In normal times, there is no doubt whether drugs with opioid effects should be proven safe and effective and approved by the Food and Drug Administration (FDA) forward It is widely sold. But this is not the usual time, and the herbal supplement kratom is not a typical medicine.
In fact, the question of whether to ban kratom is a good touchstone to test whether the Biden administration will actually use the harm reduction concept to Guide drug policy-Or just use popular slogans as window decorations to cover up the ongoing drug war.
An estimate 10-16 million Americans currently use kratom as a substitute for opioids, most commonly used to treat pain or as a substitute for street drugs.The official name of this herb is Mitrogyna speciosa, There are hundreds of years of herbal use in Southeast Asia-especially as a substitute for opium. It is usually sold as a bitter powder and can be swallowed as a tea or capsule.
Since kratom has never attracted enough international attention to stimulate the US or global ban, we areHealth products“It is made from plants and can be sold legally here. In recent years, sales have risen sharply because pain sufferers and addicts have become increasingly unable to obtain medical opioids during the overdose crisis.
Kratom does seem to be much safer than all illegal and most prescription opioids: CDC’s research on certain drugs 27,000 overdose An incident that occurred between 2016 and 2017 was found to be related to less than 1% of deaths.Given the large number of people who use it regularly and the low number of deaths, researchers estimate that it has been used more than 1,000 times less Might kill Than typical prescription opioids.
In addition, in almost all overdose deaths associated with kratom, it is accompanied by stronger drugs that kill more frequently, so it is not clear that it actually played a major role, or even did not play a role at all.For example, about two-thirds of 152 deaths The CDC study also involved illegal fentanyl and its analogs, which are thousands of times more potent. In only 7 cases, kratom is the only certain substance—even here, the researchers cannot rule out the possibility that the drug is not detected.
However, regardless of the specific facts of a particular drug, the main strategy used by the United States to deal with the drug problem for more than 100 years has been prohibition. Except for alcohol, caffeine and tobacco, almost all substances related to recreational use are completely banned or strictly restricted to medical use. Anti-drug policies-such as the war on drugs-assume that restricting drug sales and possession will solve the problem, period.
In contrast, when policymakers are guided by harm reduction, they must assess whether banning certain drugs or allowing continued sales will cause greater damage-in the current situation, it may replace other drugs and be related to arrests The harm of other factors and imprisonment.
For example, in a country where no one abuses more potent opioids and no one is already using kratom, introducing it without control is likely to be harmful.However, in the United States and The highest number of deaths from drug overdose in history-Mainly driven by street fentanyl-removing safer alternatives will almost certainly increase mortality.
Unfortunately, the kratom ban may be coming: the FDA is now seeking public opinion on whether the United States should support the international ban on the drug, and the United Nations is considering it through the World Health Organization.
The agency’s own position is clear: it opposes the over-the-counter sale of kratom as a health supplement and hopes that its sale will be illegal unless it is proven to have a medical effect. According to its treaty obligations, the international ban will automatically require the United States to ban the drug domestically.
In cooperation with the Drug Enforcement Administration, the FDA had previously tried to ban kratom. In 2016, DEA Announce It is planned to include kratom in Schedule I of the “Controlled Substances Act”-this category is used for drugs that may be abused and have no medical use. Along with drugs such as cocaine, this is where marijuana, ecstasy (ecstasy) and LSD are currently languishing; the classification itself makes it extremely difficult to determine the medical use research, resulting in a certain degree of capture22.
However, this is clearly the first time since the Harrison Act of 1914 legally banned drugs, consumers have successfully CounterattackWhen LSD and MDMA became popular in the 1960s and 1980s, respectively, DEA had no problem in making the media and Congress fear LSD and MDMA. However, by 2016, both journalists and elected officials were more skeptical about the usefulness of the ban — and, probably not accidentally, by then, Katoom’s sales had become a billion-dollar industry. The proposal was abandoned.
However, the FDA still seems to want it to withdraw from the market.In its call Regarding the public opinion on whether the drug should be banned globally, it described the herb like this:
“Kratom is abused because of its ability to produce opioids…Kratom is an increasingly popular drug of abuse and is easily available on the recreational drug market in the United States. There is evidence that kratom is abused alone and in combination with other drugs. Psychoactive substances are abused together…In the United States, kratom is abused to self-treat chronic pain and opioid withdrawal symptoms.”
Supporters of Kratom and the industry see it as an attempt by the agency to circumvent its previous failure to win direct support for the domestic ban.In a review of Marijuana Moment, in a policy communication, Mac Haddow of the American Kratom Association (AKA) believes that the agency’s intention to support the global ban is “Abusing” its authority, Added, “If kratom is banned, more overdose deaths will occur, and this is exactly what the FDA is trying to do.”
Ideally, we should have a responsive regulatory system that allows the safest medical and recreational drugs to be approved-a system that makes decisions based on relative hazards rather than relative hazards. Moral panic This is related to fear of race, class, and race, rather than actual drug effects.
But in our current system, the FDA’s attempt to ban kratom is certainly understandable: the only alternative to a substance that is risky and may cause high concentrations is to ban or regulate it as a drug, which is in the absence of safety and clinical trials. It is the first effect that cannot be accomplished.
If we really want to formulate harm reduction policies, we must change this. Banning substances that are less harmful than other widely used alternatives can make the situation worse. President Biden’s policy needs to be more flexible; otherwise, it will only increase rather than decrease harm.
This is an opinion and analysis article; opinions expressed Author or author Not necessarily those Scientific american.