The Mystery of the Vape Shop Kratom

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Speaker 14 A few weeks ago, I talked to a search engine listener with a question.

Speaker 16 At the time, I wasn't sure whether he'd want to be anonymous or not.

Speaker 18 Okay.

Speaker 19 So first of all, do you want to just say your name, like how you want to identify yourself for the purposes of this recording?

Speaker 21 Yeah, I'm Chris Glenn. I go by Chris, but, you know,

Speaker 21 I hadn't really thought about any kind of like

Speaker 21 anonymity idea or anything like that.

Speaker 22 Do you want any anonymity?

Speaker 19 If you want it, we can offer it. If you don't care, we don't need to.

Speaker 21 I decided basically I don't care. I would be happy to have my name attached to anything I say.
It's fine.

Speaker 1 The reason I was being a little cautious here was that Chris had written to us about an experience he'd had with addiction.

Speaker 24 Addiction to a kind of drug that neither of us was sure you were even supposed to call a drug.

Speaker 28 It was hard to know how to talk about any of this.

Speaker 1 But I'd wanted to speak to him because the substance in question and Chris's questions about it, in the past year, a bunch of my friends had taken me aside. privately with similar questions.

Speaker 16 So you wrote us an email and I, all the emails go go to my phone, and I read them all, but yours I read quicker than most because it had the word, it's pronounced kratom, right?

Speaker 21 I really don't know. I've heard kratom with a long A.

Speaker 32 You hear kratom, you've heard more kratom than kratom.

Speaker 19 Yeah, all right, let's proceed with kratom. It had the word kratom in the subject, which piqued my interest because we have been talking about kratom for like a year in the office.

Speaker 19 Okay, can you just like tell me the story of like how kratom crossed your radar?

Speaker 21 Yeah, absolutely. So

Speaker 21 I, over the years, have had struggles with addiction of various kind, mostly alcohol.

Speaker 21 And so it's been a couple years ago now, I was really doing badly with alcohol and drinking a lot and decided to get into rehab, went to detox first and then got into outpatient rehab program.

Speaker 21 And it was actually there that one of the people in group, he was a lot like me. His main problem was alcohol, but any kind of substance that crossed his path, he might have problems with.

Speaker 21 I'm the same way.

Speaker 32 There's a word for that in recovery circles.

Speaker 6 It's like a garbage head.

Speaker 21 Yep.

Speaker 19 Which I'm not trying to be like pejorative. It's just a friend of mine who's a recovery person said that to me once.

Speaker 21 Yes, I have heard that as well.

Speaker 24 So Chris in rehab was talking about how he was struggling to quit cannabis.

Speaker 1 And this other guy mentioned that he had also had a bit of a problem with something called Kratom.

Speaker 21 And at that point, I didn't even know what that was. My awareness of it was basically like a sign lit up on the window of the vape shop, which around here is the main place where you see it.

Speaker 21 And the vape shops are as common as check caching places. They're just.
everywhere. So my addict brain was like, on the one hand, oh, this is something to really avoid.

Speaker 21 And then on the other hand, something that I didn't really know about that was really obviously easy to get kind kind of piqued the curiosity there. Yeah.

Speaker 21 So did well with rehab and got back to work and was keeping clean off everything for about a month. Then started back up with smoking pot.

Speaker 21 And around that same time, I popped into the vape shop to get tobacco or weed related stuff and was like, I'm going to try some of these

Speaker 21 Kratoms.

Speaker 39 If Chris was trying to figure out what to expect from Kratom, the way it's sold makes that mission a little confusing.

Speaker 1 He saw it in a vape shop.

Speaker 32 It's also sold at convenience stores and gas stations.

Speaker 1 There's often a picture of kratom on the packaging, a gray-green herb, which suggests it's natural.

Speaker 1 It's also often sold near cannabis products, suggesting it's mood-altering, but maybe not that strong.

Speaker 37 Sometimes it's behind the counter.

Speaker 15 Sometimes it's in the aisles with the candy.

Speaker 27 If Chris was wondering, will this work?

Speaker 38 Is it safe?

Speaker 1 Is it more like a medicine or a drug?

Speaker 9 The cultural signaling around it was just messy.

Speaker 28 But he wanted to try it.

Speaker 4 So he bought some.

Speaker 21 So the way that I got it initially was in capsules, but it looks like an herb powder. And the capsules, they could be vitamin pills.
Or you can also get just like a powder or liquid form of it.

Speaker 21 And it's just really nasty, very bitter.

Speaker 21 What did the high of it feel like it's not very pervasive it doesn't get all over you like even like smoking cannabis or anything but main things that i noticed pain completely gone

Speaker 21 all the like body aches and all that stuff just not there at all nervous eating nervous all kinds of things that i deal with all the time were greatly lessened but honestly as soon as those beneficial things started showing up, it came right along with it where I noticed if I didn't take them for a while, I just felt crappy.

Speaker 43 And what did crappy feel like?

Speaker 21 Like emotionally low, really pissy, just like in a really bad mood. And then my pain would come back too.

Speaker 1 Kratom had briskly gone from a substance Chris is curious about, to a substance he felt was giving him a nice high, to a substance he was pretty sure was leaving him in withdrawal.

Speaker 45 So now he needed to make sure he was taking kratom often enough to stay ahead of that withdrawal feeling.

Speaker 14 So his consumption went up, which made him feel ashamed.

Speaker 45 The shame may have been compounded by the fact that some people just don't consider kratom to be a very classy drug, whatever that means.

Speaker 21 People that I worked with are cannabis people and they all thought that it was just completely lame. It would just be like, why in the world would anybody ever take that?

Speaker 21 when you can just smoke or things like that.

Speaker 21 So yeah, I started doing stuff like I would go to different shops because I was like, I don't want to run into my coworkers buying this stuff and stuff like that. I was just embarrassed about it.

Speaker 21 But I asked a guy at one of the shops. I was like, I usually get this stuff.
What's the best? What do people like to get?

Speaker 21 And he was like, this one guy gets this every week, just loves it, swears by it. And this was a smaller bottle of capsules again, but this was branded Tiana.

Speaker 21 And I didn't even look at the small print or anything. I just thought another kind of kratom, another brand of kratom.

Speaker 10 Yeah.

Speaker 21 But it was much more expensive. So whereas I had been taking like

Speaker 21 four kratom pills at a time, I got this stuff and I took two and I felt great. Pain was gone.

Speaker 21 Pretty good, kind of euphoric vibe, basically everything that the kratom had done, but just like a little bit more.

Speaker 38 Tiana, another substance sold in America's unofficial apothecaries, our smoke shops, our delis, our gas stations.

Speaker 9 Tiana gets its name from its featured ingredient, tianaptine.

Speaker 15 Chris thought this was another form of kratom.

Speaker 39 It is not.

Speaker 1 We'll get into what it actually is later.

Speaker 29 Whatever you're guessing, I think you're wrong.

Speaker 24 But for now, what Chris knew is that the substance he knew as Tiana seemed to do more for him than kratom had.

Speaker 32 Maybe too much more.

Speaker 24 Before he could figure out what was going on, Chris was having deeper withdrawal symptoms.

Speaker 1 He now had trouble sleeping without the pills and when he would fall asleep.

Speaker 21 I would wake up midway through the night,

Speaker 21 heavy night sweats, and have to take more of the pills before I could fall back to sleep again.

Speaker 21 In the morning, I would take them into the bathroom with me and take three or four every couple hours at work.

Speaker 31 It sounds a lot like an opioid.

Speaker 21 Yeah.

Speaker 21 I haven't taken opioids recreationally, but I just was recovering from a surgery and so i i've been on them recently yeah by the same way i i've taken them for an injury but never recreationally were you surprised to find yourself in such deep water with something that you could buy at a vape shop absolutely and the whole time i was really struggling with it because it was like

Speaker 21 i knew i was hooked on it and that i was having these adverse effects.

Speaker 21 And

Speaker 21 at the same time, I was like, it can't be that big of a deal. I'm struggling with something that everybody else would deal with very easily because it's just this casual vape store stuff.

Speaker 21 I feel embarrassed to try to get help about it. This is not like alcohol where everybody understands what a big problem it can be.

Speaker 49 Were you telling anybody that you were using it? Nope.

Speaker 1 It's such a lonely experience.

Speaker 20 I feel like when people have issues with substances, you're in a big community of people have those issues.

Speaker 19 But when you're having it with something that's like more relatively unknown, it sounds like it's just like even harder to chart.

Speaker 44 Yeah.

Speaker 21 I mean, I went into detox for this eventually at the same center that I've been to rehab for alcohol. And honestly, mostly found there that people knew just as little about it as anywhere.

Speaker 10 Oh, really? Yep.

Speaker 1 When you say people, do you mean like other patients?

Speaker 19 Do you mean practitioners? Like everybody was just like, I don't know.

Speaker 21 Everybody. Yeah.
Practitioners. The psychiatrist in charge of the place was doing research on it.

Speaker 33 That's such a crazy feeling to walk in.

Speaker 19 And they're like, you know, I'm going to need to Google this one.

Speaker 18 Yeah. It's nuts, man.

Speaker 21 It is. And so I was having really serious withdrawal symptoms.
And I would describe those to the doctor or the intake people or whatnot. And they were like, that sounds just like opioids.

Speaker 21 I had these body aches and joint pain and extreme anxiety and crawling skin.

Speaker 21 And yeah, it was at the same time hard to wrap my head around that it was even a real problem or that anybody was going to acknowledge it.

Speaker 21 And then also in my face, that it was definitely a big problem.

Speaker 19 So it's like you're trying to figure out if you're in the kiddie pool or drowning in the ocean.

Speaker 20 And like when you're having opiate style withdrawals at a detox center, you kind of have your answer.

Speaker 21 Yeah.

Speaker 44 How are you now?

Speaker 21 I'm I'm good. It's been like six months since I've taken any of those now.

Speaker 39 Congratulations.

Speaker 21 Thanks. I feel much healthier and happier.

Speaker 19 And for you, is the question just like essentially like, what was that?

Speaker 51 What was that drug?

Speaker 43 Is it an opioid?

Speaker 18 Yeah.

Speaker 21 I'm curious about specifically what is it? How's it made? How does it get here? And I just. I would like to know, are other people struggling with it?

Speaker 21 Are there government or law enforcement or regulatory agencies that are working on it?

Speaker 44 All right, let me find out what we can learn.

Speaker 18 Okay.

Speaker 2 So, I decided to try to answer Chris's question.

Speaker 41 And before we go further, I want to acknowledge that there are listeners out there who will not at all relate to the idea that someone would take a substance that they didn't know very much about that they bought from a guy at a vape shop.

Speaker 1 My mom, for instance, who listens to this show, is probably drafting a text right now asking me to promise her I would never do this.

Speaker 1 So to give a little explanatory context to this choice Chris made, the truth is that we are living through a strange moment in American drug culture.

Speaker 1 Today, more adults are smoking cannabis daily than drinking.

Speaker 28 You can buy ketamine on Instagram.

Speaker 40 You're seemingly not allowed to run a startup unless you're on ayahuasca.

Speaker 10 The old world is dying.

Speaker 39 A new one struggles to be born.

Speaker 9 And nowhere are things more confusing than at vape shops and gas stations.

Speaker 47 Here, at the stores we know are not pharmacies, many Americans now buy tobacco, weed, and this new other stuff.

Speaker 34 Stuff that gave Chris opioid-like withdrawals.

Speaker 32 I couldn't imagine a world where the U.S.

Speaker 31 government would let you buy opioids from the guy at the vape shop or the dude at the gas station.

Speaker 9 And if that world existed, I certainly could not imagine being able to see that world's upsides.

Speaker 18 After the break, we learned quite a bit.

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Speaker 54 Welcome back to the show.

Speaker 1 I really don't like asking questions when I suspect I already know their answers.

Speaker 9 And at first, this seemed like one of those instances.

Speaker 1 What I knew was a guy got hooked on a shady new substance from a vape shop, got hooked on another, and ended up in detox.

Speaker 1 It felt pretty obvious to me that this was a situation crying out for serious government intervention.

Speaker 32 Why would this be remotely okay?

Speaker 28 Then I'd learn a bit, then I'd learn a bit more, and I'd discover something pretty complicated, something that has fundamentally tweaked how I think about drug policy in America.

Speaker 41 But let's start at the beginning. The first place I looked to try to understand Kratom is a place I imagine Chris would have looked, online.

Speaker 19 The internet of 2024, we know, is a very decayed place, by which I mean reliable information about anything is pretty hard to find.

Speaker 19 You're trying to eat right in a world that's all just straight hot dogs. If you're old, like me, you now tend to go to Reddit for answers, which isn't great.

Speaker 55 If you're young, you go to TikTok, which doesn't seem much better.

Speaker 41 So,

Speaker 41 Kratom.

Speaker 1 If you want to find information that will tell you Kratom is safe, fun, and even useful, you will probably wind up at Reddit's board r/slash kratom, a community fervently behind this drug.

Speaker 1 On the sidebar, a basic Kratom introduction, facts about Kratom's evolving legality, academic studies on its use.

Speaker 36 When I visited one day in September, somebody was, typically, singing Kratom's praises.

Speaker 26 Quote, I can't believe how great it works for me.

Speaker 1 I don't care if I have to sometimes take tolerance breaks.

Speaker 52 I don't care if I become addicted.

Speaker 20 Life is objectively better with Kratom.

Speaker 1 It does what I've always wanted a drug to do.

Speaker 36 It lets me calm down, think rationally, be in a better mood, state of gratitude, you name it.

Speaker 18 ⁇ End quote.

Speaker 26 This is like how meditation people talk about silent retreats.

Speaker 1 On the other hand, if you're Kratom suspicious, there's an internet for you, too.

Speaker 41 On Reddit, you'll probably land on r slash kratom withdrawal, almost exclusively devoted to horror stories.

Speaker 38 Somebody says, quote, I've been a 30 gram per day user for about six months.

Speaker 26 I've lost half my hair.

Speaker 36 So depressing. I have gorgeous hair.

Speaker 15 Almost like this stuff is eating me from the inside out.

Speaker 17 And TikTok and YouTube as well have tons of videos of people speaking on the horrors of their kratom experiences.

Speaker 57 I was taking them all throughout the day. I would wake up first thing in the morning, immediately feel like crap because of the day before and need to take another one.

Speaker 58 I tried to wean myself off and I went into full-blown opiate withdrawals.

Speaker 18 I had horrible restless legs.

Speaker 21 Restless legs, hot cold flashes, chills, puking, extreme dizziness and nausea.

Speaker 61 I couldn't go to the bathroom, constipated.

Speaker 60 Super, super dry skin. I hated it.

Speaker 61 I hated how my body felt.

Speaker 60 Some depression.

Speaker 61 I just wanted it to end.

Speaker 59 Just stay away from Kratom. The withdrawals are hell.

Speaker 1 Had I been standing in a vape shop, phone in hand, browsing these two internets while contemplating my purchase of Kratom, I would have been confused.

Speaker 37 I would have had that familiar feeling of asking a question and in response, stepping not into an answer, but an argument, one that had been roiling for years I wanted to talk not to the internet but to a human being and so I called one first things first I just need you to introduce yourself can you say your name and what you do professionally sure yes hello my name is Oliver Grundman I'm a clinical professor and assistant dean at the College of Pharmacy University of Florida I'd done a lot of reading about Kratom since I'd spoken to our listener Chris and I kept running into references to and citations of Dr.

Speaker 45 Grundman's work. He's been studying kratom for nearly a decade.

Speaker 31 So just like brass tacks, what exactly is kratom?

Speaker 49 Yeah, some call it kratom, others call it kratom. What do you say? I say kratom because in its native Southeast Asia, it's called kratom.
So they put the emphasis on the last syllable.

Speaker 49 And I've studied it since 2016.

Speaker 19 I just want to say, nearly everyone I spoke to pronounced this differently, which is maybe just a comment on how early early we are in our understanding of this drug in America.

Speaker 19 For this story, I decided to just mirror the pronunciation of whoever I was speaking to, Kratom.

Speaker 49 So kratom is both the name of a tree that grows natively in Southeast Asia, in Malaysia, Thailand, Indonesia now, and also the actual product, kratom, like the leaves of the tree that are being used to prepare a number of different products that are now on the market in the US.

Speaker 49 Traditionally it has been used for at least the last 150 years, tracing it back to 1830 when it was first reported by a Dutch botanist who was traveling to Thailand and Malaysia and his name is Corsalis and Corsalis actually observed the plant being used, both the fresh leaves being chewed to give a stimulant effect, as well as the leaves being brewed into a tea, prepared into a tea, cooked for like two to three hours, the fresh leaves, and then that tea being consumed by indigenous folks, native folks in Southeast Asia.

Speaker 16 And so my understanding of kratom is that depending on the dose, it can either produce like stimulant effects or euphoric effects.

Speaker 27 Is that correct?

Speaker 49 Yeah, so the stimulant effect, some people describe it as when you get a little bit tipsy on alcohol in the beginning, you kind of get more sociable.

Speaker 49 So more of a kind of releasing, inhibition-releasing effect. Others describe it as the slight boost that they get in the morning from their cup of joe, so from caffeine or coffee.

Speaker 49 And then others sometimes compare it to a little bit stronger stimulant effect. So I think it depends on the individual who's consuming it.

Speaker 49 When we talk about euphoria, that is more related to its comparison with opioids.

Speaker 49 So the opioid-like euphoria you would get at much higher doses when you kind of pass the relaxing and sedative stages and go into the more analgesic and opioid-like effects.

Speaker 20 So, kratom, at a low dose feels like a stimulant, but at a higher dose feels euphoric, offers opioid-like effects.

Speaker 26 Opioid-like effects.

Speaker 63 Those three words, in a way, our entire story lives in those three words.

Speaker 37 And so I want to dive into them for a moment.

Speaker 46 Opiates are drugs derived from the poppy plant, heroin, heroin, morphine.

Speaker 38 When we talk about opioids, we're talking about drugs that mimic those effects in our body, but which are not necessarily derived from the poppy.

Speaker 15 Potent drugs like oxycontin, percocet, and vicodin are opioids.

Speaker 41 But technically speaking, we can call any drug that interacts with our opioid receptors an opioid.

Speaker 45 I ended up talking to Dr.

Speaker 34 Grunman about imodium, the diarrhea drug.

Speaker 37 I knew from our fentanyl episode that the same chemist had formulated both imodium and fentanyl, but I hadn't known that both those drugs are opioids.

Speaker 45 Dr.

Speaker 41 Grundman told me immodium is an opioid.

Speaker 53 Some opioid addicts use it to get high.

Speaker 38 Others have taken so much imodium they've actually overdosed and died.

Speaker 47 Kratom contains chemicals, alkaloids, which act on our opioid receptors, which means literally kratom is an opioid.

Speaker 13 And yet, people shy away from the term.

Speaker 48 You are not allowed, for instance, on the kratom subreddit, to use the O word.

Speaker 20 That's because nearly everyone associates opioids with drugs that are highly addictive and can kill you by stopping your breathing.

Speaker 17 Calling a drug an opioid is like hitting a big red button that summons a ton of cultural fear, as well as the presence of American regulators.

Speaker 48 Kratom leaves contain at least two different alkaloids that interact with our opioid receptors, metraginine and 7-hydroxymitraginine.

Speaker 34 7-hydroxymitraginine is very strong, more than 10 times more potent than morphine, but there's not very much of it in a kratom leaf.

Speaker 38 Mitraginine, which is much weaker, is responsible for most of the effect kratom users feel.

Speaker 36 And what is your understanding of like kratom is used in a specific way in America right now in sort of like,

Speaker 37 you know, the hundreds of years before today.

Speaker 13 What were the uses?

Speaker 41 What did people think kratom was for?

Speaker 49 Yeah, so there were a number of different uses for it.

Speaker 49 It has been used both as a slight stimulant by day laborers who use it primarily to water fatigue when they work in the hot sun and the tropical humid climates to continue working, but also for pain relief, for fever, for diarrhea by indigenous folks, specifically when it is prepared as a tea.

Speaker 49 Now with the opium traits that happened in the 18th century or 19th century, 1830s, 1840s, we saw a huge influx of opium from China as well as across the world, really.

Speaker 49 That's what the opium wars of the British colonizers was about in the 19th century.

Speaker 49 And whenever opium supplies were scarce in these areas of Malaysia and Thailand, people turned to kratom to use it as a harm reduction or as simply a substitute for opium.

Speaker 24 We're going to come back to this later, this idea of kratom leaves as a natural substitute for opiate users.

Speaker 23 But kratom's story in the United States, that begins much more recently.

Speaker 37 So recently that in 2016, Dr.

Speaker 46 Grundman, one of our foremost kratom experts, had never heard of the drug.

Speaker 63 What happened was that one of his students also worked in a South Florida crime lab, and the student had come across a case where a person was found intoxicated at the scene of a car accident.

Speaker 45 The cops found kratom on the guy.

Speaker 35 So the crime lab student comes into school and asks Dr.

Speaker 33 Grunman, what's kratom?

Speaker 45 Dr. Grundman didn't know.

Speaker 18 But Dr.

Speaker 45 Grundman had a background in naturally occurring substances that affect our minds.

Speaker 35 So he was excited to learn about a new one, this drug which had arrived in the U.S.

Speaker 55 from Southeast Asia.

Speaker 41 He decided to try to figure out how popular this new to him drug was, and so he designed a survey.

Speaker 35 And how were you conducting the survey?

Speaker 9 How were you finding the users?

Speaker 49 So at the time we had the American Cratrome Association, which still exists to this day.

Speaker 49 I think they have evolved over time from a relatively really user-driven and user-advocacy group to a little bit of a lobbying arm as well.

Speaker 49 But at the time, I reached out to them and asked, hey, would you be willing to just send out an email to your members to distribute this survey.

Speaker 49 So I didn't ask them for input on how to design the survey, but just to distribute it.

Speaker 49 And the first survey, I capped it at 10,000 responses, thinking that maybe I get 500 if I'm lucky in like two weeks or so. And within two weeks, I got 10,000 responses and I had to end the survey.

Speaker 49 So I would never have expected such a huge response rate. So that was the first survey that was published on Kratom use in the United States.

Speaker 1 The survey showed that people were using Kratom to treat a comically vast range of American maladies.

Speaker 9 Anxiety, depression, ADHD, PTSD, chronic pain. And not just that, kratom is a substitute for people trying to break their relationships to other drugs.

Speaker 53 To alcohol, to fentanyl, to heroin, to benzos like Xanax, stimulants like Adderall.

Speaker 38 Kratom was even being used by people who just wanted to wean themselves off antidepressants.

Speaker 45 Dr.

Speaker 56 Grundman's survey offered a peek at Kratom's quiet, behind-the-scenes role in America.

Speaker 16 A substance a lot of people self-medicate with because either they don't trust or can't access our traditional medical system.

Speaker 17 Acknowledging this is not the same as saying kratom is an effective remedy.

Speaker 16 That's actually been the question Dr.

Speaker 38 Grundman's work has investigated for almost a decade.

Speaker 17 But with this first survey, he knew that effective or not, safe or not, kratom had become popular.

Speaker 37 And at almost the exact same time that Dr.

Speaker 54 Grundman was sending out his first survey, a U.S.

Speaker 65 government agency was squinting at kratom.

Speaker 1 The Drug Enforcement Administration, the DEA, in America decides how much a potentially dangerous drug should be restricted.

Speaker 22 Whether you need a doctor's prescription to use it, like a prescription painkiller, or whether its use by citizens is completely illegal.

Speaker 17 In 2016, when the DEA looked at Kratom, they wanted to know, how addictive is it?

Speaker 52 How dangerous is it to the user and to the people around the user?

Speaker 34 And does it have a legitimate medical use?

Speaker 1 What did those internal deliberations sound like?

Speaker 10 It's unclear.

Speaker 40 The DEA did not respond to Search Engine's request for comment, but we can guess at what the agency thought by what it did next.

Speaker 60 The drug is called Kratom, and it comes in powder and pill forms. On Friday, the DEA is expected to make it illegal.
The DEA plans to make it a Schedule I drug as soon as tomorrow.

Speaker 60 That puts it in the same category as drugs like heroin, LSD, marijuana, and ecstasy. Federal authorities called the supplement an imminent hazard to public safety.
News Channel 5's Alyssa Hyman.

Speaker 1 All this hubbub, a surprise to Dr. Grundman, a researcher just trying to collect some survey data about a new substance he'd just learned of.

Speaker 49 I didn't know about it until after my survey, I think right around the time that my survey was published, and the FDA recommended to the DEA to place mitragynin and 7-hydroxymitraginin, which were known at the time, to act on opioid receptors, to place them into Schedule I, make them basically illegal, illegal, which would have prevented us as researchers, as academicians to conduct research on it, which has been a challenge for cannabis research for a very, very long time because it is very difficult to get a DA Schedule I license to begin with.

Speaker 49 So from that perspective, from the research perspective, we were concerned.

Speaker 1 Kratom researchers were concerned.

Speaker 24 Kratom users were incensed.

Speaker 12 Kreedom advocates have reacted with anger and fear to the federal ban on a natural analgesic product they say is safer than the painkillers legally prescribed by doctors.

Speaker 32 The pushback the government got here was pretty extraordinary.

Speaker 60 Kratom supporters are fighting to keep the plant-based substance from being banned last month.

Speaker 4 The drug enforcement administration

Speaker 60 nationwide who have signed this petition to stop the Drug Enforcement Administration from banning Kratom. The DEA.

Speaker 54 A petition saying broadly there are very few good options for opioid addicts, that this seemed to be helping some of them and that they didn't want it taken away.

Speaker 67 What's up y'all? Trey Crowder. This time I want to talk to y'all about something that's deeply personal to me.

Speaker 12 Pills.

Speaker 67 Yeah, pills are a big thing with us rednecks and I ain't talking about heart pills or the ones that keep the sugar from taking you to meet Jesus early.

Speaker 67 I mean we fucks with them too, but I'm talking about party pills at Hillbilly Heroin.

Speaker 18 This video particularly struck me from this YouTuber Trey Crowder, aka the liberal redneck.

Speaker 1 He's speaking from his porch in a sleeveless shirt over a chorus of cicadas.

Speaker 41 At first, I thought the video was a parody.

Speaker 25 Crowder's a comedian, but he quickly moves into this argument for kratom.

Speaker 31 At one point, he holds up a little green mason jar of kratom tea.

Speaker 67 It's a mild stimulant.

Speaker 67 It hits some of the same parts of your brain that opiates do, and so a lot of addicts have been using it to keep off of the hard shit, which does not sit well with the lizards at the farm companies.

Speaker 67 And so their lap dogs at the DEA have announced that as of September 30th, kratom will be banned in the U.S.

Speaker 67 This all-natural herb with hundreds of years of harmless human consumption behind it will be placed on the Schedule One alongside drugs like heroin and ecstasy. Sound familiar way, people?

Speaker 27 And the report that I don't have to tell you that there are a lot of trade crowders in America, people whose families have been ravaged by opioid addiction.

Speaker 13 Enough of them demanded the government back off here that the DEA actually flinched.

Speaker 68 51 federal lawmakers oppose a plan by the DEA to ban a drug that relieves pain and helps wean addicts off of opioids.

Speaker 60 The DEA is now backpedaling, seemingly second-guessing its widely criticized decision to ban something many say could help curb the nation's opioid abuse epidemic.

Speaker 3 Kratom is a plan.

Speaker 1 51 U.S.

Speaker 16 representatives, 22 of them Republicans, banded together and wrote a letter saying the DEA should do more research before scheduling this drug.

Speaker 63 They cited work by scientists, including one of Dr.

Speaker 49 Grunman's colleagues, and surprisingly, their argument really mirrored the liberal rednecks.

Speaker 17 They did not call the people who worked at pharma companies lizards, but they said the government should not hastily ban a drug that might help in any way with our massive overdose crisis.

Speaker 41 Because while kratom is an opioid, or if you prefer, exhibits opioid-like effects, overdoses from the drug are pretty rare.

Speaker 9 From 2011 to 2017, 13 users died.

Speaker 28 11 of them had other drugs in their system.

Speaker 47 During that same time, over 200,000 users of other opioids died.

Speaker 52 The kratom ban was to take effect in September 2016.

Speaker 54 Instead, that October, the DEA posts this very unusual letter into the Federal Register.

Speaker 54 It was titled, quote, Withdrawal of Notice of Intent to Temporarily Place Mitraginine and 7-Hydroxymitraginine into Schedule 1.

Speaker 38 Those are the two predominant psychoactive ingredients in kratom, both opioids.

Speaker 1 This letter is government speak for, my bad.

Speaker 1 As a person who studies drugs, how unusual is this for the DEA to back off of a decision like this?

Speaker 49 Yeah, I have not been involved with other drugs before that were at risk of being placed into Schedule I, but it doesn't happen very often that the DEA does not move forward with placing a drug into Schedule I.

Speaker 49 So this was certainly very surprising for a lot of people at the time.

Speaker 19 After 2016, when the DEA backed off, regulation of kratom was left to the FDA, the Food and Drug Administration. We asked the FDA if kratom was legal now to sell in in the United States.

Speaker 19 A spokesperson for that agency told Search Engine that kratom is not approved for any medical use, it is an unsafe food additive, and it is not appropriate in dietary supplements.

Speaker 19 Which is a very funny way of saying, yes, it is legal to sell in the United States. As long as you follow a few rules.

Speaker 19 In some states, the ingredients in your kratom product have to match the ingredients advertised, and technically, you're not supposed to make medical claims.

Speaker 19 A rule as respected in vape shops as horn honking laws are in New York City.

Speaker 19 The world these policies have created is one in which our listener, Chris, would walk into a store and see kratom sold in various forms and under various brand names.

Speaker 19 K-Shots, MIT45 Super K, Ohm's Advanced Kratom Alkaloids.

Speaker 19 Occasionally, the packaging is sedate, like painkillers you'd get at Rite Aid, but usually it's designed to look like illicit drugs, like Trucker Speed, or at least one brand I saw, packaged like a large bag of heroin with just the word train wreck written on it in marker font.

Speaker 19 The FDA pointed out to us that kratom is locally restricted or regulated in many states, which is totally true.

Speaker 19 But federally, there are no rules about how much kratom a person can buy, how old that person has to be, or rules placing limits on how strong kratom can be if it is going to be sold.

Speaker 19 It's funny. It's like for a moment, the federal government treated kratom as if it were too dangerous to tolerate, and then it treated it as something that it mostly just didn't want to think about.

Speaker 19 For someone like Chris, standing in the vape shop aisle, he could buy kratom, he could use it, but in a fundamental way, he would not know what he was taking.

Speaker 19 And the questions the government had said it wanted to answer, was the drug lethal?

Speaker 69 Was it addictive?

Speaker 32 Could it be useful?

Speaker 19 Those remained, for most people, open questions.

Speaker 41 I'm curious, like, as a substance, how addictive is kratom?

Speaker 13 What should I compare it to?

Speaker 49 Yeah, so that's a good question, because only in recent years have a few NIDA studies, National Institute on Drug Abuse studies under Kirsten Smith, who was a postdoc at NIDA and now is a faculty member at Johns Hopkins University, kind of elucidated to some degree what the symptoms of a potential kratom use disorder are.

Speaker 49 And when we look at the criteria for what constitutes dependence, tolerance, withdrawal, and some other behaviors, we really see kratom at the lower end of meeting these criteria. So

Speaker 49 what people primarily report is tolerance, meaning they increase their dose of kratom over time. And if they stop taking it, they get withdrawal symptoms.

Speaker 49 In general, these withdrawal symptoms are relatively mild for most people, maybe comparable to heavy caffeine use when you stop using it.

Speaker 1 So Dr.

Speaker 1 Grenman's research suggests that withdrawal from kratom looks like headaches, anxiety, and occasional GI distress, which basically sounds like my Monday, or like what Chris was experiencing before he started taking that other drug, TNMT.

Speaker 47 Of course, when anybody, me, you, the federal government, is evaluating the riskiness of a drug like kratom, they're not just asking how addictive is it, they're also asking, how easily can this thing kill you?

Speaker 49 Yeah, so it's interesting that we have this discussion today because just the other day, yesterday, literally, I was giving a presentation at the North American Congress on Clinical Toxicology on kratom together with a few other folks.

Speaker 49 And we are not yet sure how somebody can get to very high concentrations in their blood of mitraginin that would cause or would contribute to a fatality.

Speaker 1 In other words, Dr.

Speaker 27 Grundman says it's unclear how someone would take enough kratom to die from it.

Speaker 1 Nearly every compound has something called LD50, lethal dose 50, the dose at which half of the lab rats died after taking the substance.

Speaker 17 Alcohol has an LD50, so does salt, so does water.

Speaker 53 The LD50 for metraginine, the star alkaloid of kratom, is high enough that people should not be able to get that much into their blood by taking kratom any of the ways we know that they take kratom.

Speaker 1 And yet, there have been dozens of deaths in which the only substance found in the person's blood was high levels of metraginine.

Speaker 47 So this is kind of a mystery.

Speaker 45 One theory for what might be happening here is that in an unregulated gray market, kratom manufacturers are incentivized to make stronger and stronger formulations of the drug because there will be customers who want a stronger effect and there's no rules stopping them.

Speaker 37 So it's possible that the people who are dying of kratom overdoses are taking kratom capsules somehow formulated to give them a way higher potency opioid high than the norm.

Speaker 51 What's interesting here and quite sad is that kratom leaf has been used internationally for hundreds of years.

Speaker 7 But it appears that it's only when the drug reached America that we discovered how to make it, in some instances, lethal.

Speaker 49 With this evolution of the kratom market where we see extracts, concentrates, isolates emerging, that might be a driving force behind these lethal outcomes, which we have not seen in Southeast Asia with just chewing on the leaf or making that tea.

Speaker 49 So it's clear

Speaker 49 there is a strong suspicion that these

Speaker 49 high potency extracts and isolates are driving the lethality.

Speaker 19 It's funny.

Speaker 15 I mean, it's sort of, to me, what it reminds me of a little bit is the current gray market cannabis system we're in where people both like broadly speaking socially we've agreed that cannabis has social upsides and that its criminalization has real social downsides but because it's a bit of a patchwork people who are buying cannabis products can't entirely be sure that they I mean at least in the state in which I live like they don't necessarily know that they are buying what is being advertised and

Speaker 56 there's this market incentive for higher and higher and higher concentrations, which can be a really different drug experience.

Speaker 49 Yeah, I actually think that what is happening now in the car to market is exactly mirroring what is happening with cannabis, right?

Speaker 49 When we look a decade ago, we had THC concentrations that ranged from like maybe 5 to 12%, maybe 15% in high quality cannabis products. And now we have concentrates or edibles that contain 40% THC.

Speaker 49 So very different ballgame, very different amount that you can get into your body from sometimes ingesting ingesting much smaller amounts.

Speaker 25 So let's return to our listener, Chris.

Speaker 3 Here is part of what I think went wrong for him.

Speaker 65 The first time in your life you try a drug, whether it's your first cup of coffee or your first sip of wine, you probably have a conversation with somebody about what to expect.

Speaker 36 and what the risks are.

Speaker 38 Chris did not have as full a conversation about Kratom as he might have wished he'd had before before he dove in.

Speaker 17 But if he'd had that conversation, what we now know he might have learned is that kratom is an opioid, but it's not particularly lethal.

Speaker 11 It can give you withdrawal symptoms you won't enjoy, but nothing like what you'd get from a prescription painkiller.

Speaker 52 And something to watch out for is that it comes from the gray market, which means the drug itself might be adulterated, or it might be getting more potent month by month.

Speaker 3 So all of these risk calculations could be changing.

Speaker 41 Of course, Chris really got in trouble not with kratom, but with another drug he mistakenly thought was a kind of kratom, T-Neptine.

Speaker 17 And the story of T-Neptine, what it is, how it got here, and how much fault lies with the country of France, those answers surprised me.

Speaker 18 Mondieu!

Speaker 16 We will continue our story after a short break.

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Speaker 54 Welcome back to the show.

Speaker 16 So what does the internet have to say about TNEptine, the drug that Chris had found after Kratom, which had caused him his real problems?

Speaker 34 The vibe on Reddit in the TNF

Speaker 48 is much darker than it is in the Kratom subreddit.

Speaker 27 I saw someone asking the question many people have wondered after consuming some exciting new substance, quote, how many days in a row can I take this before I get addicted?

Speaker 52 The top voted reply, quote, I did research before I tried it, thinking I'd be able to control what many others couldn't.

Speaker 21 Nope.

Speaker 31 I was fully addicted after a couple of weeks.

Speaker 11 I ended my addiction at six to 10 bottles of TD Red a day.

Speaker 34 I spent $20,000.

Speaker 36 This is Reddit, of course.

Speaker 28 Anyone can say anything. They often do.

Speaker 39 But you do notice here many more vivid warnings than celebrations.

Speaker 9 Many addicted users cautioning new people from following them down the path.

Speaker 70 Okay, TNF team, gas station heroin. Let's talk about it.

Speaker 54 And it's similar over on TikTok.

Speaker 70 This shit right here is sold in gas stations. Can you believe that?

Speaker 60 What they're doing is they're selling it in gas stations and head shops under the name Tia, Red, or Zaza.

Speaker 70 A lot of times it's labeled as Zaza in the gas station.

Speaker 60 And people are becoming addicted to them.

Speaker 70 Zaza at the gas station, do not start taking this stuff. If you do, you will regret it.

Speaker 47 We're going to return to Dr.

Speaker 55 Oliver Grundman with more questions.

Speaker 19 But for T and Aptine, I wanted to start by speaking to a different kind of chemist, someone whose work I've been following for a long time.

Speaker 23 My name's Hamilton Morris. I am a chemist.
I have a podcast that's about

Speaker 23 chemistry and pharmacology on Patreon.

Speaker 23 I made a documentary series about psychoactive drugs called Hamilton's Pharmacopia for many years, which you can watch for free on my Vimeo channel or a lot of other places.

Speaker 23 And I'm generally very interested in the chemistry and pharmacology of psychoactive drugs.

Speaker 34 Dear listeners, I present to you Hamilton Morris.

Speaker 16 I've never spoken to him before, but I have listened to his hypnotically dry voice for maybe hundreds of hours.

Speaker 19 I've heard him use it to soberly and methodically describe what it's like to consume the venom of a psychedelic toad, to participate in an iboga ceremony, to observe a bunch of meth heads stumble through a meth cook in a kitchen while wearing, for some reason, firemen's helmets.

Speaker 53 He's seen a lot.

Speaker 19 TNEptine was obscure to me, but I had a suspicion it'd be old hat to Hamilton Morris.

Speaker 37 What is TNEptine?

Speaker 7 Like, what is its chemical composition? Where does it come from? What is it?

Speaker 23 Yeah, so TNF is an unusual substance. It's not chemically related to any of the botanical opioids or to fentanyl.
It's kind of its own chemical structural class.

Speaker 23 It's a tricyclic that is closer to a lot of antidepressants. And that is actually

Speaker 23 the area where it was developed. So there's a French pharmaceutical company called Servier

Speaker 23 that was exploring these tricyclic antidepressant type structures. And this pharmaceutical company, Servier, had a bad reputation already.

Speaker 23 They were the major supplier of fenfluramine in Europe, which is a very cardiotoxic and potentially neurotoxic diet drug.

Speaker 38 So, first of all, TNFD is not a naturally occurring substance like kratom is.

Speaker 14 It was synthesized by a company called Servier.

Speaker 35 Servier's bad reputation partly comes from their role in France as a major supplier of fenfluramine.

Speaker 38 half of the drug fenfen, the famously lethal diet drug.

Speaker 41 Servier, the company, was also convicted for deception and manslaughter manslaughter in French court over a different diet drug, which killed approximately 2,000 people.

Speaker 37 TNEptine's path to its current life as American gas station heroin, it starts with Servier.

Speaker 53 In the 1970s, Servier synthesized T-Neptine and sold it as an antidepressant called Stabilon.

Speaker 51 The drug made people feel euphoric in opioid-like ways, but for decades, the company insisted it was not an opioid.

Speaker 56 Into this swirling morass of uncertainty stepped Hamilton Morris.

Speaker 23 So the first time I tried TNFT was probably around the first time that I tried metragenine, probably around 2009. And I had to order a box of pharmaceutical Stablon tablets from France.

Speaker 23 And I had a kind of similar I just say, you're a mailman.

Speaker 23 These are both to this day legal and certainly legal then. No one had ever even heard of this stuff really outside of people who were really interested in this at that point.

Speaker 23 And it was a widely used antidepressant. And crucially, at that time, nobody knew that it was an opioid.
So I took it and I thought, wow, this stuff makes you feel pretty good. This is interesting.

Speaker 23 I get it. This is a great antidepressant.
I wonder. And so I followed TNF teen with interest after trying it.
And what I noticed was an increasing number of reports of people

Speaker 23 abusing it, using massive, massive quantities, taking hundreds of these 12.5 milligram tablets. And

Speaker 23 there were some posts on various forums and Reddit with people saying these things like, I used to use heroin and I swear that this stuff feels just like heroin to me. My pupils are pinpoints.

Speaker 23 I get this euphoric nodding effect. I really wonder if this stuff is an opioid.

Speaker 16 To be clear, some users suspected that this French drug was an opioid because they had taken opioids before, but no one in the general public or scientists knew the actual mechanism this drug was using to have its effect.

Speaker 28 If Servier knew, they weren't telling people.

Speaker 51 And so people were taking a drug that may have been an opioid, but the official story for how it was working on its users was different.

Speaker 23 The mechanism that was... considered the explanation for its effect was that it was a serotonin re-uptake enhancer.

Speaker 52 Not Not inhibitor.

Speaker 59 Oh, not inhibitor.

Speaker 23 Enhancer. I even wrote an article for Playboy years ago that described all of this.

Speaker 23 Like, gee whiz, isn't it strange that two drugs with diametrically opposed mechanisms, one that enhances serotonin reuptake and one that inhibits serotonin reuptake, are both antidepressants.

Speaker 23 The brain sure is weird, right? Right. So there was something about this that was paradoxical.
And then more and more people kept taking higher and higher doses.

Speaker 23 The evidence that it seemed to exert some kind of opioid-type effect was continuously accumulating.

Speaker 23 Then there was a medical case report of somebody that had overdosed on TNFT tablets, and their overdose was reversed with naloxone, Narcan, the opioid-blocking medication.

Speaker 6 A strong indicator that this is an opioid.

Speaker 23 Yeah, yeah. So this was a kind of like, isn't that odd that this serotonin reuptake enhancer is blocked by an opioid blocker?

Speaker 18 Huh.

Speaker 23 Yeah. Like, what's the deal with that? So it was pretty clear that there was something going on, but no one had firmly established it.

Speaker 6 Finally, in 2017, a student at Columbia University figured out how to solve this chemical mystery.

Speaker 62 Hamilton told me that the student sent a sample of T-Neptine to UNC Chapel Hill, which has something called the Psychoactive Drug Screening Program.

Speaker 63 Chemists there can take a drug, expose it to cloned human or rodent central nervous system receptors, and actually tell you when this drug is put in your body, here are the receptors that it acts on.

Speaker 36 Since we know that we define an opioid not by its chemical structure, but by whether or not it interacts with our opioid receptors, this would be the definitive test to prove if TNAptine was in fact an opioid.

Speaker 23 And the answer was kind of the obvious answer that everybody expected, which is that it was a full agonist at the mu opioid receptor.

Speaker 63 A full agonist at the mu opioid receptor.

Speaker 16 A full agonist is a substance that binds to a receptor and fully activates it.

Speaker 50 Other full agonists at the mu opioid receptor, oxycontin, heroin.

Speaker 19 This drug was not as potent as them, but it was an opioid by anybody's definition. Some untold number of people had been taking an opioid without ever knowing it.

Speaker 37 And we know how we feel about opioids in this country.

Speaker 19 They are highly addictive substances that often kill their users.

Speaker 32 But the strange thing about T-Neptine, an opioid, is that while it does seem to be a quite addictive substance, it doesn't seem to be as lethal as other drugs in its class.

Speaker 23 For reasons that aren't fully understood, there are opioids that don't cause profound respiratory depression, relatively speaking. And for that reason, they...

Speaker 23 don't tend to cause fatal overdoses because that's the mechanism through which opioids exert their effect in terms of killing people is respiratory arrest.

Speaker 32 Few Americans' lives would be improved by the addition of an addictive opioid.

Speaker 65 But the question you'd hope the federal government might look into is whether those Americans who are already addicted to a lethal opioid might benefit from a less lethal one.

Speaker 38 I asked Hamilton about this.

Speaker 41 TNEPTEN relative to heroin, if somebody were recreationally deciding

Speaker 15 for instance, like stop using heroin, TNEptine might be a good option for that person because they'd be replacing something that gave them a high that they found that they wanted or needed with one that would be less likely to kill them in an overdose.

Speaker 23 That would be my guess. Yeah.
I mean, I wouldn't want to make that claim. I wouldn't, you know, say, hey, if you're struggling with opioid dependence issues, transition onto TNEptine.

Speaker 23 That's not something that I'm saying. But conceivably, that would work.

Speaker 23 And that's also one of the things that Kratom is very popular for is

Speaker 23 getting off of opioids. Because when it comes to our methodology for treating opioid addiction in the United States, pretty much the name of the game is simply replacement therapy.
That's it.

Speaker 23 You know, if you go to a doctor and you say, I have a problem using heroin, they'll give you methadone or they'll give you buprenorphine, both of which are opioids.

Speaker 23 And the idea is just here is a safe, regular supply of an opioid that you can take every day that is considered to have a slightly lower abuse potential. But that's pretty much it.

Speaker 19 To me, what's interesting, and tell me if this analogy feels facile to you.

Speaker 19 It's like one way you could understand T-Neptine is that it's almost similar to nicotine vaping, where the idea with nicotine vaping was, okay, for people who are addicted to cigarettes, this can be an off-ramp from cigarettes.

Speaker 19 But what also happened is that there were a lot of people who didn't smoke cigarettes and nicotine vaping was an on-ramp.

Speaker 32 Like instead of getting them off a drug to something less dangerous, it got them onto a drug.

Speaker 19 Like, is it possible that T-Neptine could work the same way?

Speaker 23 Oh, certainly. Yeah.
I think that's very much a possibility. One really important distinction that I want to make is that I think there is a huge difference between

Speaker 23 giving someone an opioid that they recognize is an opioid and providing something deceptively where they don't know what they are consuming. That is

Speaker 23 unacceptable. And unfortunately, it is incentivized by the existing legal framework.
So, if you were to say, hey, this is an opioid and it has this or that risks associated with its use, and

Speaker 23 you should use it in the following way, that would potentially make it impossible to sell.

Speaker 28 Hamilton is pointing to a pretty extraordinary contradiction here, a policy problem I don't know how you'd begin to fix.

Speaker 1 Obviously, consumers should know what drugs they're taking. They should know that kratom is a partial opioid agonist, that TNPTIN is a full one.

Speaker 43 Ideally, the government would regulate the concentration and purity of these opioids.

Speaker 26 And yet, if everyone widely understood these drugs were opioids, it's very hard to imagine that they wouldn't be outright prohibited or severely restricted.

Speaker 69 Our listener, Chris, had wanted to know if other people were struggling with these drugs and if the government was going to do anything about it.

Speaker 6 Some people are struggling with these drugs, others say they're being helped by them.

Speaker 51 There are people who are addicted to more dangerous opioids who appreciate a less lethal substitute.

Speaker 24 That's the problem I don't know how to fix.

Speaker 1 Dr.

Speaker 24 Grundman seemed to think that T-Neptine will likely end up as a prescription-only drug in America, just like in France.

Speaker 37 But kratom is tricky.

Speaker 1 There are people who feel that kratom is a medicine for them, a medicine that today they can access without having to rely on a healthcare system that may have gotten them addicted to lethal opioids in the first place.

Speaker 40 Looking at the situation, it's hard not to wish that we had some other tool, some way to get these complicated substances to the people they'd help, some option beyond prohibition, prescription, or vape store free-for-all.

Speaker 19 I asked Dr. Grunman if he had any bright ideas.

Speaker 20 If you had to guess, like,

Speaker 35 given the research we have right now,

Speaker 51 I feel like

Speaker 16 a reasonable thing to say is that the best way to distribute these drugs is not in unknown quantities from unknown manufacturer at gas stations.

Speaker 40 What

Speaker 3 would,

Speaker 15 not thinking about the political realities of life in America, but given how people use them and what we know about their risks and benefits, what would be the best way for these drugs to be distributed based on the available information?

Speaker 49 Yeah. So I like the way you phrased that because it wouldn't fit in the current regulatory scheme or how this would ever be realized.

Speaker 49 But if you look, for example, at some of the Ephedrin, pseudoephredrin products that were kind of pulled from the market in regards to just being over-the-counter.

Speaker 49 So you could just buy them from a pharmacy without any questions being asked, because we know that Plutoephedrin, Ephedrin, and alike products are being used in the manufacture of methamphetamine.

Speaker 49 And instead, they are now behind the counter, and you can get a certain amount without requiring a prescription, but you still need to present some form of identification that has been done in all US states by now.

Speaker 49 So, I think that Kratom and or Tia Neptin would qualify for something like that, because then you need to interact with a pharmacist or a pharmacy technician that can ask you, do you have any underlying health conditions?

Speaker 49 Do you have a prior substance use disorder? To kind of provide a little bit of counseling and a little bit of information and actually utilizing the pharmacist.

Speaker 49 I realize I'm advertising for pharmacists here because I'm with the College of Pharmacy and not just being pill counters, because to be honest, pharmacists are a lot more and they can provide a lot more.

Speaker 49 And they remain the most accessible healthcare professionals out there. If you want to go to a doctor, you need to make an appointment.

Speaker 49 If you need some help with figuring out is this medication safe to take or is this substance safe to take, you can go into a pharmacy and there will be a pharmacist.

Speaker 9 Is that how it works in Europe?

Speaker 49 So I grew up in Germany and I trained as a pharmacist there.

Speaker 49 Yes, we don't necessarily have over-the-counter, although some medications are now available Tylenol or so, that you can buy in small amounts, small packages in a grocery store.

Speaker 49 But most of even what is considered over-the-counter here in the US is behind the counter.

Speaker 49 So, either a pharmacy technician or a pharmacist needs to grab it at least and put it on the counter for you in order for you to purchase it.

Speaker 49 In addition to that, we have certain supplements that are considered supplements here, St.

Speaker 49 Johnsword, Ginkgo, that you can actually get as a prescription from your doctor, and it is paid by your insurance, by your health insurance.

Speaker 49 So we do have a different system where we value more the expertise of pharmacists beyond their ability to count pills.

Speaker 9 Sometimes you ask a question and you get actually a pretty good answer.

Speaker 1 Empowering pharmacists to do more than we currently ask of them does not seem like a bad solution, even if for now it does seem like, at least in America, an unlikely one.

Speaker 31 Oliver, thank you so much.

Speaker 16 I feel like I understand this much better than I did before we started talking.

Speaker 49 Certainly my pleasure.

Speaker 39 Dr.

Speaker 19 Oliver Grundman, clinical professor at the University of Florida College of Pharmacy and president of the American College of Clinical Pharmacology.

Speaker 9 Search Engine is a presentation of Odyssey and Jigsaw Productions. It was created by me, BJ Vote, and Truthy Pinamanani, and is produced by Garrett Graham and Noah John.

Speaker 9 Fact-Checking this week by Holly Patton. Theme, original composition, and mixing by Armin Bazarian.

Speaker 43 Our executive producers are Jenna Weiss-Berman and Leah Reese-Dennis.

Speaker 9 Thank you to the team at Jigsaw, Alex Gibney, Rich Perello, and John Schmidt. And to the team at Odyssey, J.D.

Speaker 6 Crowley, Rob Morandi, Craig Cox, Eric Donnelly, Kate Rose, Matt Casey, Maura Curran, Josephina Francis, Kurt Courtney, and Hilary Schaff.

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