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Arkansas, Oklahoma divided on opioid withdrawal alternative

Arkansas, Oklahoma divided on opioid withdrawal alternative

April 16th, 2018 by Associated Press in Arkansas News

FORT SMITH, Ark.—Legislation on an alternative substance that some say could help mitigate the effects of opioid withdrawals is divided along state lines.

Kratom, a tropical tree from Southeast Asia with leaves that produce stimulant and sedative effects, has been used in the Fort Smith region to both treat chronic pain and mitigate the effects of opioid painkiller withdrawals. Though it is sold legally through alternative medicine stores throughout Oklahoma, it is listed as a banned substance in Arkansas.

People in the United States have started to use kratom as a remedy for drug dependence, anxiety and pain. Proponents argue it is safer than prescription opioids like Vicodin and OxyContin, according to The Associated Press.

The Drug Enforcement Agency has listed kratom as a "Drug of Concern." In February, Food and Drug Administration Commissioner Scott Gottlieb said claiming kratom is harmless is "shortsighted and dangerous" and that it's "an opioid that's associated with novel risks because of the variability in how it's being formulated, sold and used recreationally."

Jack Henningfield, vice president of Research, Health Policy and Abuse Liability at Pinney Associates, an organization that assesses the medical value of substances, said there is "insufficient evidence" for the DEA to restrict kratom.

In Oklahoma, a similar debate is being held.

"Right now, I just don't think everyone is on board with banning it," said Kayla Madera, an employee at the kratom store Earthly Mist in Roland. "They're just butting heads right now."

Kratom was banned in February 2016 in Arkansas and is listed as a Schedule I controlled substance in the state. It is also banned from Tennessee, Alabama, Indiana, Wisconsin and Vermont.

Paul Smith, director of the 12th and 21st District Drug Task Force in Sebastian and Crawford counties, said the legislation that banned kratom likely came about after the substance was tested in the Arkansas state crime lab. He said other substances have been banned in similar fashion in Arkansas.

"They start receiving submissions, and they come back for a particular substance," Smith said. "They'll kind of keep track of it and see if it's a problem, and they'll also do their own research around the United States and see what their other colleagues at other state crime labs" think.

Smith, who supports the substance ban, said other countries that have extended experience with kratom consider it to be dangerous.

West of the Arkansas border, kratom is dispensed without fear of seizure, the Times Record reported. Though legislation has been brought against kratom in Oklahoma, no law has officially passed that would ban or schedule the substance in the state.

Because of its legality, kratom is sold through shops designed purely for its sale and smoke shops across the state. A handful of them are under the brand name Earthly Mist, which has locations in Tulsa and Oklahoma City along with its Roland location.

Earthly Mist in Roland receives 7-10 customers a day, including people who have been prescribed methadone, Madera said.

She said she does not ID people at the store, as it is not under any licensed medical practice.

"They'll come in, and they'll be tired and groggy and all that, and there will be a lot of pain," Madera said. "They'll come back a week or two later and say how great they've been feeling."

Smith said law enforcement officials have conducted one kratom seizure in Sebastian County, Ark., and a handful of seizures of the drug in Crawford County, Ark., since the substance was banned in 2016.

Though the kratom seized in Sebastian County was found in a plastic bag, it was found in Crawford County with labeling from Earthly Mist, Smith said.

"They're basically coming from Roland," Smith said of the drug seizures.

Smith said people are attracted to the drug to overcome symptoms like vomiting and diarrhea that come from heavy opioid withdrawals.

"It can be used to kind of satiate or stop that kind of withdrawal that comes when they don't have any kind of opioid pills to consume," Smith said.

Personal testimonies submitted to Earthly Mist line up with Smith's statements. Some even go as far as to say the substance gives the user energy and helps with pain.

While he has spoken against opioid over-prescribing and its effects in Sebastian County, Smith also spoke against the use of kratom in an opioid withdrawal situation.

Smith said anyone going through an opioid withdrawal—especially a severe one—needs to seek medical attention for his or her symptoms.

"It's a medical problem that needs to be addressed in a medical setting, not someone who's trying to do it themselves," Smith said of opioid withdrawals.

Smith said "all treatment facilities" in Sebastian and Crawford counties have a protocol to ensure the person going through an opioid withdrawal is medically safe while he or she is going through an opioid overdose.

"We try to steer people away from these types of remedies into treatment or medically supervised withdrawal protocols," Smith said.

Though he has discussed how opioids are over-prescribed in the past, Smith said the difference between prescription opioids and kratom is that prescription opioids are prescribed as the patient needs them. He also said prescription opioids, if prescribed correctly, are given with the patient's medical reactions in mind.

"(Kratom) causes different reactions, psychologically and physiologically to the individual that's taking them," Smith said.

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