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posted by Fnord666 on Monday February 12 2018, @05:09AM   Printer-friendly
from the scheduled-for-elimination dept.

FDA Commissioner Scott Gottlieb has released a new statement denouncing the drug kratom. The statement says that the FDA has learned about new deaths that "involved" kratom use, additional adverse effects associated with its use have been found, and that Public Health Assessment via Structural Evaluation (PHASE) "3-D computer technology" has been used to analyze the chemical compounds in kratom:

Using this computational model, scientists at the FDA first analyzed the chemical structures of the 25 most prevalent compounds in kratom. From this analysis, the agency concluded that all of the compounds share the most structural similarities with controlled opioid analgesics, such as morphine derivatives.

The FDA continues to discourage the use of kratom, which it is calling an opioid.

The American Kratom Association provided a rebuttal of the FDA statement:

Nine leading scientists in substance addiction and safety wrote to White House Opioid Crisis Team Leader Kellyanne Conway and Acting DEA Administrator Robert W. Patterson requesting they disregard the FDA's latest disinformation campaign against kratom. The scientists warned that "four surveys indicate that kratom is presently serving as a lifeline away from strong, often dangerous opioids for many of the several million Americans who use kratom. A ban on kratom that would be imposed by CSA Scheduling would put them at risk of relapse to opioid use with the potential consequence of overdose death. Similar unintended consequences are to be expected in some who would be forced to use opioids to manage acute or chronic pain."

[...] David Herman, Chairman of the AKA, called upon FDA Commissioner Gottlieb to pull back the curtain on the "black box voodoo computer model" that was unveiled by the FDA to justify their continued 'War on Kratom,' this time claiming their computer model conclusively shows kratom is an opioid, and therefore had to be banned.

The nine respected scientists pointed out that "kratom provides a far more favorable safety profile for consumers compared to more dangerously addictive and potentially deadly classical opioid medications." They also pointed out that the FDA's solution – to file a new drug application for kratom – made no sense because "the average time and cost of new drug development is more than 10 years and 2.5 billion dollars."

Previously: DEA Welcomes Kratom to the Schedule I List Beginning September 30
The Calm Before the Kratom Ban
FDA Blocks More Imports of Kratom, Warns Against Use as a Treatment for Opioid Withdrawal

Related: Opioid Commission Drops the Ball, Demonizes Cannabis


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  • (Score: 5, Interesting) by stormwyrm on Monday February 12 2018, @07:19AM (6 children)

    by stormwyrm (717) on Monday February 12 2018, @07:19AM (#636595) Journal

    There's a serious reason why herbal products are no longer used directly in today's medicine, and it has nothing to do with the fact that herbal medicines can't be patented: the amount of active ingredient in a particular herb varies greatly from plant to plant, and for many medicines the line between a therapeutic dose and a toxic one is a very fine one. Take digoxin, for instance, which is used to treat heart arrhythmias. You can get it in its natural form from the foxglove plant, but how much digoxin is available varies from one plant to the next. If you were unlucky one batch of foxglove you tried to use might have a dangerously high quantity of digoxin, and you'd kill a person if you gave a concoction like that to them.

    Which is why this outright ban on kratom is even more perplexing to me. A pharmaceutical company that did research on the active ingredients in kratom could stand to make a very large amount of money if they could isolate the sources of its pharmacological action, and come up with proper drugs based on it that have reasonably well-understood effects. The "computational model" that the FDA seems to have done and used as a basis for banning it sounds like it is the equivalent of scribbling a few equations on the back of an envelope as far as pharmacological research goes. At the rate this is going it's going to be very costly for even a major drug company to do proper research of the kind needed to even establish the pharmacological usefulness of the compounds in kratom. Even though Scott Gottlieb is just about as big a pharma shill as they come [respectfulinsolence.com], I don't see how this ban benefits the pharma companies much either.

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    Numquam ponenda est pluralitas sine necessitate.
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  • (Score: 3, Interesting) by LoRdTAW on Monday February 12 2018, @02:23PM (1 child)

    by LoRdTAW (3755) on Monday February 12 2018, @02:23PM (#636687) Journal

    Even though Scott Gottlieb is just about as big a pharma shill as they come [respectfulinsolence.com], I don't see how this ban benefits the pharma companies much either.

    Why spend money investigating a product that competes with your already existing, more addictive and VERY profitable product? They have nothing to lose here.

    • (Score: 2) by stormwyrm on Monday February 12 2018, @03:21PM

      by stormwyrm (717) on Monday February 12 2018, @03:21PM (#636707) Journal

      Why spend money investigating such a product? Tell me something, what is the status of the patents on oxycodone? It was discovered in 1916. Hydrocodone? Discovered in 1920. Fentanyl? Discovered in 1960. The patents for all of these opioid drugs expired long ago, meaning nobody has to pay anyone royalties to make them. The only reason why they're suddenly more profitable to the drug companies these days is largely because of an infamous letter in the New England Journal of Medicine in 1980 [bbc.com] alleging that addiction to opioids is "rare". Before this letter, doctors were much more reluctant to prescribe opioid painkillers out of concern for their addictive properties. The letter made these drugs much more profitable because it made doctors more willing to prescribe them, leading to the opioid crisis we have today. Now, if I were a big pharmaceutical company, I'd definitely want to do serious research into kratom. Given the kind of anecdotal evidence it carries, there's a reasonably good chance that there's something interesting in there, and the only way to find out is to actually do the research. If it pays off I could have a new, safer painkiller to compete with the dangerous opioids, and I would hold the patents on it. It would make my shareholders very rich indeed as the new drug would then be prescribed instead of the opioids. But if there are regulatory roadblocks to doing this kind of research, then it suddenly doesn't look like such a promising strategy. Look at how research into marijuana-derived compounds languished over the years thanks to the same sort of regulation that they're imposing on kratom today.

      But then again, my thinking here is probably much more far-sighted than most of the MBAs that run Big Pharma these days. They'd be content to let R&D languish if doing so would make next quarter's numbers look slightly higher.

      --
      Numquam ponenda est pluralitas sine necessitate.
  • (Score: 3, Interesting) by ElizabethGreene on Monday February 12 2018, @04:56PM

    by ElizabethGreene (6748) Subscriber Badge on Monday February 12 2018, @04:56PM (#636734) Journal

    >> A pharmaceutical company that did research on the active ingredients in kratom could stand to make a very large amount of money if they could isolate the sources of its pharmacological action

    The same pharmaceutical company should also look at https://en.wikipedia.org/wiki/Ibogaine [wikipedia.org] . It's a psychedelic herbal that anecdotally _permanently_ turns off the physical mechanisms of Opiod addiction in 90%+ of the people that try it. It was a non-trivial risk of death in herbal form, particularly if the patient has low K or Mg.

    It's banned in the US too.

  • (Score: 0) by Anonymous Coward on Monday February 12 2018, @05:37PM (1 child)

    by Anonymous Coward on Monday February 12 2018, @05:37PM (#636744)

    In fairness, this is an FDA ban on domestic sales of kratom, not a ban on its possession or import. A pharmaceutical company that wishes to isolate and market active chemicals here would in no way be precluded from doing so, especially since this ban doesn't in any way weigh in on the sale of the active chemical, merely the plant.

    Notions of analogs and containers and all that are not applicable here, as this isn't a DEA schedule.

  • (Score: 2) by requerdanos on Monday February 12 2018, @08:44PM

    by requerdanos (5997) Subscriber Badge on Monday February 12 2018, @08:44PM (#636819) Journal

    "There's a serious reason why herbal products are no longer used directly in today's medicine... the amount of active ingredient in a particular herb varies greatly from plant to plant... Take digoxin, for instance"

    We aren't taking digoxin here; we're taking mitragynine and 7-hydroxymitragynine, and I have not seen any evidence that their respective alkaloid concentrations in the plant matter deviates in any unexpected way.

    If you were unlucky one batch of foxglove you tried to use might have a dangerously high quantity of digoxin, and you'd kill a person

    If you were unlucky and a batch of kratom had an unexpectedly high quantity of mitragynine or 7-hydroxymitragynine, you might give a person feelings of euphoria and/or discomfort for several hours.

    Studies at places like Columbia University [acs.org] and University of Massachusetts Medical School [scientificamerican.com] indicate that unlike opioids (or "unlike other opioids" if you class these as such), mitragynine and 7-hydroxymitragynine don't have the respiratory depression effect that causes these overdose deaths that are behind the current "opioid crisis."

    Of course, these compounds have an LD-50 *somewhere*, but the point is that their wide theraputic index [wikipedia.org] is nothing like the narrow tightrope walk that you're describing.

    It makes sense that people who are unsettled by the thought of dosages that are not 100% consistent would prefer something like a standardized extract to just eating kratom leaves, but that scarcely seems to be the objection here.