality are widely agreed upon by kratom experts and surveys, and that is its use to self-manage opioid and other drug addiction and withdrawal symptoms, and thereby reduce use and overdose from far deadlier substances. This type of use is not unique in the US but was long reported in SEA (Raffa, 2014; Henningfield et al., 2018a). This was also reported in the first major US Internet survey of kratom use , as well as in subsequent surveys (Coe et al., 2019; Garcia-Romeu et al., 2020; Pain News Network ). This was also a conclusion of a systematic review of 13 studies addressing kratom use and mental health in the US, SEA, and other countries and regions of the world, and a review by an international consortium of kratom researchers (Swogger and Walsh, 2018; Prozialeck et al., 2019).

Articles on Opioid epidemic

Founded by Sarah Blyth, President of the Overdose Prevention Society, High Hopes offers cannabis products, which include bud, edibles, capsules, CBD, kratom, and cannabis-infused honey as an alternative to opioids for pain management and as a measure to stem the tide of fentanyl overdoses in the DTES, the epicentre of the opioid crisis in Canada. Although it is very much an emerging area of research, there is some evidence to support the cannabis-opioid-sparing hypothesis. Some of the population-level research on states with medical cannabis and recreational cannabis laws, for instance, has linked the presence of laws to decreases in opioid prescribing and harms.

According to the findings of an interactive study conducted in 2014, people who use this in the Americas are generally middle-aged or half-aged persons in pain. The vast majority of the almost 6,000 people who responded to the study claimed they used imperial kratom to relieve pain or boost their mood. Furthermore, high doses may significantly obstruct the nervous system, resulting in significant respiratory sluggishness. While Columbus kratom is occasionally promoted to overcome opioid overdose, it is compelling in and of itself.

These findings do not support the conclusion that kratom use represents an imminent health threat and in fact kratom is not listed in the most recent DEA National Drug Threat Assessment . There is no evidence that kratom is “fueling” or otherwise contributing to the opioid epidemic, though the survey data suggest that it is an informal self-management approach supporting the efforts of many opioid users to reduce and discontinue opioid use (Grundmann, 2017; Coe et al., 2019; Garcia-Romeu et al., 2020; Grundmann et al., 2021). Survey data incidence reports for DAWN, MTFS, NFLIS, and TEDS are apparently below the threshold for reporting as confirmed in an inquiry to NFLIS (Drug Enforcement Administration, 2020a; Drug Abuse Warning Network, 2020; Substance Abuse and Mental, 2020). Pharmacokinetics and safety data from multiple species, kratom preparations, alkaloids, and metabolites; advances in bioanalytical assays providing more accurate and reliable findings; and data from multiple studies with MG doses many times higher than those human kratom users take are now available. These studies add to those described in Factors 1 and 2 confirming little evidence of serious adverse or life-threatening effects over a broad range of doses, dosage forms, and in four species .

The NDA must be supported by “substantial evidence of effectiveness,” and is defined as “evidence consisting of adequate and well-controlled investigations” (Katz, 2004; Dabrowska and Thaul, 2018). The time and cost to develop and achieve FDA approval of a product as therapeutically effective and acceptably safe varies widely but is often approximated at 10 years and 1 billion dollars (DiMasi et al., 2016; Wouters et al., 2020). Only two botanical substances, Veregen® and Mytesi™ , were developed as drug products consistent with FDA’s Botanical Drug Guidance and both are available only as prescription drugs that is typical of new drug approvals . Surveys and more than 20,000 comments to the DEA suggest that many kratom users fear resumption of opioid use and the need to resort to illicit kratom markets (Drug Enforcement Adm, 2016; Grundmann, 2017; Coe et al., 2019; Garcia-Romeu et al., 2020). It is not possible to project how many people would relapse to opioids and potentially overdose (Henningfield et al., 2018a; Henningfield et al., 2018b; Henningfield et al., 2018c; Henningfield et al., 2018d; Grundmann et al., 2018; Prozialeck et al., 2020). This was a concern of the DEA in withdrawing its 2016 kratom scheduling proposal and in the US DHHS kratom scheduling recission letter .

Similarly, the pharmacokinetics of corynanthidine, a minor kratom alkaloid and perhaps a MOR antagonist, were determined after 2.5 mg/kg IV and 20 mg/kg oral doses to rats, yielding a 50% oral bioavailability, a 4.1 h Tmax and extensive distribution including in brain corpus callosum and hippocampus regions (King et al., 2020). Thirteen MG metabolites were identified in human liver microsomes and S9 fraction studies (Kamble et al., 2019), and potential MG and other kratom alkaloids drug interactions were investigated including with pharmaceutic products (Kamble et al., 2020a). Kratom alkaloids are of interest as templates for novel synthesized molecules (i.e., analogs) for new medicines. One third to one half of FDA-approved medicines are based on natural plant product substances from which novel chemical entities were developed (Newman and Cragg, 2016; Domnic et al., 2021a).

All about Kratom merchant account

Experts and marketers agree that the kratom market substantially expanded since that time, with kratom export data from Indonesia to the US and major marketer consensus finding that the US consumer base was likely 10–16 million. This is consistent with a nationally projectable survey estimate from 2020 concluding past year kratom use as 4.1% or 10,500,000 kratom users (Covvey et al., 2020). Speciociliatine pharmacokinetics were characterized following IV and oral dosing to help understand the potential contribution of this alkaloid to in vivo kratom administration effects (Berthold et al., 2021). Speciociliatine had higher systemic exposure and lower clearance compared to the other kratom alkaloids mitragynine and corynantheidine.

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