More Lope in the Literature

loptab3Not Your Regular High: Cardiac Dysrhythmias Caused by Loperamide

DOI: 10.3109/15563650.2016.1159310 Rachel Sarah Wightmana*, Robert S Hoffmana, Mary Ann Howlandab, Brian Ricec, Rana Biarya & Daniel Lugassya

a Division of Medical Toxicology, Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA; b St. John’s University College of Pharmacy and Health Sciences, Department of Emergency Medicine, Division of Medical Toxicology, New York, NY, USA; c Ronald O. Perelman Department of Emergency Medicine, NYU School of Medicine, New York, NY, USA

Discussion: Loperamide produces both QRS and QT prolongation at supra-therapeutic dosing. A blood loperamide concentration of 210 ng/mL is among the highest concentrations reported. Supra-therapeutic dosing of loperamide is promoted on multiple drug-use websites and online forums as a treatment for opioid withdrawal, as well as for euphoric effects. With the current epidemic of prescription opioid abuse, toxicity related to loperamide, an opioid agonist that is readily available without a prescription is occurring more frequently. It is important for clinicians to be aware of the potentially life-threatening toxicity related to loperamide abuse in order to provide proper diagnosis, management and patient education.

Clinical Toxicology, Volume 54, Issue 5, 2016, pages 454-458

loptab3High-dose loperamide abuse–associated ventricular arrhythmias

Charles W. O’Connell, MD-1, Amir A. Schricker, MD-2, MS, Aaron B. Schneir, MD-1, Imir G. Metushi, PhD-3, Ulrika Birgersdotter-Green, MD-2, Alicia B. Minns, MD-1

1 Division of Medical Toxicology, Department of Emergency Medicine, University of California – San Diego, San Diego, California; 2 Division of Cardiovascular Medicine, University of California – San Diego, San Diego, California; 3 Center of Advanced Laboratory Medicine, University of California – San Diego, San Diego, California

Conclusion: This case details the very serious and potentially life-threatening cardiac dysrhythmias that are associated with both chronic and very high doses of loperamide. Loperamide may not be as innocuous as once thought, when purposefully abused in chronic, high quantities. Isoproterenol infusion was very successful in eliminating ventricular arrhythmias in this setting. Loperamide overdose should be considered, when case appropriate, as a potential cause in similar cases of significant cardiac syncope and cardiac conduction disturbances with prolonged QRS and QTc intervals. Given the ubiquity of loperamide and the epidemic of opioid abuse, this may represent a growing problem. The number of new cases warrants further investigation and physician provider awareness.

Heart Rhythm Case Reports
Published Online: March 07, 2016, Open Access DOI:

loptab3An Additional Clinical Scenario of Risk for Loperamide Cardiac-Induced Toxicity

Gilberto Fabián Hurtado-Torres, MD, MEda Rosa Laura Sandoval-Munro, MDb

a Internal Medicine and Clinical Nutrition Department Hospital Central Dr Ignacio Morones Prieto/UASLPS an Luis Potosí, Mexico; b Faculty of Medicine University of San Luis Potosí San Luis Potosí, Mexico

Excerpt: Because the drug is available over the counter, unregulated use is frequent to control gastrointestinal symptoms, mainly diarrhea and unfortunately as an increasing nonillicit drug of abuse in opioid users. Another potential clinical condition with risk of loperamide electrophysiologic side effects derives from the wide use and proven utility of loperamide in the management of loop ileostomy and short bowel syndrome-associated diarrhea.

The American Journal of Medicine 04/2016; 129(4):e33. DOI: 10.1016/j.amjmed.2015.10.041


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Two New Loperamide Abuse Articles in the Literature

loptab3Loperamide Induced Torsades de Pointes: A Case Report and Review of the Literature

O. Mukarram, 1; Y. Hindi, 1; G. Catalasan, 2; and J. Ward, 3

1 Department of Internal Medicine, Texas Tech University Health Sciences Center, Permian Basin, USA; 2 Department of Critical Care, Texas Tech University Health Sciences Center, Midland Memorial Hospital, Midland, TX, USA; 3 Department of Clinical Pharmacology, Medical Center Hospital, Odessa, TX, USA

Abstract: Abuse of over the counter drugs often gets overlooked by health care providers. Loperamide is one such over the counter drug that is often abused by drug addicts. We present here a case of a young male attaining euphoria from taking massive doses of loperamide. He developed Torsades de Pointes and subsequent cardiac arrest. We found similarities in the progression of myocardial electrical conduction abnormalities among loperamide and other previously known arrhythmogenic drugs. We intend to raise concern over the ease of availability of such drugs over the counter and increase the index of suspicion for over the counter drug abuse from our experience.

Case Reports in Medicine
Volume 2016 (2016), Article ID 4061980, 3 pages

loptab3Ventricular Dysrhythmias from Loperamide Misuse

Daniel R. Lasoff, MD Veterans’ Administration Medical Center, San Diego, California
Aaron Schneir, MD Department of Emergency Medicine, Division of Medical Toxicology, University of California, San Diego Health System, San Diego, California

Abstract: We would like to alert emergency physicians to the potential for cardiac dysrhythmias associated with the misuse of loperamide. Multiple websites and online forums have described using high doses of oral loperamide for recreational abuse and amelioration of opioid withdrawal (1). A burgeoning number of reports have detailed the potential for QRS width prolongation, QTc prolongation, ventricular dysrhythmias, and cardiac arrest with this practice (2–6). We recently were involved in the management of such a patient.

Journal of Emergency Medicine
March 2016 Volume 50, Issue 3, Pages 508–509


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Having a thing and losing it


I have come to the ultimate conclusion that I have to let him go. It’s not that I want to; I don’t. It’s simply the most intelligent thing I can do under the circumstances to keep my sanity and a modicum of what’s left of my dignity.

I am miserable. All the time now.

Oh, don’t get me wrong. When he’s around, I’m fluttering around like a butterfly on heroin. But when he’s gone, I can’t figure out what the hell to do with myself. That’s not fair — to him or to me.

So I’m going silent. I’m holding back from texting or calling him. It’s the only thing I can think of to distance myself. He hasn’t voluntarily texted me in days (meaning: without my texting him first), so I suspect if I just let things lie, this whole thing my die on the vine of its own accord.

Why is it that not doing anything is so damned hard?

As is usually the case, I’m blaming myself. Yes, yes, I know. I knew what I was signing up for. But in a way, I didn’t. I didn’t realize how much the situation would grow on me. How the adventure of it all would bond me to him. How much it would mean to me to be held, wanted, and desired. To have him pull me in, breathlessly tight, kissing me so deeply I thought I might faint. The smell of his cologne on me long after he left. To feel his heartbeat on mine; his head nuzzled in the crook of my neck. I had no idea how much these things would insinuate themselves into my consciousness. How much they would come to mean to me. How my emotions, despite my best judgement and and ocean of precautions, would betray me.

And because of that, I’m burying the whole mess. Sinking it into silence. I cannot allow any of these things to get under my skin, especially in a no-win situation such as this. I’ve erased all our text messages. The particularly intimate ones I hung onto are gone. None of them mean anything anyway.

I am exhausted from feeling so pathetic.

I know what I am. I don’t know why he was with me. I don’t know why he whispered in my ear or why he called me to his bed. No idea at all. Chalk it up to bad judgement on his part, I suppose. Everybody makes mistakes. I want him to forget I was ever a part of any of it — I would take some comfort in that.

But the hardest thing of all to let go is having had that glimpse of hope. That momentary, temporary joy. Seeing inside a world — a joy — I want to be part of, only to have to leave again and never return. Every time it happens, that’s the worst part; accepting it’s all over and won’t be back.

I’m reminded of a scene from the novel Cold Mountain when Inman comes along a blind man selling peanuts:

“The blind man said, It might have been worse had I ever been given a glimpse of the world and then lost it.

–Maybe, Inman said. Though what would you pay right now to have your eyeballs back for ten minutes? Plenty, I bet.

The man studied on the question. He worked his tongue around the corner of his mouth. He said, I’d not give an Indian-head cent. I fear it might turn me hateful.

–It’s done it to me, Inman said. There’s plenty I wish I’d never seen.

–That’s not the way I meant it. You said ten minutes. It’s having a thing and the loss I’m talking about.”

The loss. Seeing something so joyously wonderful that only staying there forever would make it worthwhile. But having it for just a moment, then having it taken away again? Yes, it might turn one hateful, indeed.

PS: I’m pleased to discover that Cold Mountain has been adapted to the operatic stage by Opera Philadelphia. Check it out!


“I will hold my head up high,
You will never see me cry.
I’ll smile and say I’m good,
But I will fall apart if I could.”

— “I Will Never Let You Know” (Clare Bowen & Sam Palladio)






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7 Side Piece Rules


A few tips for all my fellow foolish girls out there who end up entangled with a man who is already tangled. It’s a slow, undignified stroll to Nowheresville, ladies. Like being hired to flip burgers then being insulted that you didn’t get your own office and the keys to the company car.

We’re not out to hurt anybody, we’re just stupid like that.

Let us reassess the situation with a reality check and go from there, then, shall we?

1. Know your place. If you’re going to end up a man’s cheap-ass, dime-store, floozy side-piece, don’t even think it’s ever going to be more than that. You are not the asshole live-in girlfriend who treats him like shit, and who, after every time he goes out to get his bacchanalian drink on and stumbles home at 8 the next morning, keeps taking him back in like a two-bit sucker. You’re the one he’s been out ’til 8am with. But he still won’t pick you over her, so get over yourself.

2. Do not fall in love or ever speak of having “feelings”. Not for his sake, but for yours. (Tip: he has NO feelings for you; that’s why he’s with you on the side, duh! If he cared, ya’ll wouldn’t be in this situation.) Do not go all soft and gooshy inside when you think about him, when you smell his cologne, or hear his voice. And don’t wait by the phone for him to call. You are the cheap, floozy side-ho, not the shitty girlfriend. You are to act the understanding, lovable creature he comes to for comfort and comfort-based activity, even when he calls at 2am from the bar. And that’s all. That’s pretty much what you’ve signed up for. You’re the equivalent of a nice pet to have. You will be discarded. So be ready.

3. If you’re gonna do it, upgrade. Start taking pride in your damn self! Dress better. Wear makeup. Do your hair. Wear nice clothes — but not too nice unless you’re getting paid well. If you’re lucky, you’ll find someone better to be with, not some cheating loser who keeps promising that he’ll be with you once he leaves this “girlfriend” person. [And if you believe that’ll ever happen, I’ve got a bridge to sell you.]

4. If you’re gonna do it, find someone good looking or rich, but remember that, in lieu of wealth, finding someone too good looking can be worse. You never want to be the person who…  well… looks like my situation or you’re just begging for problems.


Me, most days.


Him, most days. Yeah, I know. He’s super hot.

5. Know this is only temporary. And I do mean temporary. Side-pieces come and go with the wind. One day you’re hot, the next day, just an old hot mess. Use protection in all ways possible (inside bedroom and outside). Be sure to keep your back end in check; do not give up anything of your own — no money, no career, no friends, nothing — to be with him. He’ll drop you in a hot second the minute he suspects something’s amiss, so make sure you’re compensated in one way (sex) or the other (money). And if all your doing is picking his drunk ass up at all hours and listening to him go on about how awful he has it at home, and you’re not getting compensated? GET OUT and go. Any ho, even a cheap one, would do the same.

6. Avoid slipping into alcoholism or drug use. Too easy when your man parties hard on both and you wish to participate, but avoid ANY such entanglements that will likely last well beyond a couple nights of sloppy sex and foolish behavior. Nobody wants to hear that you blacked out on top of the man you’re sneaking around with, never forgave yourself, and ended up a hopeless drunk. Don’t be pathetic.

7. Don’t even bother pretending to feel guilty. You knew he had a girlfriend, but you wanted sex with a desirable man, plain and simple. Maybe it started differently. Maybe you got suckered. Maybe you knew each other a while, and it seemed as if he really cared. Maybe he looked deep into your eyes but when things got weird, you felt that familiar acidy feeling in your gut warning you about trouble, but you ignored it anyway. Yep.

So best of luck, my fellow Cheap, Dime-Store, Floozy Side-Pieces! May we all grow the hell up and get out before it’s too late.

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Glitter and Be Gay

glitter-and-be-gayI found myself singing this morning. I’ve had a song stuck in my head for days. Not unusual for me, but this song just won’t get out of my head. It’s one of the hardest songs in all of operatic literature to sing: “Glitter and Be Gay” from Candide. Leonard Bernstein knew what he was doing when he wrote it — it is both comedic and tragic at the same time. And with a top note at a high F, it’s nearly impossible for most sopranos to reach.

I used to be able to do that. After taking lessons this past year, my vocal strength is back, but it’s a bit of come-and-go. Sometimes it’s glorious — like a miracle — and sometimes it just sounds like crap. All of my bravado and courage in singing has been shut down for so long, that what once came so easily, now requires work.

At any rate, the song is sung by Cunegonda, a beautiful young girl who survives war only to become a kept woman, trying to determine if she should be ashamed of herself or delighted in all her newfound wealth (hint: the newfound wealth wins out most gleefully). The song’s music begins with legato minor key as she bemoans her fate and questions her position, eventually progressing to an upbeat major key as she laughs with delight, decorating herself with wealth and jewels.

It’s one helluva song to sing, and I’ve been singing it a lot. Still not quite to that high F, but I did get a solid high D. Not bad.

That said, I’m not Cunegonda by any means, but life has taken a few odd turns lately.

First off, let me say, the depression has been at bay for a couple of months. That feels fantastic. I’ve been fully functional — going to work, having a good time, laughing genuinely, going out with friends, and getting things done.


I was expecting Christmas bonuses from my job with Mrs. H. that never came. That kinda started it. I had a bit of money set aside, but anticipating the bonus, I used that extra $$ on Christmas presents. Bad planning. I’m now WAY behind in rent and haven’t paid the electric bill yet.

Then my New-To-Me Car blew a couple of spark plugs. That was an $80 bill I wasn’t expecting. That put me further behind in bill-paying.

Anytime I can’t make my bills, I feel like a massive scumbag. I’ve tried SO HARD to keep up with these things, it’s a tremendous blow to my ego that I have failed once again in something so important to me.

My apartment is still a wreck. I need to do deep cleaning, but, feeling like a scumbag more than usual, I don’t feel like attacking the issue. So the pile of clothes grows, the garbage still hasn’t been put out, there’s stuff in the refrigerator that’s growing stuff or become petrified and hasn’t been tossed. Don’t even get me started on the bathroom.

In truth, I never ever have people over to my apartment, so the apartment mess is mostly an ongoing issue. The only person that’s ever been there besides me is the bldg superintendent. I always go to visit friends at THEIR house, thus avoiding the discomfort of EVER actually making my place comfortable for company. I still have cardboard furniture from when I first moved in. Most knicknacks are still packed away. It’s sad. Think of it this way: consider if a 12-year old boy had his own apartment unsupervised, that’s what mine is set up like  all the time. And since I haven’t had a proper boyfriend since the stone age, there’s never been much concern about being “found out” as a perpetual slob.

Which brings me to the next situation.  That whole, you know, boyfriend thing.

You might remember this past spring when The Stalker was my most recent potential romantic offering. Well, yeah, as we know, that didn’t work out for beans. Some stalker! Two weeks and he found something better. I did what I always do: blamed myself and got over it fairly quickly and moved back to being myself. Lesson learned. (For those of you constant readers  who may wish to know, according to Facebook, he’s still alive and really into Ju Jitsu now). Life moves on.

So most of the time, I wander around through life in my current weighty condition, just being me. I don’t wear makeup most of the time because I simply don’t care. I am free to just be goofy me. There’s a comfort found in that, strange as it might sound. It cuts down on societal pressure. I’d rather be thin, honestly, but it’s so much work. Now, I don’t worry about falling in love or dealing with men hitting on me because my present physical condition inadvertently creates a neon verboten sign with a six foot radius around me. And until I am fully willing to fix that problem — much like the messy condition of my apartment — the whole touchy-feely thing becomes verboten. And my heart remains safely hidden in nuclear winter.

Some psychiatrists would say that my subconscious is protecting me with this layer of port and literal junk in my apartment. They’re probably right. It definitely serves as a very real barrier. Can’t get hurt if you don’t let anyone in, right?

Well, not necessarily. Sometimes, as they say in Jurassic Park, nature finds a way.

I have been hit on. And it’s getting interesting.

I’m doing my best to remain emotionally neutral, but I’m struggling to control it. The gentleman in question is notably younger than I am. He’s adorable and good-hearted. Not well educated, but sincere. I used to work with him at the thrift store. And apparently, he has a thing for me.

Now by “thing” I mean, in my mind, this is pretty undefined. I don’t know what he wants, really. I don’t know why he picked me. He’s good looking. He’s charming. Why me, I wonder?

And that question vexes me.

He began texting me shortly after he left our company. We kept in touch, flirting and being silly. I mean, we did that at work too — in fact, my boss actually took me aside one day, concerned, and asked me what was going on with us. Relationships between employees is strictly — you got it — verboten. When asked, I laughed and spoke the truth: “nothing”. We’re just two silly people innocently flirting. Besides, he had a girlfriend. No problem, right?

But the problem is, I’m Charlie Brown and romance is that fucking football. My futile hope that this time will be different does me in every single time. AAARRRGH!

Then one day, he called me and wanted to come to my apartment. That of course is way off limits to normal people, so I suggested we have coffee instead. He laid it all on the line over coffee. He and aforementioned girlfriend were breaking up, he didn’t know how to do it. He told me about his hardships and all the things he’d been going through, telling me he’d wanted to tell me for a long time, but because we worked together, he couldn’t. But there was more. Long eye contact. Intimacy.

We kissed goodnight on the cheek, but there was something more. I just couldn’t trust myself to know.

I’m trying to play it by ear and remain open to whatever experience happens. Most days he texts me or calls. One night last week, when we started texting and flirting, it took a sudden turn into x-rated land. That’s how I experienced my very first time sexting — with him. Damn. Oh. My. God. Seriously hot. My initial reaction was “Is this really happening? Are we really going there?” And guess what? We did.

I’ll refer to him here as The Midnight Rider (since most of the time, he calls me late at night).

But no in-person visit because my apartment is still a shithole. And until I clean the apt., no hope of a personal visit. He’s in the process of moving out from aforementioned girlfriend’s apartment, so we can’t go to his place (yet). And having just started his new job, the money will take a month or so. At least.

And here’s where it gets dodgy. How is this going to end up? Am I being taken for a ride? He has already told me once to please keep our trysts to myself for now (so he “doesn’t get in trouble”).

Perhaps I can be more mercenary than that. Perhaps I can just use him for… well, sex… and not worry about the rest of it. While, I am NOT one to break up any happy relationship; not even a bad relationship, perhaps it’s as things should be. As long as I get something out of it. I refuse to be taken for a ride here.

Can I handle that??

Yesterday, someone posted a group picture to Facebook that included me at a Christmas Party and I was horrified by how I looked. How can I so easily forget myself? Then the mood swings started again.

My moods have been all over the map. One minute depressed, the next in control, then agitated and angry. I’m actually quite concerned about it. What if this sends me into a manic state? This is a bad time to get to that point. I need my wits about me and remain focused on what’s really important to me.

I’m notorious for losing it over a man. I become unfocused. I obsess. I can’t concentrate on work or school or life goals. I wonder if this one is “the one”. I know it’s ridiculous, but it’s as if some demon has taken over my mind. I spend money recklessly. I become entirely undisciplined.

Of course, that was long before I started going to therapy and taking my antidepressants. So now could be different. Maybe that’s how I’m able to control it as much as I have.

Worry. Everything is tipping sideways again. I hate that! My instinct is to right the boat, but maybe I should go where the wind takes me for once.

So not unlike Cunagonda, I am placing before the world a glittery, gay image of myself despite what worries I have inside. I am not always unhappy, but I so enjoy feeling happy. So I laugh and giggle and be silly. Why not laugh at the ridiculousness of life?

According to the song, the glitter will win, but will it for me? The Midnight Rider may soon tell.

Either that, or the whole thing’s gonna die off as quickly as it started. Who the hell knows.


Enough! Enough!
I’ll take their diamond necklace
And show my noble stuff
By being gay and reckless!
Ha ha ha ha ha! Ha!

Observe how bravely I conceal
The dreadful, dreadful shame I feel.
Ha ha ha ha!

— “Glitter and Be Gay” from Candide










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A Few Words on The Kratom Kraze


When it comes to addictive substances, most of what I write about on Sobrietyland has to do with my former Vicodin and Loperamide addictions. But there are so many other “new” or “natural alternative” drugs emerging on the scene! I get questions regarding Kratom with some frequency. Recently, one of my relatives has started touting the wonders of Kratom to me, not knowing of my drug addictive past. She has sent me invitations on Facebook to join her various and sundry Kratom Use Promotion Groups, all of which I have declined. They are often filled with hyperbole and bad science. So I decided to investigate and study for myself.

Kratom (botanical name Mitragyna speciosa) is a “relatively” new drug to the US and Europe, widely sold, unregulated, in head shops, often labeled as “incense” and hypocritically labeled “not for human consumption” (though everyone knows that’s exactly what it’s for). It has been popular for centuries in Southeast Asia as an anti-diarrheal medicine, a painkiller, and a recreational drug (numerous reports in the literature of this being a major health problem there). The kratom plant is in the same family as coffee, and the drug is derived from the leaves of the tree. The leaves are often crushed and chewed, eaten, smoked, or consumed using various other methods of ingestion. “The pharmacokinetics of M. speciosa in humans has not been well studied and various aspects such as the half-life, protein binding properties and other properties such as the elimination or metabolism is not known.” (Wikipedia) Users often compare it to coffee with a kick — or consider it as innocuous as a caffeine addiction or a light marijuana habit.

As I am sort-of, kind-of, ya-know, now in the business of substance abuse/addiction, I decided it was long-past time that I start researching this opiate alternative and see for myself. In doing so, I began to worry that my niece is being fed a ton of internet-based false information. Hey, when I first started using Loperamide, I looked at the internet discussion groups and thought it was a wonder drug too. It wasn’t.

[Full disclosure: way back in the day, before Loperamide, I had tried Kratom for my Vicodin withdrawals, entirely unimpressed with the results. It tasted like rotten sweatsocks and was too expensive in my opinion. But times have changed.]

The rise of opiate alternatives (like Kratom and Loperamide) are worrisome to me — and the medical community at large as well.

Okay, before people get all weird and crazy and defensive about the Kratom thing (as they are wont to do), here’s why I’m concerned.

If you overdose on a traditional opiate (Vicodin, Heroin, etc.) and present to the Emergency Department unconscious (or at the very least, unwilling to tell them what you’re on) there are certain tests that teams can administer to save your stupid ass from yourself. First, they run a fast tox screen to see what you’ve been taking. Traditional opiates light up like a Christmas tree, so your ED team can administer Narcan and other medications to ensure you don’t die from your overdose.

A bit about tox screens for a minute. Toxicology screens are tests used to determine if an individual has been exposed to certain legal or illegal drugs. They are designed to do this by keying in on particular metabolites of drugs. For instance, the metabolite for Vicodin is Hydromorphone. If that lights up on the tox screen, they know what you’ve been taking so they know how to treat it. If you’ve been using cocaine, Benzoylecgonine will be highlighted, and appropriate treatment can be started.

BUT if you use an alternative substance, like Loperamide — or like Kratom — that bind to opiate receptors, but don’t show up on a traditional tox screen, you’re screwed. Loperamide’s metabolite is N-Desmethyl-loperamide — that’s not on the list. Kratom’s metabolites, one of which is 5-desmethylmitragynine, isn’t on that list either. They are detectable in a lab setting however, but not in the standard set of ED tox screens. This can lead to misdiagnosis or improper treatment.

So what to do with the Kratom thing?

kratLike Loperamide, people use Kratom to ease symptoms of withdrawal from traditional opioids. Some just use it as a legal high. BUT…. do they stop?

And as with loperamide, there is a lot of misinformation out there regarding Kratom’s safety that I take issue with.

They say….

  1. Kratom is “herbal” and “natural” so it’s perfectly safe. FALSE. Oh please. A drug is a drug is a drug. Heroin, for instance, happens to be derived from Papaver Somniferum, a specific species of the Poppy flower. One could easily argue that it is also safe because it comes from nature. Bad assumption there.
  2. Kratom is not an opioid. FALSE. This is really just a game of semantics. Just because it doesn’t come from a poppy doesn’t mean it isn’t an opioid. If the drug’s metabolites bind with opiate receptors (in Kratom’s case, both mu and kappa), then yes, that would be an opioid. A non-traditional one, but one just the same.
  3. It is said that Kratom is not addictive. As a mind-altering substance, you’re damn skippy it IS addictive. Will everyone become addicted to it? No. Just like any other potential drug of abuse, if you have addictive tendencies, and you’re on a mind altering substance that makes you feel good, and you NEED to feel good, the odds are in your favor that addiction will follow. Just remember, the same argument could be made for opium — some will be addicted, some won’t. Do you really want to find out?
  4. Some say Kratom has no tolerance or withdrawal symptoms. FALSE. Just like any opiate, it has both tolerance and withdrawal, the severity of which is dependent on the dosage and length of time of usage. Just like Vicodin.
  5. Nobody ever overdoses or dies from Kratom. FALSE. Both deaths and overdoses have been reported in the medical literature (particularly seizures and coma), leading some states and regions to ban or regulate the drug.

Maybe I’m just being a party-pooper asshole who’s trying to ruin someone’s legal high, or trying to remove a poor chronic pain patient’s only means of effective pain relief, right? BUT I look at it this way: I feel it’s incumbent on me to blow a few of these misconceptions out of the water. If you want to use Kratom, you should know what you’re getting into.

It’s legal. It’s unregulated. But just like loperamide in high doses, or any other mind-altering substance, it can cause addiction and there’s a lot of crap information out there to help you justify your usage if that’s what you’re looking for. That’s the danger. Be clear with your doctor what you’re on. If you don’t want to do that, put a little index card in your wallet or purse that could tell medical staff what you’re using (and how much) in case of an emergency. And please, above all, don’t combine it with other psychotropic medications without consulting your doctor. Seriously.

If you’re gonna do it, I certainly don’t recommend it. But know the facts about what you’re getting into. An informed decision is better than one based on bullshit.


“An intelligent person can rationalize anything, a wise person doesn’t try.”― Jen Knox



The pharmacology and toxicology of kratom: from traditional herb to drug of abuse

28 October, 2015, International Journal of Legal Medicine. Marcus L. Warner, Nellie C. Kaufman, Oliver Grundmann

An accidental poisoning with mitragynine

Forensic Science International, Volume 245, December 2014, Pages e29–e32, Ritva Karinena, Jan Toralf Fosena, Sidsel Rogdea, Vigdis Vindenesa

New Drugs of Abuse

Pharmacotherapy, article first published online: 4 DEC 2014 DOI: 10.1002/phar.1522 Megan A. Rech, Elisabeth Donahey, Jacqueline M. Cappiello Dziedzic, Laura Oh, and Elizabeth Greenhalgh

Seizure and coma following Kratom (Mitragynina speciosa Korth) exposure

J Med Toxicology, 2010 Dec;6(4):424-6. doi: 10.1007/s13181-010-0079-5. Nelsen JL1, Lapoint J, Hodgman MJ, Aldous KM.

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