Categories
Chronic Pain Drug User Advocacy Vaping

Why Vaping, Chronic Pain Patient, and Harm Reduction Advocates Need to Join Hands

As of now, the phrase “harm reduction” is generally associated with illicit drugs — particularly “hard” drugs like opioids (e.g., heroin) or “radical,” “hardcore” things like injecting drugs. 

Although not watering down our cause and staying true to long-term, often-problematic drug users like me is something virtually all harm reductionists share, with this idea, we’re shooting ourselves in the foot.

Why haven’t we begun associating harm reduction with vaping or chronic pain patient advocacy on a widespread scale yet? Some of us have, but the vast majority of us haven’t. These two associations, in particular, will launch the societal acceptance of “harm reduction” into the god damn exosphere. In other words, regularly associating our cause with chronic pain patient advocacy and vaping will improve our advocacy efforts big-fuckin’-time. And, also, the tenets we share as harm reductionists will help improve chronic pain patient advocacy and vaping — this isn’t a one-sided affair.

But First, a Definition — What Is Harm Reduction?

There’s no widely-accepted definition of “harm reduction” (HR), though I define it as things that reduce harm done to or experienced by drug-involved people (e.g., active users, dealers, people in recovery, family members of addicts). Generally, it consists of doing things to help active drug users like me.

How Do We Benefit From Associating Ourselves With Patient Advocacy and Vaping?

Let’s face it — HR is generally associated with “hard” drugs and radical ideas. Although most, if not all, of the tenets we support as harm reductionists are based in academic research, evidence, and the oh-so-beautiful scientific process, our movement is still fringe because of the harsh stigma associated with our nature of work — largely-illicit drugs!

Although many Americans are on board with the idea of rolling back drug possession laws and even full-fledged cannabis legalization, most of us aren’t comfortable with the idea of non-cannabis drug policy reform — especially not with “hard” drugs — let alone doing things that actively help current drug users keep using drugs in ways that we perceive as problematic (i.e., running syringe exchanges, supervising consumption to respond to overdose). 

Don’t get it twisted — I still agree with these things. However, we can’t deny that most Americans don’t agree.

We harm reductionists benefit from associating our cause — as well as drug policy reform and drug user advocacy — with vaping and chronic pain patient advocacy by:

  • Expanding our scope.
  • Being viewed as reasonable.

I’m sure there are some other ways converging our interests benefits us, but these are the primary two that come to mind.

How Do We Help Vaping and Chronic Pain Patient Advocacy?

Again, this relationship isn’t parasitic in nature — we both benefit from this ordeal. Rather than acting as the blood-sucking leaches every mammal just loves, I like to think of us as altruistic cleaner shrimps that rid acquatic creatures of parasites.

Although not entirely, harm reduction is largely concerned with practical actions that have real-world benefits as opposed to vague ideas that are often pushed solely by voice or writing and take many decades to pay off. While vaping is very much a practical, real-world thing that has near-immediate utility, chronic pain patient advocacy is often the opposite. Or so it seems. 

Vaping, in general, is viewed as most people as something that reduces harm from already-legal tobacco products. Tobacco-associated stigma is low compared to other drugs. Harm reduction is viewed as more of a “drug thing” than vaping. In 2019 — and still today, though it’s overshadowed by the ongoing COVID-19 pandemic — vaping took a reputation hit by being associated with illicit counterfeit cannabis concentrate cartridges. HR benefits vaping by better acknowledging that regulated vaping is a very real alternative to such harmful illicit options, as many people currently just view vaping as an alternative to something that’s already legal (tobacco).

Where Do We Go From Here?

I’ll be the first to tell you — I don’t know, exactly. We certainly need to start talking about it as individuals. So, in other words, that means you can reach out to members of the social media-based communities that you aren’t already on board with (vaping and/or harm reduction and/or chronic pain patient advocacy) and spreading this idea with them.

Although I almost always say that most people’s activity on social media falls short of being “advocacy,” I genuinely do believe that uniting these three communities by personally reaching out to people on social media is an effective way to advocate for these causes — not just harm reduction.

Categories
Chronic Pain Drug User Advocacy

Joining Forces Between Chronic Pain Patient and Drug User Advocates — a Worthwhile Endeavor

If you go to any chronic pain community on social media, Internet forums, or elsewhere, you’ll quickly find patients — who’re often under-treated, giving them good reason to be upset — who blame the drug-seeking habits of many thousands of opportunistic black market entrepreneurs and irreverent recreational drug users for causing modern American pain management to be where it stands now.

Even though I’ve never been doctor-shopping, or purposely visiting physicians and other prescribers with the intention of being prescribed one or more pre-desired drugs, we “addicts” — at least that’s what we’re often called by angry chronic pain patients and their advocates — I am sometimes still blamed for contributing to the opioid epidemic. And, even if I’m not directly blamed for doing such, I often feel like I’m being blamed for that thanks to the quite-often-angry attitudes and firey rhetoric of these deservedly-mad chronic pain sufferers.

What’s With the Finger-Pointing?

I won’t break them down, but there are several reasons as to why at least some members of web-based chronic pain patient advocacy groups actively place blame on us. It makes them feel better. They might feel like, since they’ve got an inherently-evil, dirty, negligent character in “dirty junkies” or “drug addicts” — I use quotations because they’re jam-packed with a lot of stigma and I try to avoid using them where appropriate (and avoiding their use is so very often appropriate — they have a better chance of getting justice in the form of pain management treatment that truly dumbs their symptoms down to a universally-manageable level… or, at least that’s how it seems like many of them think.

I think most chronic pain patients and other non-patient advocates know that blaming selfish, ruthless, objectively-bad “dopeheads” won’t get them anywhere. But maybe not.

Why Don’t Advocacy Effort Leaders Make Way for Change?

No cause or community wants to become known as salty, bitter, or toxic. At least not any advocacy group, that’s for sure.

While, of course, changing the collective behavior of an entire community member by member is difficult — and only possible to a certain degree, as some members won’t be willing to play ball — I still think it’s worthwhile to weed out this addict-blaming behavior from the crowd.

Now, as Drug User Advocates, Let’s Think About the Flip Side

I haven’t seen much conversion among the drug user advocacy, drug policy reform, harm reduction, and otherwise-helping-drug-involved-people crowd — I’ll call this “drug stuff,” for lack of a better wording — and the chronic pain patient cohort.

Where would these groups overlap, anyway?

Chronic pain patient advocates — and, surely, there’s a better name for this group than “chronic pain patient advocates”; this phrasing, although accurate, is fairly clunky — generally want to roll back the relatively-recently-implemented guidelines that have extensively limited opioid prescribing.

We, too, as “drug stuff” advocates, want access to a safe drug supply. Both of these — expanding opioid prescribing and opening up access to pharmaceutical-quality, reliably-dosed, otherwise-illicit drugs — involve expanding opioid access in a medical capacity. Although our goals are different, we ultimately want roughly the same outcome, give or take a few shades of variance.

Something Else We Both Want

It’s safe to say that most members of both groups want greater individual liberties. Although this is something virtually everybody supports, I think our — we (a) “drug stuff” supporters and (b) chronic pain patient advocates — desires are far different from most people’s ideas of “civil liberties.”

Lower property taxes is one of the most common requests from people who request expanded civil liberties. Here are some other common demands:

  • Taking away the often-viewed-as-unfair amount of power that law enforcement has to search and seize assets — police didn’t have this ability whenever the Founding Fathers formed the United States.
  • Blocking government agencies from conducting surveillance on innocent citizens.
  • Abolishing the cash bail system, thereby restoring low-income people’s rights to fairly develop a legal defense strategy. In modern practice, low-income defendants often plead guilty to crimes even if they know they’re not guilty because they’re so scared to fight the system.
  • Giving felons, parolees, and incarcerated people back their ability to vote and possess guns.
  • Severely limiting the ability of law enforcement agencies to use physical, corporal, sometimes-deadly.

We differ from most in that we’re not vying for less government involvement in general. Rather, at least in this category, we want better access to safe, legal, regulated, standardized drugs — particularly opioids.

And Another Thing

I think both of our sides can agree that we don’t like urine drug screens. Although medical providers — and especially specialized pain management physicians — can’t force patients to submit urine samples, in practice, they do, in fact, effectively force patients to put up with drug screens.

Refusing drug screens, as we all know, regularly results in getting fired from a pain management program.

Illicit drug users like me don’t like drug screens. Although, yes, I recognize utility in drug screens because they can prevent heavy machinery operators from potentially harmful situations. Here’s the big issue, though — cannabinoids, for example, can stay in our systems for well over a week, if not a month; how can an employer reliably infer that an employee is under the influence of psychoactive drugs at the time of screening if they test positive for long-lingering cannabinoids or drugs with long half-lives like buprenorphine or methadone?

They can’t.

As we all know, although we can’t really have drug screens forced upon us unless we’re on probation or parole or incarcerated. However, just as in the doctor’s office example above, oftentimes, entities that ask for drug screens are typically able to weasel people into taking them. It’s not just doctors’ offices.

People who work for state and federal departments of transportation are usually required to remain abstinent from drug use at all times, even in their personal lives. Just like the heavy machinery operator can be fired for “dropping dirty,” as we often call it, even if they aren’t actually high at the time of testing, other transportation industry workers are subject to similar treatment.

Such policies allow employers to extensively control employees’ lives — oftentimes, it’s not like people can just up and leave one day from their jobs; as such, people who are disproportionately affected by such invasive policies often feel trapped… it’s just not very cash money.

Not cash money at all.

Here’s one caveat: physicians may be able to prevent serious adverse drug reactions and even death by administering drug screens. For example, if a pain management doctor’s patient tests positive for a benzodiazepine, he may warn the patient to cease benzodiazepine use, require them to promptly report for random drug tests at any time, or even outright fire the patient, thus potentially cutting them off from the misused opioid analgesics that could end up taking their lives.

The same caveat holds true for protecting workers from the threat of heavy machinery mishaps. I’m sure there are several other caveats, too.

How Can We Overlap Our Two Causes?

Unfortunately, I don’t know, exactly, how we can get the show on the road.

If you regularly use social media or a web-based message board and are a “drug stuff” advocate, consider engaging with chronic pain patient advocacy circles to potentially turn them on to the idea that we could get more done by joining forces. Now, I will say this: In general, using social media to change other people’s minds is silly. This is not, at all, “advocacy.”

It might feel like advocacy, but it sure as hell ain’t. With that being said, I’m not otherwise aware of how to turn these people (pain patient advocates) on to the potential of merging at least some of our advocacy efforts.

Time to Wrap It Up

I usually don’t like writing about things unless I have concrete, do-able recommendations, strategies, or tweaks to share. This is one of those times where I’m shit outta ideas — but, since this’ll need to be a collaborative effort throughout the “drug stuff” and the chronic pain patient advocacy communities, anyway, you should share your ideas with me, directly, or either of these communities at large.

Categories
Chronic Pain From Personal Experience Internet

Using Opioid Equianalgesic Charts to Determine Equivalent Doses of Different Kinds of Opioids

No, I’m not a physician. I’m not into pharmacology. But, I do know what “equianalgesic” means. I don’t usually use medical or pharmacological terms like this, but it’s necessary for what I’m about to explain.

What Does “Equianalgesic” Mean?

”Equi-“ is a prefix that means “equal.” “Analgesic” is a complete word on its own and is simply a fancy, proper way of saying “pain reliever.”

When we put these together, what do we get?

Equal pain reliever!

Okay, that doesn’t make any sense…

Anyways, the World Wide Web is home to several reliable charts that make it easy to determine equal dosages of different opioids. When combined with simple math, we can do just this.

Keep in mind that I’m not a physician. I’ve never been professionally trained in medicine. My advice is not a substitute for advice from a professional clinician.

Let’s Head on Over to Wikipedia

The equianalgesic chart I, personally, prefer to use is quite comprehensive, at least for comparing mainstream opioids, and can be found on Wikipedia’s “Equianalgesic” page.

I encourage you to head over there now to build up some hands-on, practical experience with using this chart.

When Might Equianalgesic Conversions Come in Handy?

Physicians often use equianalgesic calculators or charts when switching patients over to new opioids for pain relief.

In my world, and likely yours, too, you may find utility from knowing how to perform equianalgesic conversions when trying out opioids that you don’t have much experience with.

Note: before going any further, know that simply using an equianalgesic chart is not sufficient if you plan on using routes of administration that aren’t covered on basic equianalgesic charts.

Take a shot for every time you read “equianalgesic chart” — doesn’t that sound like a fun game! Anyways, let’s get into crunching numbers and making sense of converting the potency of one opioid to another.

Example 1 — Converting Morphine to Hydromorphone

We’ll be assuming that all opioids will be consumed orally at first, then we’ll break out the bioavailability data. Keep in mind that most such charts — both equianalgesic and bioavailability charts for opioids — will feature slight differences. These differences are typically immaterial.

First, find “morphine.” Now, find the value in the second column. It should read 1. Now, take a visit to “Hydromorphone” Lane — you’ll see a value of 4.

This means hydromorphone is four times stronger than morphine when taken orally.

Use this conversion to determine how many milligrams of morphine are equal to 32 mg of hydromorphone.

I would solve this problem by multiplying 32 by four, the “exchange rate” from hydromorphone to morphine. We’d end up with 128 mg of oral (PO) morphine — “PO,” by the way, is an abbreviation for “oral” used in medicine.

For this problem, we used this conversion: PO H/PO M.

Let’s mix things up a bit.

Example 2 — Introducing Bioavailability Into the Mix

Bioavailability refers to how well the human body absorbs drugs based on how they’re administered. Intravenous administration (IV) is always 100%. As such, other routes of administration (RoA) are expressed in proportion to IV administration.

How many milligrams of intravenous hydromorphone is equivalent to oral morphine?

Before going further, let’s pull out our bioavailability chart. I will be using one found on the sidebar of r/Opiates, a subreddit dedicated to — you guessed it! — all things opioid-related.

We’re dealing with IV hydromorphone, which is absorbed by our bodies entirely — aka 100%. PO (by mouth) hydromorphone’s BA is just 35%.

Let’s convert 16 milligrams of IV hydromorphone — which just might be enough for an elephant — to oral morphine. First, I would divide 16 mg IV by 0.35, resulting in roughly 45.7 mg PO hydromorphone.

Just like above, we’ll multiply this figure by four, the factor by which hydromorphone is stronger than morphine, to get 182.8 mg PO morphine.

We’ve made the following conversions: IV H/PO H then PO H/PO M.

Example 3 — Let’s Go Double on the Bioavailability Stuff

It’s time to convert 18 mg of IV hydromorphone into an equivalent dosage of intranasal (IN) morphine. First, I’d divide 18 mg IV by the oral bioavailability of hydromorphone, 0.35, to get 51.43 mg PO hydromorphone.

Using Wikipedia’s handy-dandy chart, I’d then multiply 51.43 PO hydromorphone by a factor of four to get 205.72 mg PO morphine.

Now, all we need to do is account for the intranasal bioavailability of morphine, which, according to the BA chart I’ve linked above, is between 25 and 30 percent.

Since the oral BA of morphine is already 30 percent, we don’t have to do anything to get the lower range of this answer — 205.72 mg IN morphine.

I’d multiply 205.72 mg IN morphine by 0.3 and divide the result by 0.25. What results is 246.86 mg IN morphine. Since it is greater than 205.72 mg, we can deduce that this number is the lower bound, whereas 246.86 mg is the upper bound.

Nobody really snorts morphine — the FDA found just 4% of morphine users to sniff the drug — but, this is just an example.

Again, here’s the conversions we’ve made: IV H/PO H then PO H/PO M then PO M/IN M.

Am I a Physician?

No! I’m not a clinician in any capacity. You shouldn’t be making dose adjustments by yourself.

However, unfortunately, since illicit drug users often aren’t given any assistance by clinicians, it’s useful for us to have information like this available on the Internet.

People are going to use drugs whether or not they’re offered help by healthcare or pharmacological experts — better understanding opioid equianalgesia is a solid harm reduction practice.

Do not take any information I’ve written herein as a substitute for professional advice from a licensed healthcare expert.

Categories
Chronic Pain From Personal Experience Harm Reduction Kratom

Kratom’s Utility in Addressing Opioid Use

Kratom trees, scientifically known as Mitragyna speciosa, are indigenous to Southeast Asia. Their leaves have been consumed by locals for hundreds, if not thousands, of years primarily for helping laborers work harder, longer, and more effectively. Kratom, which refers to the leaves of Mitragyna speciosa trees, has also been relied on for various medicinal and social applications by people indigenous to Southeast Asia.

More recently, in the past couple of decades, the Western world has grown fond of kratom. The United States is currently the world’s number-one national consumer of the drug. I believe that the recent climb of opioid use throughout the United States is responsible for kratom’s uptick in popularity in the past two-or-so decades.

Just like cannabis, kratom contains a few dozen alkaloids that are responsible for its effects. Unlike cannabis, kratom’s alkaloids have not yet been studied very well. We know that these alkaloids act on the brain’s opioid receptors. Some, particularly advocates of keeping kratom legal, backed by the American Kratom Association, argue that kratom is distinct from other opioids and should not be classified as one.

I will not be differentiating or comparing kratom and opioids in this article. Rather, I will simply address the utility of kratom in replacing traditional opioids among people who suffer from opioid use disorder, as well as how kratom can be used to dampen the effects of opioid withdrawal syndrome among people who are physically dependent on opioids.

Also, I will refer to kratom as an opioid in this article because, put simply, it acts very much like an opioid. It stops opioid withdrawal for most people suffering from opioid use disorder. It provides pain relief in the same fashion as traditional opioids. I understand that there are differences between traditional opioids and kratom — however, for all practical purposes, they are largely the same.

Opioids Are Known for Causing Dependency

One of the most common reasons why people suffering from opioid use disorder find quitting to be difficult is that they don’t want to face the effects of opioid withdrawal syndrome. As you likely know, after using opioids daily for even just a couple of months, users experience physical withdrawal symptoms that can be particularly rough.

Although opioid withdrawal is not typically known to cause death, the Internet, rehabs, medication-assisted treatment programs, and general drug culture are all littered with anecdotes of how harsh opioid withdrawal symptoms are.

In general, non-prescription drugs and prescription medications alike — the latter often known by prescribers as “comfort meds” — are used to ease opioid-dependent persons from opioids.

12 name-brand Suboxone films, commonly used as opioid replacements, stacked on top of one another.
Wikimedia Commons

Drugs such as methadone and buprenorphine (e.g., Suboxone, Subutex, Bunavail) are often used by medication-assisted treatment (MAT) providers to help opioid-dependent people from experiencing withdrawal symptoms and help them maintain neurological normalcy, two things that such opioid-dependent people would otherwise experience if they were to entirely cease the use of opioids.

Without getting into the problems that opioid users in Northwest Tennessee and elsewhere in rural Tennessee face in seeking out methadone or buprenorphine in place of their current opioids of choice, what’s important to know is that we — I say “we” as a long-term opioid user myself; fortunately, I’m currently on Suboxone and have been for a little over two months now, as of mid-November 2019 — often struggle to afford to pay for these MAT programs or the medication they prescribe, let alone have access to resources like reliable transportation to be able to visit them.

The Utility of Kratom in Addressing Opioid Use

Kratom isn’t only useful in serving people suffering from opioid use disorder as an alternative to other, often-illicit, expensive, not-always-available opioids. However, this article only addresses kratom in this light — just so you know.

Put simply, kratom relieves the symptoms of opioid withdrawal, both physical and mental. The Internet is flooded with anecdotal reports of regular opioid users who have used kratom in place of other opioids, having completely molly-whopped their expected opioid withdrawal symptoms from rearing their ugly heads in true Whack-A-Mole fashion. Personally, kratom has done just this for me.

However, for others, kratom only reduces the severity of opioid withdrawal symptoms.

Either way, kratom does a good job at eliminating or reducing the gut-wrenching effects of opioid withdrawal syndrome.

Why Use Kratom in Place of Other Opioids?

Opioids are expensive for the overwhelming majority of opioid users in Northwest Tennessee — and elsewhere throughout the United States. Since prescribers have cracked down on their once-liberal opioid prescribing practices, causing the available supply of prescription opioids diverted to the domestic black market for sale to drop, the price of available opioid tablets — and other less-common formulations, such as Actiq fentanyl lozenges or hydromorphone rectal suppositories — has skyrocketed for most of us.

In Southern Middle Tennessee, for example, according to personal experience and reports of fellow drug users who are from the area, the standard price of 30-milligram, instant-release oxycodone tablets — aka roxies or blues, as they’re often called — have risen to $50 to $60 per tablet! That’s up from a standard rate of roughly $20 per tablet in this same area around 2011 or 2012, when I first got into opioids.

Reason Number One

Mitragyna speciosa (Kratom) tree in the wild.

Kratom is far cheaper than other opioids. Although some blessed — or not-so-blessed, depending on how you look at it — individuals are able to secure ultra-high-dosage prescriptions from legitimate physicians and cover the cost of both their medication and doctor visits with insurance coverage or source low-cost prescriptions from family members in such a fashion, the vast majority of us are forced to pay lots of money for illicit opioids.

Currently, standard-quality, unadulterated, powdered kratom costs as little as $80 per kilogram from U.S.-based vendors. It goes for as little as $40 to $50 per kilogram from Indonesian-based vendors, where the vast majority of kratom consumed by American users originates.

Some people pay much more for kratom, such as in gas stations, convenience stores, or head shops, with prices ranging upward of a dollar per gram — that’s $1,000 per kilogram!

For reference, when I used kratom more often, I would usually dose between 6 and 12 grams, taken up to five or six times per day, if not more. Kratom doses for others usually range between 1 and 15 grams per dose.

Reason Number Two

Kratom is more readily available than other opioids. Back before the contemporary opioid epidemic, when the United States was home to fewer street heroin users, the domestic population of people suffering from opioid use disorder consisted of a greater proportion of those who sourced prescription opioids (including prescriptions diverted to the black market) rather than heroin to fuel their addictions.

In these days, even though the supply of legitimate prescription opioids was saturated, dealers ran out of opioids because of the problems related to sourcing prescription opioids. Of course, this persists today, just in far more prevalent fashion than before.

Heroin — I often refer to heroin as “street heroin” or “illicit street heroin” because heroin is used in pharmaceutical applications elsewhere, such as Diaphin, a brand-name, pharmaceutical version of heroin… in practical local use, though, nobody calls it that — does not fall short to this “prescription problem.” Due to its black-market nature, heroin is more consistently available than pharmaceutical opioids.

Reason Number Three

Kratom doesn’t cause respiratory depression like traditional opioids.

What’s more important is that kratom doesn’t cause people to lose consciousness — respiratory depression isn’t, actually, the main cause of opioid overdose deaths. Rather, sedatives sometimes cause people to lose consciousness and the ability to keep their airways open.

In other words, people find themselves unable to breathe during opioid overdoses.

Considering that kratom isn’t as likely to cause the single-most dangerous side effect of traditional opioids, it’s loads safer!

I should note that some studies claim that kratom does cause respiratory depression. However, widely-supported kratom reseach such as the AKA’s 8-Factor Analysis of kratom indicates that such concerns are blown out of proportion by federal government agencies such as the U.S. Food and Drug Administration (FDA).

Make your own determination regarding whether the FDA is unbiased in pumping out research that unfairly, untruly portrays the facts about drug use. One major incentive for the FDA to do so is to maintain the War on Drugs waged by the U.S. government against drug users and, by extension, society at large.

Also, another way that opioids cause overdose is through asphyxiation. Opioids sometimes cause vomiting. They also cause people to lose consciousness. Combined, opioid overdoses sometimes manifest themselves by users choking on their vomit.

In my experience — and according to countless thousands of anecdotal reports spread far and wide across the World Wide Web — kratom isn’t prone to making people pass out. While kratom may make people barf, at least they won’t spill their guts while unconscious, further separating kratom from traditional opioids in terms of safety.

Another way to look at safety is, because of kratom’s legality in both Indonesia — the overwhelming majority of kratom unarguably comes from Indonesia, specifically West Kalimantan, part of the Republic of Indonesia’s legally-owned stake of the island of Borneo, a large Southeast Asian island — and most of the United States, kratom is less likely to be cut — another word for “adulterated” or “made impure” — with other unwanted active ingredients or unknown adulterants.

I’ve heard that some batches of kratom are adulterated with “matcha,” or powdered green tea leaves. They taste largely the same as kratom and are the same color as ground, powdered kratom. Batches are rarely adulterated with active ingredients other than matcha (which contains caffeine, if you didn’t know), according to my experience with close, personal relations with Indonesian kratom vendors and processors (to read more about my relationship with these two people, skip to the section below about it).

All considered, the market status of kratom also makes it safer than many drugs sold on the black-market economy many common psychoactive drugs are sold on in the United States. Cannabis is largely safe, even in illegal states, for example, though many other popular drugs, such as heroin, are often loaded with adulterants.

Compare the relative safety of kratom to traditional opioids, then combine it with the above, to understand the full picture on kratom’s safety-related utility on opioid users.

Reason Number Four

Of course, in both my experience and the minds of countless other regular illicit drug users throughout the world, the illegality of drugs isn’t stopping hardly anybody. We’re still going to use drugs, whether or not they’re legal.

In other words, the ongoing War on Drugs isn’t working.

The primary reason why I enrolled in a MAT program is that heroin, my now-former drug of choice, is illegal. Everything about it is illegal. People who sell it are often engaged in other criminal activities — not because they’re bad people, in most cases, but because of a combination of other factors that are too lengthy to get into in this article.

I grew tired of the bullshit associated with heroin thanks to its illegal nature.

Although some drug users are disciplined in avoiding run-ins with law enforcement, inevitably, the vast majority of us will face legal trouble at some point in our drug-using careers. I’ve known this from the start, but, of course, it wasn’t enough to stop me from using drugs.

Without getting into too much detail, I wasn’t willing to risk getting in legal trouble any further, and, just a couple of months ago, I turned to a medication-assisted treatment program for help dealing with my regular use of heroin and other opioids.

The criminal justice system ultimately turned me to Suboxone. I’m grateful for that today. No more worrying about dying every fucking time I want to get high.

Suboxone is super expensive, but at least I’m safer.

Anyway.

Kratom, at least here throughout the state of Tennessee, is legal. You can’t get in trouble for kratom, legally-speaking, that is — well, at least you’re not supposed to, as some people in the Volunteer State very much have gotten in trouble for kratom possession or sale.

Most — most, not all — drug screens do not test for kratom’s alkaloids or any of their metabolites. Therefore, people in drug court, on probation, or on parole may find utility in turning to kratom as a substitute for other drugs.

Whether you’re on probation/parole, or if you simply are too scared to use illicit drugs because of potential negative outcomes stemming from run-ins with law enforcement — which includes potentially harmful interactions with law enforcement officers, such as unlawfully being shot or physically struck, however unlikely that may be, or having large amounts of cash seized as “drug money,” even if they’re not related to drugs in the slightest, among other things — or sentences placed upon you by the criminal justice system, kratom is a fine alternative to other drugs.

By the way, there’s nothing wrong with being scared of law enforcement. I am, that’s for sure! I hate that so many of us drug users have to feel that way.

Note the idea of “toxic masculinity,” whereby men have been raised by parents or society — usually both — to not be scared of or admit being scared by real threats such as those posed by doing illegal things. People who hold such ideas, which are especially prevalent in NWTN and the rest of the Southeast, are seemingly more likely to engage in adopting common harm reduction practices to some degree, however how small. This is of my personal opinion and experience spending my short lifetime in rural Tennessee, particularly Southern Middle and Northwest Tennessee.

Reason Number Five

People who face the threat of employment-related drug screens also use kratom for this very reason. Keep in mind that some state- and federal-level government agencies acting as employers are typically more likely than other employers to engage in the expensive, wide-ranging drug tests that are more likely to detect kratom as opposed to mainstream, run-of-the-mill urine and saliva drug tests.

Someone, assumed to be an employer, offering a urine drug screen and clipboard with disclosure form to the viewer.

This can be largely related to the drug screens often required by probation and parole requirements referenced above.

Reason Number Six

Kratom was illegal in the Volunteer State as recently as 2016. Since kratom isn’t illegal, it’s more on par in terms of social acceptability à la alcohol as opposed to largely-illicit drugs that are not societally considered as acceptable.

Official logo of the
PRNewsfoto / American Kratom Association

Just for the record, and in the interest of being fair to the American Kratom Association (AKA), I should also mention what positive work the AKA has done for kratom.

I feel like the differentiation between traditional opioids and kratom has harmed my efforts of promoting the normalcy of drug use, particularly opioid use. Opioids have consumed the bulk of my attention in being an active advocate for harm reduction (i.e., giving out free and clean syringes, providing naloxone to users and laypeople alike and educating them best practices in preventing opioid-related deaths) because of opioids having been my drug of choice for about five-and-a-half years as of now, mid-November 2019 and the ongoing opioid epidemic.

The FDA has argued against kratom advocates by say it should be grouped into the category of traditional opioids as a tool to keep kratom illegal throughout the United States.

I should mention that the AKA claims that kratom “is not a drug,” which is wholly false. Drugs, put simply, are things that change how we feel. Kratom very much changes how people feel, with the exception of long-term users who’ve built up tolerance to the leafy green psychoactive drug.

The AKA also says, per its “Follow the Science” web page, that it’s “not a synthetic substance” or “an opiate.” First off, synthetic substances aren’t inherently harmful; also, just because something is natural doesn’t mean it’s safe. Second, opiates — a more appropriate, all-encompassing term is “opioid,” as opposed to “opiate,” which refers only to drugs that are found naturally in the opium poppy — aren’t inherently bad, either.

However, I understand that avoiding labeling kratom as a synthetic substance or opioid helps the American Kratom Association in its efforts to keep kratom legal throughout the United States. I’m torn between praising the AKA for doing a great job of keeping kratom legal and damning them for piling even more stigma onto opioids — and kratom is pretty darn similar to opioids, might I add.

A Side Note

With this in mind, I consider the AKA’s efforts over the past few years as being detrimentally influential to my largely-opioid-related harm reduction efforts.

However, seeing as I have used kratom regularly over the past three years when I couldn’t afford illicit opioids — something that often happened quite frequently throughout my time as a drug user when focused on opioids as my drug of choice — to make keep me happy, away from anxiety and depression, and feeling “normal,” the AKA has sure helped my outlook of experiencing serious outcomes from my almost-six-year period as a concurrent traditional opioid and kratom user.

Put simply, AKA good bc provide legal & cheap alternative to opioid use.

IMO, AKA bad bc didn’t advocate for all drugs.

Doing so would have obviously made it so much more difficult for the kratom advocacy community and the AKA to successfully reverse many near-decisions to make kratom illegal on several levels of state and municipal governments.

Tying This All Together — Here’s the Skinny

Modern American illicit opioid users are plagued by countless major market-wide issues, such as a lack of regulation and policing as the sole mode of industry administration.

This is especially true in backwards-thinking areas of the United States, such as in Northwest Tennessee.

Kratom has many benefits to illicit opioids in modern America. Keep in mind that kratom definitely isn’t a cure-all. Also, there’s a lack of research — of its commercial market and on an academic, a pharmacological, and a medical level — that makes understanding truly how much kratom improves the long-term outcomes of modern American illicit opioid users.

My Relationship With Two Indonesian Kratom Vendors/Processors/Harvesters

Most Americans don’t talk to native Indonesians very often. Personally, I don’t know any languages but English. I’ve never been out of the country and travel very little. I am not well cultured myself and am not trying to seem that way or brag about my time being connected to the industry in this way.

Since the kratom industry in Indonesia isn’t regulated and kratom trees grow wild there, making it easy for anybody to visit public lands that contain wide ranges of rainforest, which is what the island of Borneo consists of.

The U.S. Dollar goes far in Indonesia. The number-one national consumer of kratom, again, is the United States. Indonesians capable of harvesting, processing, and selling kratom are incentivized to do so.

Some privately-owned kratom trees exist in both small-time residential capacities and large, farmed capacities. However, you should understand that most kratom is not farmed, no matter what the majority of American kratom consumers might think.

Because of the nature of kratom in Indonesia, commercially speaking, it makes sense why Indonesians would want to keep industry-specific information — admittedly, they’ve done a good job of securing these details among themselves — within their own country and out of the lexicon of American kratom users.

Here’s How It Happened

I offered to write articles for about 10 kratom vendors active on the Internet via email. One of them was based in Indonesia. We’ll call them KootaBang, or KB for short.

KB was operated by a pair of young Indonesian men. They had been selling kratom shipped from Indonesia for a few years and worked with at least two other individuals they met online in the United States. I was the third that I know of. Even if they have to risk someone running off with a shipment of kratom — the largest single incoming shipment, in my situation, was less than 200 pounds, which was lasted about a month — it was worth taking the risk (see USD exchange rates with the Indonesian Rupiah, etc., above) for their potential reward.

I simply performed customer service, as they weren’t fluent English speakers, and shipped the already-packaged kratom throughout the U.S. via my local post office. I paid nothing for the kratom shipments. It was all loaned to me. They paid for all shipping, too. The customer service function of my job work was something I offered to do after shipping kratom for a little while.

So, I didn’t own KootaBang, but I pretty much ran it myself — operations-wise, that is.

I bring this up to explain why they would have been incentivized to share some industry insider information — keep in mind that kratom is largely new across the U.S. and that we grow absolutely none used on a commercial scale here — with me rather than hide it. Any of the now-four people who have run KootaBang’s United States-based operations could have run away at any time with current inventory stores worth a few thousand dollars. Doing so also would have taken KootaBang out of business due to how long finding a new suitable U.S.-based vendor, including shipping kratom some 7,000 to 9,000 miles away from Indonesia to the United States, takes.

Did I Learn Everything There Is to Know?

Absolutely not! All of the stuff I learned — the stuff that most other American kratom consumers wouldn’t know about — didn’t scratch the surface of what there is to know.

I don’t know how the various drying or curing methods affect the alkaloid concentrations and their proportions to one another. I don’t know how to grow kratom myself. I didn’t ever go there, let alone participate in the industry myself.

I didn’t get the gig with them because I was good — I got lucky! I can’t pretend that I earned it myself. I was very small-time and my experience spanned just four months of hands-on kratom selling.

Also, as time goes on, these “trade secrets” will become more widely known across American kratom consumers. I think this is great, by the way, in the name of better understanding kratom.

I share this stuff not to seem like I’m special and holier than thou — I just want to share what should be common knowledge across the world of kratom. I wish I, and everybody else, knew it from the jump.

If you visit the Kratom subreddit on Reddit, you’ll see that ignorance is common across the community, but that’s only because Indonesian kratom industry participants benefit from keeping it that way and withholding information that only people who have hands-on experience with kratom harvesting and processing possess.