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This is a first-person account from a psychiatry resident (me) enrolling in a clinical trial of psilocybin. Somewhere between a trip report, an overview of the pharmacology of psilocybin, and a review of the clinical evidence suggesting pronounced benefits for depression.
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Notes -
Kratom provides a kinda-sorta opiate-like buzz the very first few times its used that taper off pretty fast and generally stop around the 3rd-4th use. It is a fantastic pain reliever though, and a godsend for people with chronic pain who cant get medical pain management from a doctor. The pain relief doesn't go away with repeated use like the buzz does.
There is a predictable profile for the people we see who have problems with kratom (I volunteer at a local rehab). They are opiate addicts, usually heroin, pretty deep into it. They get off dope but are struggling with terrible withdrawal. They learn that in the cultures that kratom is native too people use it to get off dope, that it blunts the withdrawal symptoms. This is true, its great for this. Then, the first time they use it they get sorta opiate-like buzz and a lightbulb goes off in their heads: "I've found a loophole! I can keep getting high! I'll still pass my drug tests!" But as mentioned the psychoactive effects fade very fast. This can temporarily be countered by taking more, so they move from the capsules to the liquid extracts then the more concentrated extracts. Still by the end of the first week the buzz is entirely gone. It still offers relief from withdrawal but thats not why they're using it now. This stuff got them high once, why isn't it working anymore? This is where the huge amounts of money kick in. The individual bottles of the concentrated extract cost $20 each or so and they're taking 5-10 a day chasing that buzz that isn't coming back. Way more than they ever spent on heroin (which has been dirt cheap for a while now) Many go back to dope at this point. We see a lot of ODs at this point; having been clean for a while, even just 1 month sometimes, is enough to reset their opiate tolerance but they still dose based on their previous habit, which is now too much.
Kratom is a very effective treatment for pain. Its also very good as alleviating withdrawal, but those first few doses that provide a ersatz high for recovering addicts ruins this use case for some people leading to the observations in the above post.
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