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 opiates. 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 opiate. 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 opiate. If the drug’s metabolites bind with opiate receptors (in Kratom’s case, both mu and kappa), then yes, that would be an opiate. 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, 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.

Posted in sobrietyland | Tagged , , , , | 3 Comments

Two new loperamide articles in the literature (Nov 2015)

In addition to being interesting articles on their face, they are also the first ones in the literature that discuss withdrawal symptoms with regard to loperamide. Up until now, it’s only been “anecdotal” (though we ALL know the withdrawal is excruciating) —  the conventional medical  belief is that loperamide cessation causes mild to no withdrawal symptoms.

The second article in particular discusses the use of buprenorphine (Suboxone/Subutex) in the ED setting for opiate withdrawal symptoms resultant from loperamide abuse — to startlingly bad results due to a particularly vicious precipitated withdrawal. This is important, serving as a warning to others who might consider using Suboxone to get off loperamide!

(Same goes for Narcan [naloxone], by the way. Cardiac arrhythmias are made worse due to precipitated withdrawal.)

Both articles encourage further research.


Abstracts from the 2015 Annual Meeting of the North American Congress of Clinical Toxicology (NACCT)

Clinical Toxicology (2015), 53, 639–777
Copyright © 2015 Informa Healthcare USA, Inc.
ISSN: 1556-3650 print / 1556-9519 online
DOI: 10.3109/15563650.2015.1071025

loptab344. An unusual method of loperamide abuse leading to opiate withdrawal

Lauren M Graham, Joseph H Yanta
University of Pittsburgh Medical Center, Pittsburgh PA USA

“Cessation of loperamide abuse can lead to withdrawal symptoms similar to those seen with other centrally acting opiates.
“Conclusion: While usually considered safe, clinicians should be aware of the abuse-potential of loperamide when used in conjunction with CYP3A4 and p-glycoprotein modulators like grapefruit juice and cimetidine.”

loptab350. Buprenorphine induced acute precipitated withdrawal in the setting of loperamide abuse

William Eggleston2, Nicholas Nacca1, Jeanna M Marraffa1
1SUNY Upstate Medical University, Department of Emergency
Medicine, Syracuse NY USA, 2SUNY Upstate Medical University,
Upstate New York Poison Center, Syracuse NY USA

“Conclusion: Loperamide abuse may be associated with a withdrawal syndrome in the setting of drug discontinuation. Use of buprenorphine in patients actively intoxicated with loperamide may cause rapid reversal of mu-receptor agonism and induce acute precipitated withdrawal.”

Posted in addiction, loperamide, loperamide abuse, opiates | Tagged , , , , | 2 Comments

Two New Articles on Lopermide in the Literature….

Stay tuned. This afternoon, I have two new medical articles regarding loperamide.

One is VERY important. Stay tuned!

(Sorry kids. Too bad I have to go to work!)

Posted in sobrietyland | Leave a comment

Freedom Comes on Four Wheels


My freedom has been bought!

I am writing this from a much happier place than I’ve been in a long, long time.

After four long years without a car of my own, I am once again among the car-driving “elite” — workin’ it in a 1998 Toyota SUV! Finally fixed and ready to go!

It’s fantastic!

The first day, I drove around just because I could. I stopped by the local hospital to put in an application for work. I dropped by a few places I’ve missed going to. The next day, I went to the next city over just to drive around for a bit. Then I drove to and sat at the bookstore, then to a local Panera for lunch. Every day since has been more of driving just for the sheer joy of it! Just because I CAN!

The SUV even has a power sunroof — a feature that, for some reason, I have never had on any car I’ve driven. I open it, even when it’s 50 degrees. Why? Just because I CAN!

The 18-year old car has its quirks though. Hey, it’s an 18-year old car, what do you expect? The front tires have slow leaks that need to be addressed before winter; the wipers need replacing; the seat belt keeps catching, etc. But on the overall, it’s an absolute joy and blessing to have. Body is in great condition. Gas mileage is good. Interior looks great. Power everything.

The car was the one thing I promised myself would be taken care of this year above and beyond everything else. It’s key to all of it. And how amazing is it that such a blessing came from a completely unexpected source?

Aside: Regarding this miracle car’s acquisition:

As you may know, the deal is that (***) retains the title to the car, and he has added me to his insurance. I get to drive it as much as I need as long as I take care of it, put gas in it, take care of minor repairs and oil changes, etc. My main job with this gift is to work on getting a better job and improving my life so that I can: A) buy this car from (***) or B) buy a different car.

[BTW, an election update: As expected, (***) lost his bid for mayor. However, while he came in last, he earned a great deal of community support and respect. His intention now is to re-brand the campaign as a community action group. The mayoral elect is supportive of (***’s) efforts so the hope is, we can work with and influence the new administration. I’m still on PR, so I remain involved.]

In the program (and in a lot of self-help literature) they often talk about the gift of desperation. When it came to the car, I had waited so damned long for it, and was so frustrated walking through mudpuddles with wet feet, several feet of snow, freezing cold, blazing heat, waiting for buses, and making excuses why I couldn’t do things or get what I needed, I finally sat up one night and vowed that I would have a car NO MATTER WHAT. As soon as money and opportunity came into my life to solve the problem, I made it happen. No matter what. I prioritized. I knew what I wanted and I was no longer willing to compromise out of laziness and depression. And boy did it pay off!

Since this vehicle came into my life about three weeks ago, my entire outlook on life has shifted toward the positive. I am SO grateful! Now, opportunities are wide-open and available everywhere. I can shop where I want. I can drive where I need to go. I can stay late at work and earn extra money because I’m not tied to the bus schedule which means I’m a more valuable asset at work. I can haul laundry. I can purchase and transport heavy things. I can buy groceries that fit into more than one bag. I can drive somewhere that’s ten minutes away and be back home in a reasonable period of time — a trip that would take at least an hour-and-a-half round trip by bus.

curl-clipart-curls-blank-bckgrnd-hiI have discussed the situation with my new therapist, Miss C — another fresh graduate, about 25-years old, petite with dark curly hair, and filled with youthful optimism. No time to have been jaded yet. Miss C has no idea what she’s up against with me. The good news is, because the car is fixed and I’m joyously driving it, she really hasn’t had to see my dark side at all. Every time I see her, things seem to be getting better, and I chatter away at all my recent successes and daily joys and gratitudes.

I’m sure she has no idea how bleak the landscape can be when the depression grips me. Miss C. is very pleased about my car situation, not having realized (or having any reference point for) my being without one for four years. I see her again tomorrow. She’s certainly earnest enough and impressed with my background. But I’m betting that like Therapist Barbie, Miss C has no idea how dark things can get for me until they do (and it gets pretty scary when that happens). Poor kid.

medmgtThe new medication management guru is an incredibly cool black lady who is no-nonsense, knows her stuff, and is strictly by-the-book. I like her very much. No bullshit. I won’t see her often, but I’m encouraged by her outlook on things. She’s very knowledgeable. I mentioned to her that I often have a hard time taking my antidepressant in the morning, often forgetting because it MUST be taken with food, which cause disturbances in my mood. She told me to take it anyway, every day, even without food. Since I’ve been doing that, I’ve had far fewer depressive relapses. Awesome!

I have put in for a few jobs with the local hospital. I’m DETERMINED to get in there. I lost out on two nurse assistant positions (most likely they say because it was an internal fill), but there is a job with their fundraising department that it appears I am ideal for. PLEASE cross your fingers for me. This could be massive. Not a lot of money per hour, but it’s full time and offers health benefits — which would get me out of the thrift shop and off the government dole!

nptie.jpgIt would also mean that I could see the Square-Jawed NP again! As you may recall, my favorite Nazi has relocated two counties south of here in a teeny two-mile across “city”. I can’t see him now because of Medicaid rules forbidding me to see providers outside of my county.

However, when I last spoke with the NP a bit over a month ago, he informed me that if I had private health insurance, I could, in fact, see him there. So if this job thing works out, I’ll be in business to once again, able to write about the exciting and ongoing adventures with the NP.

I know it’s silly, but I feel an obligation to show him that I’m making progress. I want him to be proud of me. I want him to see that I’m really trying — and not that I’m making excuses. Because no matter how legitimate the excuses are, after a while, it just seems like I’m not trying anymore. And maybe they’re right. (That’s transference in action, kiddies.)

So until I get everything straightened out, I have decided to maintain some distance from NP. It isn’t fair that I keep contacting him just to say hey until I’m able to pay him accordingly and give him a fully positive report card: Car, Job, Insurance, School.

Regarding school, I’m still struggling with filling out the financial forms. Yeah, I know, I know. You see, I have to do taxes first, then do the forms and it imbues in me a sense of incredibly deep guttural terror. I realize that to virtually everyone else on the planet, that’s a silly and cheap excuse. But to me, there is a very real, physical, and mental panic involved in completing any task like that. It’s not fear of success. I’m not sure what it is, and I have no idea why it happens, but it makes me avoid it like the plague.

All that said, I’m insisting that I get my act together this week though. It HAS to be done or I will lose everything I’ve done so far to get back to school. Now is a non-negotiable timeframe — my next meeting with the finance people is next week Thursday (and frankly, now that I have a car, I’ve little or no legitimate excuse). Depression is a weird enemy sometimes.

And an FYI update, I have started a Facebook presence for this blog: https://www.facebook.com/MadMargaret-503998129782756.  Feel free to like, share, and/or comment. I am also working on a website strictly dedicated to loperamide addiction and information and articles (stay tuned for that).

Regarding my own loperamide situation, I am coming up on two years clean from it later this month. It’s been an experience I never, ever want to repeat, but I have learned so much and grown from it. (Just don’t ever let me go back there!). Many people have commented and/or emailed me privately, and it’s been my honor to respond and get to know you. Thank you for the privilege. Please keep your letters and comments coming! Now that things are rolling along better, my response time should be better.

I am filled with gratitude for so many things today. Not that everything is all that great, either — but for what I have earned back, I am so pleased. I’m fighting to keep it too.

And that’s a very good thing.


“If one wanted to find a modern symbol of personal freedom, the motor car is right there near the top of the list. But a car has come to mean much more than that. It has become a powerful statement about who you are and how much you earn.”

— Martin Jacques


Posted in AA, addiction, blessings, car, depression, gratitude, happiness, loperamide, random crap | Tagged , , , , , , , , , , , | 2 Comments

Exits and Entreaties


Some of you may be wondering where my recent depression posts went. Thanks for your letters by the way. I’m doing okay, and yes, I’m still here! The posts were redacted temporarily. They’ll be back.

The cloud of the depression has lifted somewhat. I’m beginning to function again. (And yes, I’m still sober.)


Farethee well Barbie! I will miss you!

Turns out Therapist Barbie is now also leaving (NO!!) taking a job about an hour to the east of here where she’ll be working with kids. I think it’s a great move for her. I’m sad that she’s leaving, of course. I have been “transferred” to another therapist in the practice who works evenings. That doesn’t happen for another 7 weeks or so — apparently, getting an appointment with that person is going to be a problem. I already smell trouble. I’ll let you all know how that goes. Therapist Barbie, unfazed by propriety, has given me her private email so we can keep in touch. I think the idea that she’ll be working with troubled children is a fantastic placement for her talents. Yeah, I’ll miss her. A lot. She was really worried, with all the losses I’ve had so far, that I was going to take this really hard. I didn’t, but maybe it simply hasn’t hit me yet. I think that perhaps because I have her email, I feel safe, as if she’s not really leaving at all.

I get a lot of mentions on this site, Fraülein.

I get a lot of mentions on this site, Fraülein.

Speaking of abandonment, the Square-Jawed NP called me about two weeks ago to check in on me. We talked for a bit. He’s getting accustomed to his new locale, and he’s getting settled in to the new office too. He’s disappointed (understatement) that I didn’t go back to school this fall like I’d promised. I told him I had no choice. He wasn’t sure he believed me.

I told NP I’d drive down to his new location and we can go out for coffee either later this month or next month; he agreed. I miss him. (And I admit, so want to help him get his private practice going — it’s such a temptation to help him, especially when that’s the sort of thing I do, and the kind of thing I’m actually pretty good at. Oh! A challenge!!) So I’ll meet with him in a few weeks. Depends on when I get my car back.

Oh, did I mention the car?



You may recall the car was in trade for my PR services in (***)’s campaign. About six weeks ago, the car was functional and I was given the key. Two hours later, the radiator blew. So, once again, no car. A friend of (***) was supposed to fix it, but has been sitting on the project, untouched, for six weeks — something he said he could do for $40 and within a half-hour. Yeah, right. While all the political nonsense work continues, I still don’t have the car I was promised, and this is becoming a serious problem for me.

So I have decided to bite the bullet and “donate” a radiator and get it fixed on my own dime since I have some overtime money coming my way. I need that car. Even though (***) is holding the title, he doesn’t have any money to fix it either, so if I want it, something has to get done. I’ll make him pay me back later. I WANT THAT CAR.

It’s not fair, really. That’s clear. If (***) is holding the title, then he should pay to have it fixed right? Well. Yeah. But I WANT IT. A car means freedom. It means I don’t have to walk in the rain or snow anymore. It means I can take a better job somewhere that isn’t on the bus line, that makes me more than minimum wage. That leads to more money and more freedom. That car is everything to me right now, so if it’s really a matter of a hundred bucks or so, I will have to be the one to make that happen.

As I said, with the depression lifting, I’m starting to get feisty again. This is my life, and if that damned car means I can make things better, so be it.

The campaign itself is going about as expected. (***) is running for mayor of this small burg, and the race has gotten ugly already. His main Democratic rival is playing dirty with a smear campaign — actually unfounded (and when you consider how much I know that (***) is capable of, I would be the one to tell you where the skeletons are buried). Their accusations are actually baseless. The competition is paying people to smear (***)’s name with absolute rubbish. Sheesh! You’d think they’d at least dig up a few TRUE things in their efforts. Idiots.

The results of the primary were abominable, but completely expected, by me if no one else. (***) came in dead last even behind another unknown thanks in large part to the opponents’ smear campaigns. Out of five, one dropped out, so four now remain in the race heading into the elections; one Dem, one Rep, and two “independent” lines. (***) is the only one running on a zero budget — so is it any big surprise he’s dead last? He’s also the one, thanks to me, that’s been running a clean campaign so far.

That may have to end.

There is dirt to be had on the other candidates. We have unleashed our minions to dig it up and spread it around — under the condition that it’s true and provable, not bullshit. That’s my only proviso. And if anything big happens, they are to check with me first.

I am also sending (***) out door-to-door to grip and grin with people in person. His campaign manager is now setting up meet and greets, fundraisers, and town halls. I told them there’s NO WAY he can win without any money. Historically, it’s impossible. But nobody listens. Fact is, grassroots campaigns ONLY win if they catch fire and people start handing over the cash.

I also told him that no matter what the competition does or says, (***) is to be polite to everybody. No more sticking his nose up in the air when another walks by. I was horrified. I always make a point of saying hello to everyone, no matter who they are or what I know they’ve paid to have said. It’s simply good politics. He disagreed, but I told him it’s a non-negotiable.

I’m so sick of everything political at this point. Jesus, I so don’t care! What’s frightening is the mindset of everyone to be gossipy little bitches about everything. And viciously mean too. They all — candidates and minions alike — are like rotten kids in the playground pushing, shoving, cliquey, and nasty, pooping and peeing in the sandbox and saying it was the other guy’s fault. I’m the ONLY sane person — the playground monitor — calling the kids on their crap and sending them into time outs. Or at least I wish I could. What a bunch of friggin’ babies. For instance…

There was a debate a few weeks ago. After the debate, the campaign manager and I met with one of the Dems to discuss something of a peace treaty, agreeing to control our minions from spreading vicious lies and being, well… assholes. One of OUR minions had caused an altercation with his team DURING the debate (because our person claimed that one of HIS minions looked at her funny), so this sit-down was a long time coming. I will not tolerate impoliteness.

So anyway, we came to an agreement, shook hands and hugged, and went on our merry ways. A bunch of us piled into the car to go to post-debate dinner and passed by (***)’s opponent with whom we had just agreed to the peace treaty. One of the particularly troublesome minions who was riding in the car (who was not present for the treaty) flipped him the bird. I went apeshit about it.

The next day, the smears were back only worse. That f*cking minion ruined it. All because she said she hated the guy and “couldn’t help it.” My answer: “Yes you CAN help it, you idiot!!”

This is what happens when people get riled up about politics. All manners and civility go right out the window. Don’t get me wrong — I hate political correctness. But there are times when you must handle things POLITELY and not go off the handle because, just like in this case, it comes back to haunt you. The game must be played soberly and deftly, like chess. Anticipate the next move, and do what you can to minimize damage.

So the big question I keep getting asked is, “Do you think he can win?”

Truth is, no. No I don’t. Is it possible? Yes, I suppose. If things go our way and something completely devastating comes to light about the other candidates, then (***) has a halfway shot at it. But without money — without doing all the dirty rotten things the other candidates do like making promises, backdoor deals, buying off people, paying for Private Investigators, buying minions — it’s not a level playing field.

Someone told me the other day that it’s a shame (***) didn’t do better in the primary because he’s intelligent and actually has great ideas that make sense. Too bad he’ll probably never win.

That’s politics.


Politics is supposed to be the second-oldest profession. I have come to realize that it bears a very close resemblance to the first. — Ronald Reagan


Posted in sobrietyland | Leave a comment

Loperamide online article

A very interesting article from the point of view of a Pharmacist (PharmD).


Posted in sobrietyland | 3 Comments