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This article contains the following information:
- What is Harm Reduction?
- What is Harm Reduction in relation to drugs?
- What does Harm Reduction have to do with pain patients?
We cover the following Harm Reduction information/resources:
What is Harm Reduction?
There isn't one standard definition, but I asked Maia Szalavitz, a Harm Reduction expert who wrote the first comprehensive book on the history of Harm Reduction and drugs called Undoing Drugs , how she would define it. She said "It's policy that focuses first on stopping people from getting hurt, not stopping them from getting high or engaging in other risky behavior. Importantly, that definition doesn't exclude abstinence approaches for those who seek them." The concept of Harm Reduction has been used for years in this country.
- Seat belts - We know people will drive carelessly and there will always be car accidents. So, we use seat belts to reduce harm of the accidents.
- Condoms - We know people are going to have sex and teaching abstinence only won't prevent unwanted pregnancies and STD's. So, we have things like condoms to try to prevent pregnancies and STD's.
- Designated Driver - We know some people will drink when eating dinner out. So, there is the recommendation to have a designated driver who won't drink to prevent driving while intoxicated.
What is Harm Reduction In Relation to Drugs?
National Harm Reduction Coalition explains it like this: "National Harm Reduction Coalition works for the Harm Reduction movement built on a belief in and respect for the rights of people who use drugs. Our strategies include building leadership among people who use drugs and supporting communities in reducing the negative consequences associated with drug use." So, basically it means instead of telling people to not use drugs (like Nancy Reagan's just say no movement) Harm Reduction acknowledges that people are going to use drugs, so they do what they can to keep them safe and alive by using different strategies and techniques. In the last year, there have been over 100,000 drug related deaths in the USA, so clearly what we are doing (the war on drugs) isn't working. As Maia mentioned, if people choose abstinence like with a 12 step program, that is included in Harm Reduction. Although Harm Reduction has been accepted in USA in relation to cars or alcohol, Maia explains that "it's a very old idea, but in drug policy it is radical because we've always focused on stopping drugs, not on harm and we cause lots of harm trying to stop drugs." There are many techniques used in Harm Reduction in drug use. I'll list some examples, and then will add content about each one. As we add each category listed below, we will link each one to the information we add. This isn't an exhaustive list.
- Illicit Fentanyl testing strips
- Never Use Alone Hotline and Information
- Naloxone (Narcan)
- Lock Boxes/Safe for controlled substances
- Safe or safer supply
- Needle exchange (syringe service programs)
- Safe Injection Sites
What does Harm Reduction Have To Do With Pain Patients?
You might be asking how this relates to pain patients and why this information is even on our website. As more and more pain patients are cut off from their medication, many are going to the streets to purchase pain medication out of desperation for pain relief. Since up to half of the supply of medication on the street is actually counterfeit containing illicit fentanyl, we feel it's very important for pain patients to know how to access Harm Reduction techniques so they can test their medication and not die from drug poisoning. I didn't know much about Harm Reduction (HR) until last year. Several prominent CPP advocates have been trying to join the CPP community with the HR community for a few years. Lelena Peacock, Carrie Judy (a researcher with our org), and D. S. Nelson were the first CPP advocates I saw who understood early on how HR and CPP's need to be working together and not against each other.
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- What is Kratom?
- What can Kratom treat?
- How do I take Kratom?
- What do the different strains mean?
- What dose should I start with?
- What happens if I take too much?
- What happens if my dose is too small?
- Where should I buy Kratom?
- How does Kratom help chronic pain patients?
- Will it help my pain as much as opioids do?
- Will my pain doctor test for Kratom in a UDT?
- Is Kratom legal?
- Other info. about Kratom
"A well-organized, coordinated campaign from the FDA and Big Pharma is threatening access to the supplements you depend on. Using the false premise that supplements are unsafe, the FDA is working to gain more power over the regulation of supplements in order to further solidify Big Pharma’s monopoly over medicine. These efforts must be opposed.
If this passes, the FDA would have the power to ban kratom by denying supplement registrations.
Please write to your Congressional representatives and tell them to oppose efforts to establish a "mandatory filing" for supplements."
We are not doctors and we aren't giving out medical advice. We are patient advocates who are passing along valuable information and we hope it helps you.
We've received many questions about Kratom. Many of you have been cut off of your pain medication or have been tapered to a dose that no longer helps. Kratom can be a good option for some, but we know it can be overwhelming to figure it all out. We've included information and links to help you get started in case Kratom is an option you'd like to explore.
- From Kratom IQ: "Kratom is a leafy plant native to Southeast Asia, namely Indonesia, Thailand, Malaysia and Bali, that’s actually part of the coffee family. The leaves can be chewed (what Thai workers do to work long hours in the heat) but for the typical end user, the leaves are most commonly crushed and processed to form a fine powder."
- From American Kratom Association: "Kratom is not a drug. Kratom is not an opiate. Kratom is not a synthetic substance. Naturally occurring Kratom is a safe herbal supplement that behaves as a partial mu-opioid receptor agonist and is used for paiWn management, energy, even depression and anxiety that are common among Americans. Kratom contains no opiates, but it does bind to the same receptor sites in the brain. Chocolate, coffee, and exercise hit these receptor sites in a similar fashion."
Please understand Kratom is not FDA approved, but there have been some studies done. People have claimed Kratom has helped them with the following:
- Opioid Withdrawal
- Lack of Energy
- There are three main ways to take Kratom:
- Steep the powder in tea-this is why you sometimes hear it referred to as "tea."
- Watch this tutorial by Kratom IQ
- "You boil up the powder with some water for 30 minutes or so, let it sit, then strain off the liquid. Some people feel this results in better and more consistent effects but it’s obviously more time consuming to produce. The taste isn’t too bad and you can drink it hot or cold. It’s quite nice chilled actually."
- Take the powder straight, also called "toss and wash."
- Some tips on how to do this by Kratom IQ
- The steps are pretty simple
- Measure out power (it can be helpful to use a measuring spoon so you know exact amount of dose)
- Put it in your mouth
- Swallow it using something to drink.
- Taking them in capsules
- You can purchase capsules from a vendor
- You can encapsulate them yourself as explained by Kratom IQ
- Steep the powder in tea-this is why you sometimes hear it referred to as "tea."
- There are three main strains:
- Red- This is usually best for pain and relaxation. It's also recommended for those going through opioid withdrawal. It can make some people sleepy. Not everyone is the same and some people actually get energy from red stains.
- Green- This is usually best for anxiety. Some greens are relaxing and some energizing. Again everyone responds differently to different strains.
- White- This is usually best for energy. Often people will take a little white with red when they need pain relief but need to counteract the sedating effects of a red. Not everyone is the same and some people get sleepy from whites or even anxious.
- It is ok to mix the strains, and each strain also has many different varieties. Kratom is a lot of trial and error to find what dose and strain work for you.
This varies from person to person. It does take time to find the right strain and the right dose for your body. Don't give up after trying a few times. Keep at it, and you should be able to find a therapeutic dose for you. This dose is often referred to as the "sweet spot."
Most vendors and Kratom organizations will suggest you weigh your kratom instead of measuring it with a spoon because it's more exact. One teaspoon is approximately 2-2.5 grams of kratom. The following are the steps we suggest you take when beginning Kratom taken from Kratom IQ. Keep in mind a typical beginner dose of Kratom is anywhere from 3 grams (1 tsp) - 10 grams (about 1 tbsp):
- Step 1: Take 2 or 3 grams (or I suggest 1/2-1tsp). You should start to feel some relief after 20 minutes or so.
- Step 2: Assess how you feel after 30 – 45 minutes. If you think you need some more, take another 1 to 2 grams.
- Step 3: Assess how you feel after 15 – 30 minutes. Remember you might have a bit of a higher tolerance if you've taken daily opioids.
- Step 4: If you still don't feel relief add another 1/2 tsp.
- Step 5: If you don't feel relief yet, wait another 4-5 hours to try again.
- Step 6: After 4 or 5 hours have passed and you want to take more, repeat this process with the SAME strain you used earlier in the day (starting with the dose you ended with).
- VERY IMPORTANT to remember that just because you found your dose with one strain it doesn't mean it will be the same with all strains. Any time you start a new strain, always repeat this process.
- You'll know if you take too much Kratom because you may feel nauseated or even throw up. This is why we suggest starting small and taking it in increasing small increments until you find your "sweet spot." Many pain patients start out with too large of a dose out of desperation for pain relief, they end up vomiting, and then think they're allergic to it.
- There is also something Kratom users refer to as "the wobbles."
- What is it?: You may feel dizzy, have brain fog, feel like you can't focus your eyes.
- How can I avoid it?: It's pretty easy to avoid. Don't take huge doses of kratom. Follow the instructions we've listed and you should be fine.
- How can I treat it?: There are varying opinions on the internet on how to treat this. Mostly, just know it's not dangerous and it will pass. Drink a lot of water and lie down if you can.
Nothing. You'll get little to no relief. So, keep trying increasing your dose slowly until you find the right dose for you.
We highly suggest you don't buy Kratom at a local smoke shop, but instead use a reputable online vendor. Here are some tips on how to pick a vendor:
- Talk to other CPP's and ask them what they use.
- Read reviews.
- Some vendors test their product and list what is in it. This is always a positive thing to look for.
- American Kratom Association has the following programs:
- GMP standard program (Good Manufacturing Practice Standards Program).
- Truth in labeling program. "The AKA strongly opposes unscrupulous vendors who use illegal health claims to increase sales of kratom products. This new self-regulation program will encourage consumers to report potential marketing violations so that the FDA can investigate and, when appropriate, take needed enforcement actions against kratom vendors who use impermissible health claims to mislead consumers about the actual benefits of using this otherwise safe food product. This new program is a valuable addition to the current AKA vendor GMP program that requires participating vendors to adhere to good manufacturing practices (GMPs) and to submit to an independent 3rd party audit to verify compliance."
- Here is a list of vendors that qualify for these programs with American Kratom Association
- Pain- Kratom can help treat pain. It varies from person to person how much it actually helps, but it definitely can help some people manage their pain.
- Opioid withdrawal - Many CPP's are being abandoned, cut off their opioid medication completely, or quickly tapered causing not only increased pain but also horrific withdrawal. Kratom can definitely help mitigate some of the symptoms of withdrawal.
For some people it will and for others it won't. It's worth trying to see if you can get some relief using Kratom.
We have heard of some doctors testing for Kratom in their UDT's. Check your pain contract to see if it's listed. Depending on how much you trust your doctor, you may want to discuss it to see what their policy is on Kratom. Since Kratom is considered a supplement and isn't a controlled substance, it shouldn't be against a pain contract unless it's specifically stated. That isn't to say a doctor won't consider it a breach of contract. We've heard of that happening.
Kratom is legal in most states. There are currently 6 states where Kratom is banned, and some others with varying laws.
- The states as of 2022 where is is completely banned are:
- Rhode Island
- Check to see what Kratom laws are in your state.
- Kratom has a strong lobbying presence. To find out how to get involved with efforts to keep Kratom legal, please contact the American Kratom Association.
- Since Kratom interacts with receptors in the brain, it's suggested that you put about four hours between taking Kratom and prescription opioids. Some people who don't get enough prescription opioids to treat their pain use Kratom in between doses of medication. It won't be dangerous to take with opioids, but if you don't leave enough time between taking opioids and Kratom, they can cancel each other out.
- It's important to make sure you stay hydrated by drinking extra water while taking Kratom.
- You can build a tolerance to Kratom if you take it daily.
- Less seems to be more with Kratom. If your dose stops working, instead of taking more, try to cut your dose a little. For some reason this seems to work well.
- Rotate strains so you don't develop tolerance as quickly.
- Kratom is considered a Harm Reduction resource since it can prevent patients from purchasing medication illicitly to self-treat their pain or withdrawal.
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This article covers the following information:
- What is Naloxone?
- Where can I get Naloxone?
- How does this information apply to CPP's?
- When is Naloxone used?
- What are common symptoms of opioid overdose?
- How do I use Naloxone?
What is Naloxone?
From SAMHSA's website (Substance Abuse and Mental Health Services Administration):
- Naloxone is an FDA approved medication used to rapidly reverse an opioid overdose.
- "It is an opioid antagonist—meaning that it binds to opioid receptors and can reverse and block the effects of other opioids, such as heroin, morphine, and oxycodone"
- It should be given to a patient who is showing the signs of an opioid overdose.
- It can be given by
- intranasal spray (into the nose)
- intramuscular (into the muscle)
- subcutaneous (under the skin)
- intravenous injection.
Where can I get Naloxone?
Use this link at Nextdistro to access Naloxone. They also have a lot of other information about Naloxone and other Harm Reduction resources.
How does it apply to CPP's?
- Unfortunately, as many of us know, it's becoming increasingly harder to access prescription opioids for pain. While we would never encourage anyone to go to obtain their medication from someone other than their provider, we are well aware of how common that's becoming.
- It is important to understand that someone can't use naloxone on themselves to reverse an overdose, so it's essential to teach others how to use naloxone.
- If someone purchases opioid medication the chance of getting a counterfeit pill laced with illicit fentanyl is quite high. If you know of anyone who obtains their medication this way please give them the following information (in addition to info on naloxone):
When is Naloxone Used?
Naloxone should be used when someone is overdosing on opioids. Recognizing the signs of opioid overdose is essential to saving lives.
What are the Symptoms of an Opioid Overdose?
- Their face is extremely pale and/or feels clammy to the touch
- Their body goes limp
- Their fingernails or lips have a purple or blue color
- They start vomiting or making gurgling noises
- They cannot be awakened or are unable to speak
- Their breathing or heartbeat slows or stops
How Do I Use Naloxone?
From Harm Reduction expert Amanda Mazur: