The Cost Benefit Analysis of Kratom as a Medication.

[7ohm]

As a Vendor of something potentially addictive, I constantly have this inner dialogue / debate about whether I am adequately informing people about the dangers of Kratom. I'm perpetually paranoid about getting people addicted because they were ignorant or misinformed. Let's take a look at the potential costs and the potential benefits, so that we can all do our own analysis before making such an important decision. As long as we are making a well informed decision, I am confident that we will make the correct one.

Understanding the plant is necessary in order to maximize the utility of this plant and avoid some of the pitfalls of addiction/abuse. We know it's not deadly or dangerous. More people have died defecating, I'm sure. This is partly why I'm so obsessed with uncovering the science that sometimes gets buried in the hype. There is undoubtedly a ton of misinformation in this industry, along with America in general. It appears to be a current trend for whatever reason. It's obviously incumbent on the individual to decide whether something is believable or not. In my mind, only the principles that can't be backed by evidence or theory (logical) are worth arguing. Otherwise, the possibilities are endless. Anecdotal accounts can't really show more than a possible correlation between variables. But, sometimes that's good enough. It depends on the context, right?

To be clear:
This is from the perspective of Modern Western Medicine and how it pertains to Kratom as a Medication. The argument doesn't even exist if you consider it a supplement, or think that the costs are insignificant, ie is it even worth comparing if there are no dangers?

There is an entire subreddit of angry people who say that Kratom ruined their lives and is 20K members deep. The subreddit r/kratom is 100k members. A recent survey showed that 20% of users in the US are addicted, vs 10% indigenously in Asia. A distinction should be made between addiction and physical dependency. Dependence is use to a point where it becomes necessary to use to avoid withdrawal or rebound. Addiction is use despite negative consequences, psychological and/or physical.

How negative do they have to be to count?

I personally think that if you're stressed about your use, that's enough. Even if you're only slightly stressed, I feel like that is addiction. If, on the other hand, you are not concerned with the fact that you cannot control your use, then I feel like it won't be an issue, unless of course there is some other negative consequence that outweighs the potential (physiological) benefit. So, only when costs outweigh the benefits, will there be negative consequences from it's use as a med: a net effect Just the fact that you are not in full control of your use is not enough to be considered addiction by my definition. This is not the prevailing definition of addiction in the recovery community, however.

Dependence of any kind to any substance (not considered medicine) is considered addiction by the 12 step community (somehow not cigarettes or caffeine though), but not without dissonance. Replacement therapy like with suboxone is considered the gold standard for opiate addiction treatment, but for some reason, in many circles, Kratom use is not. The main issue is that the FDA has not approved kratom for anything, not even as a dietary supplement. The entire medical community revolves around the FDA, unfortunately, who is excessively anti-kratom. They are so anti that they have been caught spreading propaganda falsehoods on numerous occasions, diminishing their credibility as a public health agency. So much of the politics has to do with the misunderstandings and the stigmas associated with an incredibly medicinal plant. Just the idea that there are scientists on the other side that want this banned makes me quiver. The FDA is a group of scientists who are so pretentious that they aren't even practicing the principles of science. Objectivity. Observation. etc...They appear to have this God Complex and want to tell adult human beings what they can or cannot do with their own bodies based on generalizations and stereotypes.

Because of the potency and possible addictive nature of the compound 7ohm, one must use cost benefit analysis when determining whether to use it, just like any medication. Unfortunately, all Opioid medications are going to have tradeoffs. The FDA approves medications that kill people for a reason. This is because the diseases that they treat most certainly will, or have even worse consequences. The use of cost benefit analysis is the cornerstone of modern western medicine. Some people will say that the negative side is not negative enough for addiction to be considered a legitimate concern with this as a medication. The main reasons are the clear cut ceiling effect and the lack of beta arrestin.

Although 7ohm is a G Protein signaled pathway to the MOR, there is addiction potential, tolerance, and respiratory depression at the level a fraction of opiates. Regardless, it needs to be respected as a powerful opioid. Responsible use, whether recreational or medicinal is what will ensure that the plant remains legal. There is a woman arguing that kratom withdrawal is what made here son commit suicide, although there is little evidence. Arguably, there could be deficit of neurotransmitters during rebound, causing instability. It would be hard to tell if that is ultimately what caused it, but worth considering as an objective observer of the world. Being well informed on what kratom does and how to use it is essential, I feel. So, let's identify what the potential cost and benefits are, and calculate the probability they will occur. This way we can all make an informed decision on how to use this substance, regardless of whether you consider it a drug or supplement and regardless of how dangerous you think it is.

Although it has been used for hundreds of years by indigenous people, it has not been studied extensively by science until just recently. So, while there is historical basis, there is not that much in the progression of scholarly studies. These costs and benefits are historically based, and/or documented by science.


Costs:

Addiction (Compuslive Redosing)

Dependence / Withdrawal Syndrome

Hepatic Face (Dark Spots, Not reported by Americans)

Hair Loss/Thinning (Not reported by Asian users)

GI Irritation (Acidity)

Excessive Sweating

Constipation



Benefits:

Addiction Treatment (New evidence shows efficacy with cigarette cessation, and alcoholism.)

Antidepressant effects (Serotonin)

Anxiolytic (Dopamine)

Reduced Stress Response (Reduced Cortisol in Rats)

Antipsychotic (Showed Improvement in Dissociation, Alzheimer's potential?)

Stimulating (Adenosine)

Adrenergic (Addiction)

Analgesia

Muscle Relaxer

Anti-inflammatory (Mitraphyline)

Hypothalamus Regulator (Appetite Suppressor)

Lower Blood Pressure (Raise or Lower actually)

Antidiabetic (one study showed insulin like action in rats)

Antiviral (some support)

Antiparasitic (folklore)

Antidiarrhetic (folk)

High Cholesterol (Not much evidence exists for kratom per se, but anecdotally opiates in general are supposed to have a tendency to do this, there is a recent study of 100 kratom users who showed lower cholesterol actually)



Please add to the list as you see fit when doing your own analysis.



Keep in mind, that heart disease is the number one cause of death (650k) in this country, 1 in 10 people have diabetes, there were 70k opioid overdose deaths last year, 95k alcohol related deaths. 10% of worldwide disability claims are from depression. That's a lot of benefit to weigh against costs. I imagine the cost benefit curve is going to be a little different depending on the reason you're using Kratom.

[DittonW]

I personally think that if you're stressed about your use, that's enough. Even if you're only slightly stressed, I feel like that is addiction. If, on the other hand, you are not concerned with the fact that you cannot control your use, then I feel like it won't be an issue, unless of course there is some other negative consequence that outweighs the potential (physiological) benefit. So, only when costs outweigh the benefits, will there be negative consequences from it's use as a med: a net effect Just the fact that you are not in full control of your use is not enough to be considered addiction by my definition. This is not the prevailing definition of addiction in the recovery community, however.

Dependence of any kind to any substance (not considered medicine) is considered addiction by the 12 step community (somehow not cigarettes or caffeine though), but not without dissonance. Replacement therapy like with suboxone is considered the gold standard for opiate addiction treatment, but for some reason, in many circles, Kratom use is not.

So much of any individuals perception of negative or positive consequences is a subjective thing based on which direction they are coming from or their history and past experience . I think that is partially what has made the "what is your dose" thread a little contentious.
I am writing from the perspective on the United States, other countries may get more or less milage out of the "sobriety=abstinence" attitude. The 12 step treatment model has dominated addictions treatment and attitudes for a long time. I've been in inpatient treatment with 18 year olds who were sent there by their parent for their marijuana addiction. The more hard core people made fun of them , but really , like you said, positive and negative consequences can only be made by each individual. But if you ever want to feel "stressed about your use", try sitting in an addictions treatment group and being told by everyone that "your weed use is tearing your family apart man!" And that is a large part of the issue , because another engrained attitude inherited from 12 step models is that an individual who is addicted is rationalizing their behavior and is fundamentally unable weigh consequences in order to make an informed decision.

look at two different cases. A 17 year old who becomes physically dependent after he starts taking smoke shop kratom because he heard it's a legal high; likely stressed and possibly addicted. And a longtime junky/alcoholic who is physically dependent on kratom because it saved his life from junky hell . Not stressed one bit about being physically dependent and the question of addiction is a moot point because his kratom use has had nothing but positive consequences in his life.

You can say, accurately, that kratom has the potential to have a huge positive impact on the opiate crisis and save thousands of lives. But if you are proslytizing Kratom use you are also boosting the numbers of the 20% from r/quitingkratom , and those are the people that the control centers have the interest of publicizing. Ulterior motive or not, the "save our kids from addiction" headline pushes more policy than "save our fent addicts from death". And everything always has to be black and white. no complexities or grey area's allowed.

It makes absolute sense to say , "hey we need to be responsible and educate people and we have to tell kids and people who have just been introduced to kratom that they need to keep their doses low so hey don't get withdrawls and have problems ", but I don't think that means that the recovering addicts should be shushed when their reporting what is actually working for them .

Your cost benefit analysis is spot on , I think . The twofold problem is 1. Out healthcare system considers us too stupid to do our own analysis, for good reason sometimes. and 2. Addicts don't do cost benefit analysis . I sure didn't when I started shooting dope.

[7ohm]

I wish there was another approach besides all or nothing. All behavior can be learned, can't it? You can even teach a dog how to eat a moderate amount, and hunger arguably is evolutionarily the strongest addiction we have.