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InvisibleveggieM

Registered: 07/25/04
Posts: 17,538
[ID] How kratom, a legal 'herbal opioid,' tore one local family apart
    #28385910 - 07/05/23 12:23 PM (10 months, 8 days ago)

How kratom, a legal 'herbal opioid,' tore one local family apart
July 5, 2023 - Idaho Mountain Express

Widely available supplement is growing in popularity despite addiction risk

The first time Bruce Nesbitt tried kratom, he was running deliveries for a restaurant when a coworker asked him to stop and pick up a bottle. Sold behind the counter of a gas station, the label on the 1.9-ounce “shot” looked similar to that of a 5 Hour Energy drink, only it promised pain relief in addition to mood-lifting qualities. Nesbitt, whose name has been changed to protect his identity, bought two bottles—one for himself and one for his coworker—drank it down, and didn’t think much of it.

Two years passed before Nesbitt tried kratom again. This time, in June 2021, he was commuting an hour-and-a-half from Twin Falls to Ketchum, in a period of his life he describes as “incredibly stressful.” The commute was wearing him down. His family was in the midst of selling their home and moving. He was struggling with alcohol as well as depression and anxiety. “I was reaching for something to take the edge off and it just kind of jumped out at me,” he recalled of that day in the gas station. Arranged in a plexiglass case, bottles of liquid kratom, under the brand name Vivazen, offered him “feel good relief.”

Nesbitt bought two shots, for roughly $9.50 a piece, and downed them both immediately. The effect this time was much stronger. “It’s kind of a mellow feeling, with a heightened awareness and stamina that’s hard to describe,” Nesbitt said. He went back the next day and bought more.

Kratom seemed like a safe, even healthy, solution—until it spun out of control. Only later, when his marriage was crumbling, his finances were in trouble, and still he couldn’t stop using it, did Nesbitt learn that kratom—a widely available and largely unregulated herbal supplement derived from the leaves of a tree from Southeast Asia—affects the brain like an opiate and can be addictive.

Vivazen did not respond to email and phone requests for comment.

Kratom’s opioid-like effects have been known for centuries in its native Thailand, where it was recently decriminalized after decades of being listed as a controlled substance. This comes as state and federal health experts in the U.S. consider regulations to crack down on the supplement, warning that it binds to the same receptors in the brain as morphine and other opioids and is prone to being abused.

Kratom’s popularity, meanwhile, has ballooned since the 2000s—in step with the opioid crisis—into a $1.3 billing industry, according to the American Kratom Association. Despite Federal warnings, the supplement is widely available in smoke shops, gas stations, and in some states, a growing number of bars. Several million Americans are now believed to use it. Many users swear by the herb as a way to wean off opioids, and even treat PTSD, although these claims have yet to be vetted by science.

Efforts to regulate the supplement garnered rare bipartisan support in both the Obama and Trump administrations, if little legal traction. The Drug Enforcement Agency tried to ban kratom in 2016, but failed amid public and congressional resistance. In 2018, the Department of Health and Human Service recommended a ban that would have made kratom a Schedule 1 drug and, therefore illegal, as are LSD and heroin.

The Food and Drug Administration, too, has long been skeptical of kratom, advising consumers to avoid it, pushing for new regulations, and sending warning letters to several kratom distributors for marketing it as a treatment for opioid addiction or pain without sufficient evidence. Because kratom is classified as a botanic dietary supplement, the FDA cannot restrict its sale unless it is proven unsafe or that it treats a medical condition.

If there’s any consensus on kratom, it’s that more research needs to be done.

Advocates say the substance is a promising alternative to opioids that could reduce the number of opioid-related deaths in America—a staggering 107,735 between August 2021 and August 2022. But some substance abuse experts and government officials say kratom is being marketed misleadingly as a way to curb addiction, despite being addictive itself.

The opioid effects from kratom derive from two powerful compounds, mitragynine and 7-hydroxymitragynine in the tree’s leaf. Mitragynine is the more prevalent of the two and has very mild opioid effects, while 7-hydroxymitragynine is 13 times more potent than morphine milligram for milligram, according to a study published by the National Library of Medicine.

At lower doses, kratom acts as a stimulant. This dual effect—a stimulant and sedative in one—is why kratom is sometimes described as “herbal Adderall” or a natural opioid, depending on the dosage.

Dr. Reid Lofgran, medical director and addiction specialist at the Walker Center, a drug and alcohol addiction treatment provider in Gooding, described this upper-downer effect in more detail: “When people mix stimulants and opiates, one drug gets rid of some of the negative effects of the other. A classic example is the speedball, when people mix heroin and meth. Kratom is like a baby speedball that gives you lots of energy and just kind of numbs you up.”

A recent survey of roughly 2,800 self-described kratom users in the U.S. found that they’re typically middle-aged and white and used the substance to treat symptoms of anxiety, depression, pain, and opioid withdrawal, according to researchers at John Hopkins University School of Medicine. Forty-one percent reported using kratom to curb their addiction to opioids, with more than a third of that group saying they stayed off those drugs for more than a year.

Another small study of 136 people in Malaysia found that kratom was effective in weaning people off opioids. But of the 78% of respondents who subsequently tried to get off kratom, none were successful.

“It’s a double-edged sword that has abuse potential, but it also has medical potential,” Albert Perez Garcia-Romeum, a scientist who studies pharmacology at John Hopkins, told Politico. He and other experts have warned that listing kratom as a Schedule 1 drug would block much-needed research and potentially steer users toward deadlier options like heroin and fentanyl.

As a doctor on the frontlines of treating addiction, Lofgren has a much dimmer view of the supplement.

“People see it and it says it will give you energy and make you feel better. And, there’s a lot of information saying it’s a great way to detox from opiates,” he said. “But of course, what it is is a simple transition from a synthetic opiate to a natural one.

“Kratom is easy to get, but it’s expensive, and what I’ve seen is that people develop a tolerance really fast, so they keep needing more. I’ve treated people who are taking 70 kratom pills a day to just stay stable and that gets to be a lot of money. Eventually, people say, ‘Wow, compared to that, I can get fentanyl for nothing.’ That’s when they switch to fentanyl and that’s when they overdose.”

Although not nearly as lethal as opioids, an increasing number of deaths have been linked to mitragynine intoxication. Kratom is banned in Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin, and even some cities and counties, including San Diego, where it’s considered a Schedule 1 substance like heroin or cocaine. In recent months, lawmakers in Georgia, Florida, Texas, and West Virginia have moved to tighten laws around the supplement.

Nesbitt’s story is just one of many. He wasn’t a heroin user in search of a safer fix. Nor was he buying kratom powder in bulk to “toss and wash”—a term that describes users who pour a spoonful or more of it dry into their mouths and then wash it down with water to get a stronger effect. Nesbitt’s story is much more ordinary for the unsuspecting way he stumbled into abusing the supplement.

Nesbitt was an alcoholic—a self-described addict in search of a way to cope. But to hear him tell what happened, he first bought kratom on a whim, without fully understanding the risks, while commuting to work. Compared to alcohol and marijuana, kratom seemed benign. It was legal. It was botanical. With few regulations in Idaho, kratom was easier to buy than a can of beer or a nip of vodka.

Nesbitt didn’t know that getting addicted to Vivazen was even a possibility. He hadn’t read the myriad posts on Reddit by people who were struggling to quit and failing. He wasn’t aware he was buying an “herbal opioid.” Nothing on the label said, at least not explicitly, that the drink contained a psychoactive and potentially habit-forming drug. Nesbitt had no idea that kratom, in the form of a drink he bought at a gas station, would blow up his finances, his marriage, his life.

Lofgran has seen this before. “Most people have no idea what kratom is. A lot of people who come into our practice for opiate dependence show up positive for kratom on our drug test. And they’re like, ‘Oh, I didn’t know that was an opiate.’ It really seems to be a common usage item.”

Within a month, Nesbitt was buying kratom multiple times a day, always drinking two bottles at a time, always the Vivazen brand. Two bottles a day quickly mushroomed into six and soon it was eight or more. At roughly $9.50 a bottle, Nesbitt’s habit was more than just costly, it was potentially ruinous—a $100 a day addiction that few Americans, and certainly not a middle-class family, can afford. (According to experts like Lofgran, that’s one of the biggest risks—that kratom can lead former users back to heroin, which is cheaper and stronger.)

“I didn’t want to do it, but I liked the feeling and it became a habit. It definitely had a pull on me,” Nesbitt said. “I liked alcohol, but I never craved it like I craved kratom. I knew it was wrong, I knew I shouldn’t be doing it, in terms of the money I was spending on it. It was money I didn’t have, and you know, I had to come up with the money somehow.”

Nesbitt’s wife, Claire, whose name has also been changed, first became suspicious when she noticed the gas station charges.

“We’d always been very team-oriented towards our budget. So when he told me he was filling up his tank three or four times a day for work, for $25 a time, that was the first red flag,” she said. “I thought, ‘you’re not spending $100 a day on gas and breaking it up over three or four tanks.’”

Financial indiscretions snowballed from there. Claire noticed her husband was using personal checks at the grocery store, something she said he’d never done before. Tools and equipment went missing from their garage. Claire didn’t know it at the time, but her husband had fallen into a financial trap that’s common among kratom users. Because kratom is legal in 43 states, including Idaho, most users aren’t getting into trouble for possessing the supplement, or for selling it. They’re getting into trouble for trying to pay for a habit that’s well beyond their means. In short, financial crimes.

Blaine County Prosecuting Attorney Matt Fredback has encountered a lot of such cases.

“It’s something I see frequently—theft crimes that are related to supporting a kratom addiction,” he said. “I’ve had several of them and even one recently that was an embezzlement case, and when we looked at the evidence, we could see that the money was being spent at local gas stations supporting a $100 a day habit.”

That case involved a 29-year-old Ketchum woman who pleaded guilty to felony grand theft after stealing more than $6,000 from a local retailer to buy kratom.

Fredback has also witnessed the substance abuse side—namely, opioid addicts who turn to kratom precisely because it’s legal.

“Kratom is prohibited during felony probation and drug court, but it is tested less frequently, so some people use it to avoid detection,” Fredback said.

Kim Hayes, a counselor in Hailey, recalled a time when it was easier to slip through drug court—an intensive form of parole heavy on testing and counseling—using kratom without getting caught. She described a person in drug court who, after graduating, admitted to her that they had been using kratom the whole time.

“That was back in 2015 or so, when we didn’t know anyone was even using this substance,” Hayes said. “It looked like a person was successfully going through treatment, when in fact they were substituting one addiction for something else. Drug and alcohol testing labs now offer to test for kratom, which is helpful.”

During that first summer using kratom, Nesbitt’s behavior at home grew increasingly erratic. He often abused alcohol, but according to Claire, his reaction to kratom was different.

“His personality shifted in a way I had never seen before, even with the alcohol. He’s normally a really great employee and worker and always communicates really well, efficiently and kindly. But he started hiding things and not telling the full truth. I suspected something, but I didn’t know what it was,” Claire said. “It was different than anything I’d experienced before and we’d been married 14 years.”

It wasn’t long before Nesbitt started taking more deceptive steps to acquire kratom. Personal checks at the grocery store gave way to loans taken out in secret.

Aware that something was up and desperate to know what it was, Claire kept pressing him for answers.

She finally got her answer in September, when tempers flared and Nesbitt confessed that he was addicted to a drink he was buying at gas stations. He admitted to using personal checks at the grocery store for cash back so he could conceal his kratom transactions. He admitted to pawning off tools from their garage and selling some on eBay. To Claire’s shock, he admitted to taking out personal loans to support his habit—something so reckless and out of character that she knew his addiction was serious.

At that point, Nesbitt had only been using kratom for three months. And yet his addiction was full blown, controlling his daily life.

“He told me he could not stop,” Claire said. “He gave me permission to control his finances. He cut up all his cards. I opened accounts in my name so he couldn’t access them. He was very remorseful and I thought he was going to get better.”

Nesbitt agreed to go into recovery. He started going to meetings. But Claire got the feeling he wasn’t taking it seriously. “His personality still wasn’t right,” she said. “He was disconnected at home. Not getting up in the morning and having coffee or breakfast. Just bypassing all of us. It wasn’t him, because when he’s in a sober state of mind he’s a really good friend and dad.”

In March 2022, nearly nine months after Nesbitt first started using kratom, Claire went on a trip with a friend. While she was away, her bank notified her that several checks had bounced. Something didn’t add up: The account to which the checks were connected no longer existed. Claire had closed it months before when she took control of their finances. She finally put it together: Bruce had found some old checks from their closed account and used them for cash to buy kratom.

“We were on a blacklist at stores around town. And that’s when I said, ‘Okay, I’ve got to do something drastic. We have to sever everything. And if you’re going to fall flat on your face, you can’t drag the family down. We can’t lose our house.’”

Claire filed for a divorce when she got home.

“I had to protect the kids, me, us from losing everything,” she said. “In less than a year, six months really, we went from being a solid unit to everything being destroyed.”

Although exact numbers have been hard to come by, Claire estimated that during that time her husband spent at least $15,000 on kratom.

If there is such a thing as rock bottom, Bruce Nesbitt had hit it. Threatened with losing custody of his kids, he went back into recovery and quit Vivazen cold turkey. That’s when he learned of the risks of kratom and met other people who had abused it.

“In recovery, some of the guys were like, ‘Man, you think that’s hard to quit, try heroin.’ It seems laughable to say you’re addicted to kratom to most drug users,” Nesbitt said. “There’s some truth in that. Compared to hard drugs it’s not as difficult to quit. Then again, I had a lot of motivation.”

Nesbitt said he knows of another valley resident who went into recovery and used Suboxone—a prescription medication designed to treat opioid addiction—to quit kratom. Lofgran said that kratom withdrawal can be just as difficult as opioids, if not worse, because of its stimulant component.

“The dangerous thing about kratom is you’re mixing a stimulant with an opioid, and that makes coming off it even harder,” Lofgran said. “As with any other stimulant, you feel like you have all this energy and you’re really productive. And then when you stop the stimulant, you’re tired for weeks, you’re probably not sleeping well, and the knock-on effect is that patients tend to develop a lot of anxiety because they feel like they can’t accomplish anything. So, unfortunately, it’s more than just an opiate detox, it’s a combination.”

Lofgran added: “We’ve been able to treat (kratom users) with the use of other medicines that we treat opioid dependence with—buprenorphine, specifically. But if they’re taking a large amount, it can be bad. Opioid withdrawal won’t kill you, but people often say it feels like they’re going to die. I’ve seen people feel the same way when they’re trying to come off kratom.”

Sonya Wilander, executive director of the Men’s Second Chance Living sober house in Hailey, is also on the frontlines of kratom, both from her real-world encounters, and because she researched it for a class towards her bachelor’s degree in substance abuse counseling. Her assignment was to write about a drug that was growing in popularity and came with significant risks.

“Everyone is so familiar with opioids. But no one, not even the media, really talks about kratom. I was seeing the effects in our community, and I wanted to know more about it,” Wilander said.

In the course of her research, Wilander became convinced that kratom should be better regulated, if not medically managed.

“It has this harm-reduction potential, getting people off deadlier drugs, but at the end of the day, they then become addicted to kratom. Methadone is addictive, too, but it’s also much harder to get. You have to go to a clinic. People aren’t self-administering methadone,” she said. “I often hear, ‘I’m only addicted to kratom. I’m only addicted to alcohol.’ Well, just because it’s legal, doesn’t mean it’s better. An addiction is an addiction is an addiction. Eventually, it’s doing some damage.”

Wilander said she tests for kratom regularly in the sober house but acknowledges the challenges of doing so—primarily the expense of the tests themselves. Regardless, she insisted, “In our house, the men are not permitted to use it. We ought to protect our children from starting on it.”

In a state like Idaho, where kratom is virtually unregulated, it’s up to individuals and business owners to decide how it’s sold and consumed. Clerks at the Base Camp on Warm Springs Road in Ketchum said they sell two or more cases of Vivazen a day. That’s 24 bottles or more, and it doesn’t include the customers who come in every other day to buy an entire case. K Meta shots, a less expensive competitor of Vivazen, are also popular, selling through a case and a half a day, the clerks said. Kratom Divine, their shop’s most expensive kratom product, is a 0.66 ounce liquid shot that sells for $17.70.

Even though they’re not required by Idaho law, both Base Camp and Veltex Market have signs on their kratom displays barring young customers: “Must be 18 or older to buy.” Presently, there is no age limit on who can buy kratom in Idaho.

Nesbitt has been working hard to rebuild his life. He’s sober now, and has deep regrets about kratom. It’s almost as if he’s recovering from the shock of it—of losing his marriage over a substance that most people have never heard of, and that other drug addicts don’t even take seriously. It’s a difficult thing to talk about.

“I’m an alcoholic,” he said. “My behavior when I drank was not good for my marriage. I’d say kratom was the final nail in the coffin. Just being shady about it. Companies are trying to make it seem like a healthy alternative. Compared to using painkillers, I guess it is a safer alternative. But for a person with an addictive personality like myself, it can get out of hand quickly.” 

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Invisibledurian_2008
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Registered: 04/02/08
Posts: 18,037
Loc: Raccoon City
Re: [ID] How kratom, a legal 'herbal opioid,' tore one local family apart [Re: veggie]
    #28386978 - 07/06/23 10:42 AM (10 months, 7 days ago)

Quote:

I liked alcohol, but I never craved it like I craved kratom.




As someone who has done "cleanouts", who has been sent looking for missing addicts, and who watched someone go legally blind:


Some people never find that point of satiety / satiation / satisfaction, where you put down the tobacco or beer or donut or casino.

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