The Benefits Of Naturally Existing Limits For Harm Reduction In A Legally Regulated Regime: Opioids
plus, opioid advice by two very different sets of experts
(Note: this is a First Draft. By the time I open this site to comments, it should be substantially complete. I’ve got the beginning and middle of something here. I’m just not ready to wrap it up yet.)
This question is a little stickier than marijuana. The most obvious “natural regulation” is the opium plant itself, with its 10% morphine content and entourage of chemicals, some of which have been shown to modify the properties of morphine. Opium is more difficult to overdose on than pill formulations of morphine or other opioids, to say nothing of intravenous injection, which appears to approximately triple the strength of whatever opioid is being used for the purpose. But opium can still kill the unwary with an overdose, particularly opioid-naive experimenters or occasional users. It’s much easier to ingest a large dose and keep it down until it becomes a lethal dose, compared with the most concentrated and potentially lethal forms of distilled alcohol- including 190 proof ethyl alcohol, which is of course legally available for purchase in most parts of the country (although many stores decline to carry it.)
That’s the baseline for comparison, here: how easy is it to poison oneself with opium, paregoric, or opioid cough medicine, compared to 190 proof Everclear? How easy is it to poison someone else?
I’m not convinced that a legal market for mild opioid preparations will work to do more good than harm, in balance, compared to keeping it prohibited. I’m the guy who’s wary of market sales of cannabis products, remember? But that one is an easier call (especially if some basic limits are established, as I’ve discussed elsewhere.) Cannabis is exceptionally nontoxic for a mind-altering substance. Opium and opiate/opioid preparations- even mild ones- are more dangerous. So any legal regime that makes opioids available on a basis similar to alcohol is likely to require some extra level of accountability from the buyers.
As I've noted in other posts, there are already outlets for beer and wine in parts of the country (the state of Pennsylvania, in my experience) that require all purchasers—no matter their age—to present a photo ID for copying as a digital record. Given the modern technologies available, it’s also possible to add an extra level of control over such purchases beyond that, in order to limit the amount of OTC substance being purchased in a given time period- not only at any one given outlet, but potentially others in the regional vicinity, or even across state lines.
This is not an optimal solution from a libertarian standpoint. But it is the one that’s in place in most marijuana dispensaries in the states where cannabis is legal. As long as the recorded ID isn’t vulnerable to being abused through some sort of credit scoring regime, it could work reasonably well for a market in legal opioids, as a practical control on the liability of addiction and the moral hazard of diversion. Understand how similar situations were often handled in earlier times, by local pharmacists and apothecaries: customers for poisonous medicines had to sign a poison register. There were quantity restrictions on such substances. What I’m proposing here is intended to accomplish the same goal: buyer and user accountability, and the prevention of profiteering and diversion.
Opioid consumers of strict libertarian principle who object to the policy are free to do what they do already, of course: patronize the illicit marketplace. I’d anticipate that one will still exist- especially for the more potent purified compounds and synthetics, which would remain on DEA Schedule II, just as they are now. I doubt that marketplace would be anywhere close to the size or continent-spanning scope that it is nowadays under blanket Drug Prohibition, though, and because I’d expect that some level of law enforcement would still be necessary, that market would likely be vulnerable to more disruptions of the supply chain.
That said: in my view, if someone can find it, they can have it. A little bit of it. I’m a libertarian about all personal drug use, at the consumer level: I don’t think anyone should be subject to arrest for the personal possession of any substance. Considering that anyone who wants to can drive themselves mad on legally obtainable trumpet flowers or jimson weed, it seems churlish to bust someone for anything else. But I’m open to mandatory confiscation of some particularly unsafe products, if they’re found in a patdown search. And in the case of some substances, my subjective definition of “personal use” would be strict. I’m not sure of the exact limits that I’d support in each case, but it wouldn’t be anything like five grams of heroin. After the limit, the person in possession could find themselves running afoul of the criminal statutes. I don’t think unauthorized people should be in the business of profiting from selling unsafe products, whether the product banned as unsafe is some form of dope, pesticide, asbestos, or what have you. And woe betide the person found in possession of forbidden substances- or even quasi-legal ones- in the event that they’re apprehended for any other kind of serious criminal transgression.
I hope you get the picture. My position is that at the buyer level, you are free to use anything that you can manage to score. But don’t buy too much of it. And whatever you’re high on, you better keep to a minimum standard of civil behavior around other people and their premises. Because that’s a level where I support police intervention, it if proves necessary. That goes as well for the “clean and sober”, of course. I’d expect no less in the case of the intoxicated. For me, that’s the nature of this particular social contract: you get to get high- as long as you maintain. It isn’t an excuse to cause trouble.
To return to the possibility of legal commercial sale: I don’t find any need for brand names. It’s all the same poppy juice, basically. No doubt, sales would require the full bulletproof glass barrier at the counter. I used to view that prospect as a terrible impediment—evidence of a society gone bad—before those barriers turned up in the 1990s as normal security infrastructure in kwik-marts and gas stations all over the country. Now I feel better about it; I don’t have the feeling I live in a police state, and fewer gas stations and markets are getting held up. So security barriers of that sort would just be part of the deal for the limited number of outlets licensed to sell opioids to the public, of whatever form those stores might happen to take.
Realize that selling opioids retail is not like selling booze- not even expensive booze that gets locked in cabinets to prevent shoplifting. Opioid addiction is another level. Opioid addicts experience subjective desperation. Some of them are a combination of desperate and not nice about it. As the saying goes, they’re not really themselves- especially in that condition. They’re at their worst. I support medical addiction maintenance, but it seems to me to be the case that some opioid addicts are always going to resist even the most liberal of reasonably crafted restraints. There’s a fractious and unruly subset who chafe at any limits on their pursuit of artificial paradise. They prefer to stay out of the medical system, and score illicitly, and boost and coast and rush and binge until they run out, and then throw tantrums and try to intimidate shopkeepers into handing over their entire supply, and impolite actions like that. Anyone licensed to retail opioids nowadays is in the same position as a jeweler or a pawnbroker. They’ll have armed guards, they’ll carry firearms themselves. Their books will be open to frequent inspection.
That situation is not the fault of The System. Some junkies are uncompromisingly selfish and entitled, even if they’re permitted to use legal supplies of heroin. I’d guess that modern Americans are among the worst of the lot; we’re used to extra desserts. Some other nations have a few opioid medicines available over the counter, and their citizens don’t take undue advantage of the situation. Or at least they didn’t—until modernity, globalization, and the Drug War acquainted the locals with the consumer values of foreigners, alongside a burgeoning trade in the bootleg product lines peddled by that local big business employer, the “cartels.” For decades on end, the stronger products of Meixcan farmacias used to be more like a minor demimonde attraction for tourists, and the Mexican population of junkies, speed freaks, and crackheads used to be minimal. Not any more. It isn’t like it was.
Fortunately, most opioid addicts are more tractable than the hard core. Not only that; after a sufficiently long span of years, many of them become more open to the advantages of Recovery (they’re huge!) Some long-time addicts have been known to mature out of needing opioids, or even wanting them. It’s, like, one day they’re over it. Maturing out of addiction is easier for someone who isn’t in the street life of always having to hunt up their fix. Which is why I support medical addiction maintenance as a speciality- with rewards for physicians based on how many of their patients achieve stability and productive employment, and even recovery, instead of based on how many cash patients they have in their caseload, and how many scrips they write.
It’s also a fact that the majority of opioid users are not addicts; they only use them once in a while. That would- or should- account for most of the population served by a legal market in dilute opioid preparations. What would “dilute” mean? I’d say it would be a liquid preparation about equal in strength to paregoric- 4% opium tincture. Perhaps something stronger. But not much stronger. Still strong enough to produce the desired effects- up to a point. Users with only an occasional taste for opiates should know better than to complain about the limits on strength.
(I know what it feels like- good. I’m a voluntary abstainer. I don’t want to derail my life. I have people close to me, who depend on me, who would be terribly affected by that derailment. So do most people. So I don’t think that should be an effortless thing for someone to do. Opioids make the process of derailment feel effortless. If we’re going to have a marketplace, limits are required. I’m providing my opening opinion on what they should be. It’s up for discussion.)
Up until 1970, paregoric was available over the counter in American drugstores. Per the the Wikipedia, on Paregoric:
Until 1970, paregoric could be purchased in the United States at a pharmacy without a medical prescription, in accordance with federal law. Federal law dictated that no more than two ounces of paregoric be dispensed by any pharmacy to the same purchaser within a 48-hour period. Purchasers were also required to sign a register or logbook, and pharmacies were technically required to request identification from any purchaser not personally known to the pharmacist. Some states further limited the sale of paregoric, or banned over-the-counter sales entirely. For example, Michigan law allowed over-the-counter (non-prescription) sale of paregoric until April 1964, but still allowed OTC sales of certain exempt cough medication preparations that contain 60 mg of codeine per fluid ounce."[5] Even where legally permissible by law, OTC sale of paregoric was subject to the discretion of individual pharmacists.[citation needed]
In 1970, paregoric was classified as a Schedule III drug under the Controlled Substances Act (DEA #9809);[15] however, drugs that contained a mixture of kaolin, pectin, and paregoric (e.g., Donnagel-PG, Parepectolin, and their generic equivalents) were classified as Schedule V drugs. They were available over-the-counter without a prescription in many states until the early 1990s, at which time the FDA banned the sale of anti-diarrheal drugs containing kaolin and pectin; also, Donnagel-PG contained tincture of belladonna, which became prescription-only on January 1. 1993. Paregoric is currently[when?] listed in the United States Pharmacopeia. Manufacture of the drug was discontinued for several months beginning in late 2011; however, production and distribution resumed in 2012, so the drug is still available in the United States by prescription…”
I’m trying to strike a balance between making a supply available over the counter for occasional medical purposes, or self-experiment by the curious- and even the occasional splurge into pleasure-seeking, as a substance for recreational use; vs. obviating the problems of lethal overdose, unwitting dosing for purposes of criminal exploitation, or being seduced into addiction. While understanding that it’s impossible to craft a policy solution that suits everyone’s preference.
In terms of quantity, the vast majority of opioids found in today’s illicit market are consumed by addicts. Addicts need opioids every day, often in amounts that would kill first-time users. The most effective way of suppressing the illicit market is to remove as much addict demand as possible, by implementing addiction maintenance regimes. Increased access to buproprion and oral methadone helps, but if some addicts require stronger opioids, other sorts of maintenance should be considered. I also know that opioid blocking vaccines have recently been developed. That therapeutic tool might hold significant promise. I’m not a medical professional. Some people are not only medical professionals, they have the up-close experience to have a better idea of what might work, what’s been tried and failed, why it might have failed, along with what’s been shown to improve outcomes, or might be worth trying in order to stabilize addicts, get them out of street life, and possibly encourage them to reduce and eventually stop using the substances they’re addicted to.
I realize that the position I’m asserting is anathema to dogmatic libertarians, who assert that anyone has the right to sell anything to anyone—and also to confirmed opioid fanciers, who want the easiest possible access to the substances they treasure. My response is that It Isn’t All About You. I’ve already made clear that individuals should have the freedom to possess a small quantity of any mind-altering substance without legal penalty (other than, perhaps, confiscation), and that they have a right to put whatever they want in their bodies, as long as they behave in a non-criminal way with the substance(s) in their system. But after that, the market gets involved, and opioids are unacceptably hazardous substances to be sold commercially without restriction. Beyond the risks of user overdose, the second-order consequences of diversion (including to minors) and accidental poisoning by children are non-trivial. (Unlike cannabis products, and even distilled alcohol.)It’s also all too easy to exploit these substances to enable force and fraud (as a date rape drug, or to render victims unconscious in order to roll them for valuables.)
I know, I know, the 19th century, etc. The Gilded Age was the Golden Age, in the fantasies of some libertarians. Morphine and cocaine were sold over the counter, for cheap! Paradise! It isn’t that simple. The Ocean of Modernity has continued to rise. There’s no assurance of humans living in communities with a shared ethos, sharing the sort of lifeways that work to keep the number of drug addicts and dysfunctional people to a minimum. Furthermore, consider the retail price of prescription morphine, when sold to patients with a legal prescription. It’s a lot higher price than the unregulated bootleg opioids on the illicit street market. Without insurance coverage, few pain patients could afford it.
The situation of restricted prescription in this case is not as simple as regulatory capture. It’s also about indemnification against liability. What are all the recent megamillion penalties of civil settlements against Purdue and other drug companies about? The companies abused the responsibilities of their status to profiteer from the hazardous chemicals they sold, using irresponsible recommendations to physicians and commission sales tactics that hand-waved very real dangers. The result was mass outbreaks of drug abuse and addiction that spread across the country, with even worse long-term impacts than the crack epidemic of the 1980s that followed the introduction of vapable freebase cocaine into the street market.
Much the same situation applies to prescribing physicians. I’m an advocate of medical addiction maintenance using an array of stabilization treatments that include addict access to controlled amounts of opioids. I’m not unalterably opposed to heroin maintenance, for the most resistant cases of addiction. I’m not necessarily opposed to allowing addict access to some pill forms of opioids outside of a clinical appointment setting, using outpatient prescription of maintenance amounts. Previous experiments along that line have had mixed results. Some of the problems that shut down programs such as the “British solution” of addict prescription appear to me to be fixable bugs- via increased monitoring of physicians to prevent profiteering and diversion, by not allowing access to IV formulations of the drugs, and by not adding cocaine to the list of substances provided to opioid addicts, an unscientific and terribly naive policy that may have done more to doom addict maintenance programs in the UK than anything else. The British system eventually got out of hand- mostly due to those flaws, in my opinion. But for some years, it kept the number of addicts in the UK to a very small number.
So, then, why not allow physicians to prescribe opioids to their non-addicted patients, after more or less informally clearing them as sufficiently healthy to indulge in occasional recreational use? I’m willing to keep that modest proposal on the table. But I’m dubious about going that route. Once again- medical malpractice. Conferring that ability on physicians would come with attendant burdens, like a massive increase in their malpractice insurance. Simply in terms of medical ethics, I question how many doctors would be willing to assume the professional responsibilities of prescribing substances as hazardous as opioids to patients who request them on a lark, as an experiment, or to enhance their weekends or vacation experiences. The doctors would be in the position of potentially introducing their clients to the inherent liabilities of addiction and lethal overdose carried by opioids. Considerations like patient-physician privacy would almost certainly have to be sacrified under such a regime; it isn’t any longer about therapy for a medical condition. There would be hell to pay for any prescribing physician in the event that such a client were to become addicted- especially dysfunctionally- or, worse, dead from overdose. Beyond matters of personal conscience- most doctors have those- there’s an unacceptable risk that some of the family members of the client would never forgive that outcome. The risk of an incurring an unending vendetta is not anything that can be put to rest by purchasing extra malpractice insurance, no matter how much.
I get that some physicians with a wealthy clientele are able to do it, sub rosa. Wealth has its privileges. It isn’t fair, but social justice to ensure unimpeded supply access to recreational opioid users is not a hill that I have any interest in fighting for.
That’s why I support the drug treatment option of opioid maintenance by prescription- for addicts only. The patients have to have acquired their physical dependency by patronizing the illicit bootleg or diversion market. Opioid dependency can be determined by monitoring the reaction of a person after they’re given an opioid antagonist drug like naloxone or nalorphine: actual addicts go into withdrawal. I’m only guessing without checking, but I’d venture that it’s likely that there are biochemical markers for physical dependency on opioids, especially in relation to withdrawal from the substances. It may even be possible to determine patient tolerance, and the intensity of their physical dependence; if that assessment isn’t currently possible with extant medical technology, I would hope that it’s being developed.
(Some people also acquire a physical dependency on opioids from an intractable chronic pain condition- which technically doesn’t qualify as addiction unless the patient has escalated their dose in order to access increasingly pleasurable effects. That’s a situation that happens less often than commonly supposed. A study of chronic pain maintenance patients provided the flimsy justification for Purdue’s hard sell to turn Oxycontin into a much more sidely prescribed substances, even for acute and mild or moderate pain conditions. But it really is the case that most patients with chronic pain—or extended but temporary pain, like recovery from some surgical procedures—are less likely to acquire a habit or continue it for the purpose of obtaining pleasure. Many pain patients do experience the effects as pleasurable, at least occasionally. But they’re wary of the liabilities and penalties of addiction, and view their opioid use as something to shed, as part of completing the healing process. Step-down withdrawal is most often sufficient to wean “extended but temporary pain condition” patients off of any dependency they might have developed. A smaller cohort of patients do fall into the less tractable physical dependency associated with addiction. That population should be eligible for prescription maintenance, too. They’re a group that’s quite likely to recover, if they aren’t driven on to the street.)
As I’ve said, I don’t have enough expertise to outline the specifics of various addict prescription maintenance regimes. That research is still being done. But I think that they’re a vital component as a practical therapy for improving the health and functioning of opioid addicts. Lifetime abstention is too much of an ask as the only option—especially when presented as a fiat demand from outside, rather than an internally generated and decided goal. These are matters to be negotiated by specialists in addiction medicine and their patients. Some addicts will undoubtedly try to game the system with tactics like supplementing the prescription supply. Some of them will succeed, conceivably. But many more of them will stabilize, and some will even recovery full sobriety. And, crucially, if it’s done properly and accountably, the illicit street market will be starved of demand. It may never be eradicated- especially in the digital age, the age of the Dark Net. But it will shrink to a manageable proportion. The law enforcement energies directed toward suppressing the market in those popular but terribly hazardous substances will limit the phenomenon of non-medical addiction, instead of exacerbating it.
Interestingly, the current perspective of medical knowledge is on the same page as myself, on these questions I just found this out by reading the Stanford-Lancet Report on the opioid crisis, which was published in February 2022. Their recommendations:
The profit motives of actors inside and outside of the health care system will repeatedly generate harmful over-provision of addictive pharmaceuticals unless regulatory systems are fundamentally reformed.
Opioids are both a benefit and a risk to health, function, and well-being. Opioids’ dual nature should be taken into account in drug regulation, prescribing, and opioid stewardship.
Integrated, evidence-based, enduring systems for the care of substance use disorders should be built and supported financially on a permanent basis.
Policies are available that maximize the benefit and minimize the adverse effects of criminal justice system involvement with people who are addicted to opioids.
Fostering healthier environments (e.g., through programs for safe disposal of opioid pills, substance use prevention, and childhood enrichment) may yield long-term declines in the incidence of addiction.
Innovation – in biomedical research on pain relievers and medications for opioid use disorder treatment, supply control strategy, and delivery of substance use disorder treatment – is urgently needed in response to the opioid crisis.
7. Developed nations should prevent their opioid manufacturers from promoting overprescribing in other countries. Developed nations should also provide generic morphine to low-income nations to ensure adequate pain and palliative care.
The report goes on to make specific recommendations, including pilot programs for heroin maintenance:
Recommendation 6c: To promote rapid adoption of treatments for opioid use disorder, regulatory agencies should increase their willingness to approve medications using data from trials conducted abroad rather than re-inventing the wheel.
In developed countries collectively, the range of medications used to treat OUD is broad, including oral methadone, injectable methadone, oral buprenorphine, injectable extended release buprenorphine, implanted buprenorphine, slow release oral morphine, injectable hydromorphone, injectable diacetylmorphine, inhaled/smoked diacetylmorphine, injectable extended release naltrexone, and naltrexone implants. Yet in any given country, only a subset of these medications is approved and available, reducing opportunities to expand the appeal of treatment options to a broader population and to tailor treatment to individual needs.
Regulatory agencies (e.g., the U.S. FDA) often consider international evidence to a limited extent, but still require extensive in-country data collection before drug approval, including new safety and dosage studies for drugs that have been used for many years in other developed countries. Given the exigency of the opioid epidemic, relaxing these requirements legislatively and administratively could bring more medications to patients with OUD more quickly.
The report is critical of therapies that demand abstinence or rely on active placebos like cannabinoids rather than utilizing compounds like those cited above, which work as opioids or oipoid antagonists:
Recommendation 3c: Public and private payors and regulators should curtail provision of addiction-focused health care services that have significant potential for harm.
One of the tragedies of the opioid epidemic is that even though treatment funding is in short supply, it is sometimes expended on approaches that likely make patients worse off. This includes treatment programs that actively discourage patients from using approved medications or offer bogus medications (e.g., cannabis as a cure for heroin addiction). It also includes detoxification-only services with no follow-up, which may actually increase harm by lowering tolerance and thereby increasing overdose risk. Disappointingly, treatment programs accredited by external auditors are as likely to offer ineffective services as those accredited.294
The most potent route to curtailing harmful services is to stop purchasing them. The Commission recommends that government insurance programs like Medicare and Medicaid, treatment block grants, and drug court funding no longer reimburse such services, and encourage private insurers to follow the same course. It also recommends that public and private accreditation bodies prioritize elimination of services that have significant potential for harming patients.
Note that the recommendations of the Stanford-Lancet Commission- there are many more of them, in detail- refer only to addiction treatment and medical use of opioids. They represent a sea change in attitudes- at least, if medical opinion counts for anything. Drug policy is an issue where scientific and medical opinion is routinely discounted in the political realm, in favor of ignorance and punitive moralism.
For now, I want to get back to the question of across the counter purchase of opioids, whether for for self-medication or for (frankly) recreational use.
For advice on this subject, I turned to a very different panel of experts: the users and superusers of the Reddit folder known as r/opiates . That led me down one hell of a rabbit hole, let me tell you. I burrowed into it far enough that my mind turned temporarily opiocentric, like a contact high; after reading some dozens of topic reports and their reply threads, I had to give it a rest. But I learned a lot. As I’ve known for years from reading various opioid fan pages like the now defunct Opiophile, the discussion participants are sometimes inclined to go on at length with detailed essays on various aspects of their obsession. Some of them also often quite erudite and intelligent in their observations; reading the r/opiates page upsets a lot of stereotypes about opioid addicts- while also confirming many important truths about the hazards of the substances they’re using, or have used. (The number of self-reported opioid addicts on r/opiates- whether past or present- who regret their ever using the substances is substantial. And many of them express that regret with vehemence.) At any rate, some of the regular participants keep current with the news, and they post from all over the world.
To cut to the chase on what I learned about the current status of legal opioids around the world:
the most popular and widely available OTC opioid is codeine, small amounts in tablets for oral use. Various moves have been made in Canada to ban OTC access to codeine pills, but as far as I can tell, they’re still available.
dried raw poppy heads- the source of opium- can still be found from online sources. Nothing about the natural conditions of the US works against the cultivation of poppies, and there are no per se legal impediments to cultivating them as ornamental flowers. Some cultivars features a lot more opium than others.
overseas in the nations of the less developed world, cash money talks. Prescription goods can be had, either through an easy-prescribing physician or under the table at pharmacies. There’s a hell of a lot of counterfeits peddled in various pharmacies around the world, from Afghanistan to Mexico. At least some of those pills are probably the same fentanyl pills that are found on the illicit US market.
A recent post in Ben Westhoff’s Substack page, “Drugs & Hip-Hop”, supports that last claim in some detail:
(The “Drugs and Hip-Hop” page is on my Recommended list; not only is Ben providing useful information in his posts, he’s also pursuing a video documentary on medication-assisted opioid recovery therapies that use opioid antagonists to block narcotic effects, with the working title of Antagonist. You can read more by following the link posted above to his list of posts.)
The dried poppy option is interesting, as a legal option: while raw opium and laudanum contain enough morphine to lead to lethal overdose in some cases, it’s very difficult to drink enough foul, bitter opium tea to OD. According to the user/experts on r/opiates, however, it’s entirely possible to get addicted to it, and the addiction is as nasty to shake as an addiction to oral morphine, which is similar in most respects.
I don’t think it should be illegal to grow a small household supply of opium poppies. (Yes, this is “classist”; it favors rural landowners. Real estate property owners are always going to possess advantages not available to the rest of us; if they own a big enough plot of land, that’s one of them. A dubious provilege, given the substance. But there it is.) I do think it should be illegal to sell opioid poppies on any commercial market. That’s a slippery slope. Next thing you know, venture capital vultures show up, and we have McOpium Dens around the country. Sometimes slippery slopes are real things, not just fallacies. I don’t think individuals have a Sovereign Right to sell whatever they want. I’m not that kind of libertarian. Opium is too much of an attractive nuisance, with inextricable liabilities of moral hazard for the purveyor.
That said, I guess you can find dried poppies mail-order, from overseas. If they’re a low priority for law enforcement, so be it. I support internationl police efforts that prioritize crimes like shutting down organized sex trafficking rings and the enforcing laws against trading in endangered species over obsessing over intercepting every personal-use parcel of forbidden mind-altering substances that might happen to enter the US.
The case of kratom is even more intriguing: it’s been on the gray market for years, and some Reddit users have a lot to say about it. The biggest drawback is that kratom is toxic to the liver, in some unknown percentage of people, and for some reason that hasn’t been precisely identified. But apparently it works in the human body in ways similar to an opioid, and in at least some states of the Union, it’s legal to purchase, widely available, and inexpensive. Some people swear by its pain relief properties; some swear by its recreational effects. Some kratom users prefer it as their substance of choice.
I haven’t tried kratom; I’d rather not play guinea pig to learn whether or not I’m one of the people who find it poisonous to their liver. That’s something I’d prefer to not find out the hard way. (For what it’s worth, information is currently scant on the subject. Kratom is linked with hepatotoxicity for some users. The number of reported cases is small, but liver toxicity/liver damage/liver failure is no joke. I can’t say for sure if it’s possible to be poisoned by just one use. As long as I don’t know for sure, I’m taking a pass on the experiment.) There are abundant reports by purported kratom users claiming to document their experiences; a large fraction of those reports consist of people who claim to have used it to help with their own gradual withdrawal from opioids, including fentanyl. Many of the reports claim substantial success. The FDA needs to research this stuff, not preemptively ban it.
Kratom appears to have addictive properties of its own, similar to mild opioids. That said- occasional reports of liver toxicity aside- kratom is not a major player in overdose reports, particularly lethal overdoses. The market kratom phenomenon amazes me. It really does constitute a libertarian experiment.Ironically, if the police weren’t currently up to their ears in enforcing the drug laws already on the books in the middle of the largest opioid addiction crisis in American history, the substance would probably would have been criminalized and targeted by a law enforcement crackdown long ago. The police and lawmakers around much of the country have obviously decided that the situation isn’t causing enough harm to the public to lead them to intervene by enacting criminalization statutes.
(to be continued)