Crystal meth; and Kratom, an opioid

​2 issues: dramatic increased in crystal methamphetamine use and deaths; and an FDA report on kratom, finding more evidence that it is an opiate with no therapeutic benefit (see https://www.nytimes.com/2018/02/13/us/meth-crystal-drug.html ).

Details:

--crystal meth was a huge issue in the early 2000's, with domestic meth labs all over the place, largely using OTC pseudoephedrine to synthesize meth

--in 2005 Congress passed the Combat Methamphetamine Act, which severely restricted pseudoephedrine sales by requiring pharmacies to monitor and limit sales. Some states (eg Oregon and Mississippi) required a prescription for it.

--meth use plummeted, to be replaced by opiates

--over the past several years there has been a resurgence, from imported incredibly cheap ($5/hit), pure (>90%) and strong meth from Mexico (there continues to be domestic production, though mostly small quantities produced), such that:

    --meth-related deaths in Oregon (232 in 2016) was more than twice that from heroin

    --in 2015, nearly 6,000 people in the US died from stimulants (mostly meth), a 255% increase over 2005, now about 11% of drug overdose deaths; cocaine had 6784 reported deaths in 2015

    --a 2017 US National Drug Threat Assessment from the DEA (see https://www.dea.gov/docs/DIR-040-17_2017-NDTA.pdf​ ) found that:

        --reports that meth was the greatest reported drug threat were scattered across the US (though concentrated in California) but now migrating to the area around the Mississippi River and eastwards

        --30% reported meth takes up the most law enforcement resources (heroin logs in at 36%)

        --36% reported that meth was the drug most contributing to violent crime (one difference here with opiates is that those on meth have inordinate amounts of energy and time awake to commit crimes to support their habit: in Portland Oregon more than one in five burglars and 40% of car thieves were also charged with meth crimes).     

        --high availability of meth by region: 79% Pacific, 72% West Central, 69% Southwest and 61% Southeast

        --since 2014 there have been seizures of meth mixed with fentanyl and its derivatives, as well as with heroin and cocaine, across the country though more in Eastern states (MA, FL, GA, PA, NY, NJ)

        ​--a 2015 national questionnaire found that current meth users included 897,000 people (0.3% of the US population), 757,000 of them were >25 years​ old

    --US border agents are seizing 10-20 times the amount of meth than they did a decade ago

    --some people are switching from crack cocaine to meth, since it is so cheap [though not sure that is a bad thing.... cocaine is also quite toxic]

    --the meth is often cut with heroin, just to curtail the incredible high people get from this really strong meth

    --unlike previously, meth has now made it into minority areas

Commentary:

--though meth has had a dramatic effect on the western US, i am hearing about more meth in the Boston area. a quick review of some current local articles:

    --2/7/18: a town counselor in Randolph (outside Boston) was arrested and charged with  with possession and distribution of meth ( http://boston.cbslocal.com/2018/02/07/randolph-town-councilor-arrest-james-burgess/ )

    --11/18/16: eleven men were indicted in connection with a large-scale meth trafficking and money laundering ring operation between Massachusetts and California ( https://www.justice.gov/usao-ma/pr/eleven-indicted-trans-national-methamphetamine-trafficking-ring )

so, meth seems to be making quite a comeback. one concern now is that the national focus on opiates may be becoming increasingly too narrow. the use of illicit and dangerous drugs has expanded beyond opiates, and the fear is that money, support, and coordinated programs needed for meth users may be undercut by too exclusive a focus on opiates. and there is no naloxone equivalent to reverse overdoses, nor methadone/buprenorphine to decrease cravings or usage.

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 The FDA just released an announcement about the presence of "opioid compounds in kratom" (see https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm595622.htm​ ).

Background:

--kratom (Mitragynine speciosa) is a natural product, sometimes used by people for opiate withdrawal but is itself addictive, is marketed as a "natural painkiller", is a mu-receptor agonist, is not detected in drug screening, and is cheap and apparently easy to get (though the FDA did ban its import in 2014). see prior blog http://gmodestmedblogs.blogspot.com/2016/01/2-blogs-in-1-kratom-and-repeated-opioid.html  for details.

Details of the new FDA announcement:

--there is no credible evidence, per the FDA, of any benefits from kratom, including treating opioid withdrawal symptoms

--there are now 44 reported deaths associated with the use of kratom, 8 more than was reported in November 2017

--one of the deaths reported in November involved a person with no known history or toxicologic evidence of other opioid use; several other cases suggest that  kratom is being used with an array of other drugs (benzos, opioids, loperamide)

--the FDA investigated kratom to update the scientific data on it, finding:

    --in the 25 most prevalent compounds in kratom, they all shared structural similarities with morphine derivatives

    --they used new 3-D computer simulation technology to evaluate the chemical structure of molecules to predict whether they might bind to neural receptors, finding:

        --22 of the 25 compounds in kratom bind to mu-opioid receptors; 2 of the 5 most abundant compounds (including mitragynine) are known opioid agonists. and through their computer simulation, they found that kratom itself had a strong bond with mu-opioid receptors, comparable to scheduled opioid drugs

        --and, some of the compounds "may bind to the receptors in the brain that may contribute to stress responses that impact neurologic and cardiovascular function" (the FDA had previously warned of serious side-effects including seizures and respiratory depression)

    ​--so, the FDA concludes through this modeling that kratom compounds are predicted to affect the body "just like opioids"​

so, yet another drug hitting the scene. they seem to always be a few steps ahead....

to be included in emails in the future, please let me know at gmodest@uphams.org