null24 wrote:I think you missed my point. Using kratom may be a harm redux technique, but is not a recovery modality.
I don't understand how kratom's pharmacology renders it more effective relative to other currently available opiate medications. It does not have the same pain relief properties. As far as usefulness in a MAT agent, it's comparably (very) short half life when compared with currently useful things like methadone or buprenorphine mitigates it's usefulness in anything other than a patient controlled disorder regimen, which seems like a poor option for people already disposed to addiction.
Your undeniably right, it is harm reduction, long term maintenance is not the same as completely trying to kick a habit, yet I would say kratom has every potential to be used under both situations.
In many ways it is better to have something that is not a full agonist as well as not having a long half life. Yet this also has its cons to it just as you described, its only practical for people who feel significant relief from it, which sadly many people do not.
It does not work out for all people but its potential to help people is tremendous, far beyond what is often thought to be the case.
The immune system boosting effects of kratom are also great specifically for people coming off harder opis, kratom has non-psychoactive constituents that are in no way found in isolated opioids/opiates or even in opium itself, which I believe plays a significant role in long term kratom users.
Being myself a long term addict who is regularly in the face of physical withdrawal, having experimented over the years with a wide variety of opis I can say for sure that Kratom gives me benefits I can not get from any alternative, I have also seen it do the same thing for other addicts.
I have also seen it be completely and utterly ineffective for addicts who feel no relief from it, thus under that auspice it is the LEAST desirable option for maintenance, but my ultimate conclusion is that if that person who does NOT feel relief goes and gets on a pharma they often may just end up being more "addicted" in the end.
I have often seen people who are shooting a small amount of dope get on 8-16mg of suboxone a day when they really only need about 2-4mg to feel full relief and thus after maintaining that obnoxiously high dosage for a month or a few months be unquestionably more physically addicted to opioids in general after the fact than they were when they shot a few bags of dope a day.
It sounds ridiculous but its actually somewhat common, because people arent very practical or realistic when telling people what dose of something like suboxone is appropriate for them.
In the past years I myself was put on an 8mg a day regiment when I could have felt full relief from half that, the whole thing seemed pretty counter productive to me and it especially raised a red flag when I looked into peoples of suboxone withdrawal vs heroin withdrawal.
Opioid maintenance is supposed to be about subsisting on a bare minimum, not on overloading your system with opi. Methadone addicts who are on high doses cant even feel a "normal" shot of H because they have had their tolerance raised too high by methadone, to me its insane that people on maintenance are having their addictions increased in this way, ive seen it set so many people up to fail.
I have seen too many people who are years deep into using 8-16mg suboxone think they are completely fine and out of the habit, only to realize that if they go 72 hours without a dose they will be in the worst withdrawal they can possibly imagine that will make the dope/pill withdrawal they used to have look like nothing...oh and its lasts like 3x as long...
Sadly most of this problem is really more of a dosage issue than the actual pharmacology of the compounds themselves but over the years I have concluded that doctors are usually in a bad habit of prescribing completely erroneous dosages when it comes to opioid maintenance.
Yet admittedly kratom can also set people up to fail in a different way, some people literally NEED to have the blocking effect of suboxone or methadone so they literally cant get high even if they want to, kratom does NOT provide that benefit which can be critical for many long term addicts.