Search Engine - The Mystery of the Vape Shop Kratom

Episode Date: October 4, 2024

This week we have for you ... not a whodunnit, but a what did I do? A listener tries a substance he doesn’t know much about and not long after, his life begins to change. Afterwards, he wonders — what was that, and why was it so easy to get? Search Engine investigates.  Support the show over at searchengine.show! To learn more about listener data and our privacy practices visit: https://www.audacyinc.com/privacy-policy Learn more about your ad choices. Visit https://podcastchoices.com/adchoices

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A few weeks ago, I talked to a search engine listener with a question. At the time, I wasn't sure whether he'd want to be anonymous or not. Okay. 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? Yeah, I'm Chris Glenn. I go by Chris, but, you know, I don't, I hadn't really thought about any kind of like anonymity idea or anything like that. Do you want any anonymity? If you want it, we can offer it. If you don't care, we don't need to.

I decided basically I don't care. I would be happy to have my name attached to anything I say. It's fine. The reason I was being a little cautious here was that Chris had written to us about an experience he'd had with addiction. Addiction to a kind of drug that neither of us was sure you were even supposed to call a drug.

It was hard to know how to talk about any of this. 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. So you wrote us an email, and all the emails go to my phone and I read them all, but yours I read quicker than most because it had the word. It's pronounced cratum, right? I really don't know. I've heard cratum with a long A.

You hear cratim. You've heard more cratim than cratim. Yeah. All right, let's proceed with cratum. It had the word cratum in the subject, which piqued my interest because we have been talking about cratum for like a year in the office. Okay. Can you just like tell me the story of like how cratum crossed your radar? Yeah, absolutely.

So I over the years have had struggles with addiction of various kinds, mostly alcohol. 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 an outpatient rehab program. 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, I'm the same way. There's a word for that in recovery circles. It's like a garbage head. Yep. 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. Yes, I've heard that as well. So Chris in rehab was talking about how he was struggling to quit cannabis. And this other guy mentioned that he had also had a bit of a problem with something called Kratum. 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. Yeah. Which around here is the main place where you're,

see it and the vape shops are as common as check cashing places. They're just everywhere. So my addict's brain was like on the one hand, oh, this is something to really avoid. And then on the other hand, something that I didn't really know about that was really obviously easy to get. Kind of piqued the curiosity there. Yeah. 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, 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 cratoms. If Chris was trying to figure out what to expect from cratim, the way it's sold makes that mission a little confusing. He saw it in a vape shop. It's also sold at convenience

stores and gas stations. There's often a picture of cratum on the packaging, a gray-green herb, which suggests it's natural. It's also often sold near cannabis products, suggesting it's mood altering, but maybe not that strong. Sometimes it's behind the counter, sometimes it's in the aisles with the candy. If Chris was wondering, will this work? Is it safe? Is it more like a medicine or a drug? The cultural signaling around it was just messy. But he wanted to try it. So he wanted to try it. So he about some. 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. And it's just really nasty, very bitter. 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. All the 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. And what did crappy feel like? Like emotionally low, really pissy, just like in a really bad mood,

and then my pain would come back too. 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. So now he needed to make sure he was taking Kratum often enough to stay ahead of that withdrawal feeling. So his consumption went up, which made him feel ashamed. 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? 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 when you can just smoke or things like that? 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. 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? 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. And I didn't even look at the small print or anything. I just thought another kind of crate them, another brand to create them. Yeah. But it was much more expensive. So whereas I had been taking like four Kratum pills at a time, I got this stuff and I took two and I felt great. Pain was gone, pretty good, kind of euphoric vibe, basically everything that the Kratum had done, but just like a little bit more. Tiana, another substance sold in America's unofficial apothecaries, or smoke shop, our delis, our gas stations.

Tiana gets its name from its featured ingredient, TNaptine. Chris thought this was another form of Kratum. It is not. We'll get into what it actually is later. Whatever you're guessing, I think you're wrong. But for now, what Chris knew is that the substance he knew as Tiana seemed to do more for him than Kratum had, maybe too much more. Before he could figure out what was going on,

Chris was having deeper withdrawal symptoms. He now had trouble sleeping without the pills, and when he would fall asleep. I would wake up midway through the night, heavy night sweats and have to take more of the pills before I could fall back to sleep again. In the morning, I would take them into the bathroom with me and take three or four every couple hours at work.

It sounds a lot like an opioid. Yeah. I haven't taken opioids recreationally, but I just was recording from a surgery, and so I've been on them recently. Yeah. I have the same way 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 I knew I was hooked on it and that I was having these adverse effects. And 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. 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. Were you telling anybody that you were using it?

Nope. It's such a lonely experience. I feel like when people have issues with substances, you're in a big community. People have those issues. But when you're having it with something that's like more relative. unknown, it sounds like it's just like even harder to chart. Yeah, 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. Oh, really? Yep. When you say people,

do you mean like other patients? Do you mean practitioners? Like everybody was just like, I don't know? Everybody, yeah. Practitioners, the psychiatrist in charge of the place, was doing research on it. That's such a crazy feeling to walk in. And they're like, you know, I'm going to need to Google this one. Yeah. It's nuts, man. 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. I had these body aches and joint pain and extreme anxiety and crawling skin. 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 and then also in my face that it was definitely a big problem. It's like you're trying to figure out if you're in the kitty pool or drowning in the ocean. And like when you're having opiate style

withdrawals at a detox center, you kind of have your answer. Yeah. How are you now? I'm good. It's like six months since I've taken any of those now. Congratulations. Thanks. I feel much healthier and happier. And for you as a question, just like essentially like, what was that? What was that drug? Is it an opioid?

Yeah. 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? Are there government or law enforcement or regulatory agencies that are working on it? All right, let me find out what we can learn. Okay.

So I decided to try to answer Chris's question. 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. 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. 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. Today, more adults are smoking cannabis daily than drinking. You can buy ketamine

on Instagram. You're seemingly not allowed to run a startup unless you're on ayahuasca. The old world is dying, a new one struggles to be born, and nowhere are things more confusing than at vape shops and gas stations. Here, at the stores we know are not pharmacies, many Americans now buy tobacco, weed, and this new other stuff. Stuff that gave Chris opioid-like withdrawals. I couldn't imagine a world where the U.S. government would let you buy opioids from the guy at the vape shop

or the dude at the gas station. And if that world existed, I certainly could not imagine being able to see that world's upsides. After the break, we learn quite a bit. This episode of Search Engine is brought to you in part by Vanguard. To all the financial advisors out there whose job is to help your clients keep more of what they earn, Vanguard is here to help you with that. Vanguard is slashing fees again, this time for more than 50 of its funds.

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Welcome back to the show. I really don't like asking questions when I suspect I already know their answers. And at first, this seemed like one of those instances. 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. It felt pretty obvious to me that this was a situation crying out for serious government intervention. Why would this be remotely okay? Then I'd learn a bit. Then I'd learn a bit more.

and I discover something pretty complicated, something that has fundamentally tweaked how I think about drug policy in America. But let's start at the beginning. The first place I looked to try to understand a cratum is a place I imagine Chris would have looked, online. The internet of 2024, we know, is a very decayed place, by which I mean reliable information about anything

is pretty hard to find. You're trying to eat right in a world that's all just street hot dogs. If you're old, like me, you now tend to go to Reddit for answers. which isn't great. If you're young, you go to TikTok, which doesn't seem much better. So, Kratem. 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. On the sidebar, a basic Kratom introduction, facts about Kratom's evolving legality, academic studies on its use.

When I visited one day in September, somebody was, typically, singing Kratom's praises, quote, I can't believe how great it works for me. I don't care if I have to sometimes take tolerance breaks. I don't care if I become addicted. Life is objectively better with Kratom. It does what I've always wanted a drug to do. It lets me calm down, think rationally,

be in a better mood, state of gratitude, you name it. End quote. This is like how meditation people talk about silent retreats. On the other hand, if you're Kratom suspicious, there's an internet for you, too. On Reddit, you'll probably land on R slash cratim withdrawal, almost exclusively devoted to horror stories. Somebody says, quote,

I've been a 30 gram per day user for about six months. I've lost half my hair. So depressing. I had gorgeous hair, almost like this stuff is eating me from the inside out. And TikTok and YouTube as well have tons of videos of people speaking on the horrors of their creative experiences. I was taking them all throughout the day. I would wake up first day in the morning immediately feel like crap because of the day before

and need to take another one. I tried to wean myself off and I went into full-blown opiate withdrawals. I had horrible restless legs. Restless legs, hot, cold flashes. Chills, puking. Extreme dizziness and nausea. I couldn't go to the bathroom, constipated. Super, super dry skin.

I hated it. I hated how my body felt. Some depression. I just wanted it to end. Just stay away from cradom. The withdrawals are hell. Had I been standing in a vape shop, phone in hand, browsing these two internets while contemplating my purchase of Kratum,

I would have been confused. 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 Grunman. 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. Grunman's work. He's been studying Kratum for nearly a decade. So just like brass tacks, what exactly is Kratum? Yeah, some tall at Kratum, others call it Kratum. 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 syllabi. And I've studied it since 2016.

I just want to say nearly everyone I spoke to pronounced this differently, which is maybe just a comment on how early we are in our understanding of this drug in America. For this story, I decided to just mirror the pronunciation of whoever I was speaking to, cratom. So Kratom is a... 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. 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 Corthales. And Corthales 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. And so my understanding of Kratom is that depending on the dose, it can either produce like stimulant effects or euphoric effects. Is that correct? 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, so more of a kind of releasing, inhibition releasing effect. Others describe it as the slight boost that they get in the morning from the

cup of Joe, so from caffeine or coffee. 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. When we talk about euphoria, that is more related to its comparison with opioids. 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. So, cratum, at a low dose feels like a stimulant, but at a higher dose feels you offers opioid-like effects. Opioid-like effects.

Those three words, in a way, our entire story lives in those three words. And so I want to dive into them for a moment. Opiates are drugs derived from the poppy plant, heroin, morphine. 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. Potent drugs like Oxycontin, percocet, and Vicodin are opioid. But technically speaking, we can call any drug that interacts with our opioid receptors an opioid. I ended up talking to Dr. Grunman about emodium, the diarrhea drug.

I knew from our fentanyl episode that the same chemist had formulated both emodium and fentanyl, but I hadn't known that both those drugs are opioids. Dr. Grunman told me, emodium is an opioid. Some opioid addicts use it to get high. Others have taken so much emodium they've actually overdosed and died. Kratum contains chemicals, alkaloids, which act on our opioid receptors, which means literally Kratum is an opioid. And yet, people shy away from the term.

You are not allowed, for instance, on the Kratum subreddit, to use the O word. That's because nearly everyone associates opioids with drugs that are highly addictive and can kill you by stopping your breathing. Calling a drug and opioid is like hitting a big red button that summons a ton of cultural fear, as well as the presence of American regulators. Kratum leaves contain at least two different alkaloids that interact with their opioid receptors. Metrogenin and 7-hydroxy-metrogenin.

Seven-hydroxy metraginine is very strong, more than 10 times more potent than morphine, but there's not very much of it in a cradum leaf. Metragenin, which is much weaker, is responsible for most of the effect cradam users feel. And what is your understanding of, like, Cradham is used in a specific way in America right now, in sort of like, you know, the hundreds of years before today, what were the uses? What did people think Cradom was for? Yeah, so there were a number of different uses for it that 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. 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. That's what the opium wars of the British colonizers was about in the 19th century. And whenever opium supplies were scars in these areas of Malaysia and Thailand, people turn to Kratom to use it as a harm reduction or as simply a substitute for opium. We're going to come back to this later, this idea of Kratom leaves as a natural substitute for opiate users. But Kratom's story in the United States, that begins much. more recently, so recently that in 2016, Dr. Grunman, one of our foremost Cradham experts,

had never heard of the drug. 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. The cops found cradam on the guy. So the crime lab student comes into school and asks Dr. Grunman, what's cratum? Dr. Grunman didn't know. But Dr. Grunman had a background in naturally occurring substances that affect our minds, so he was excited to learn about a new one, this drug which had arrived in the U.S. from Southeast Asia. He decided to try to figure out how popular this new to him drug was, until he designed a survey. And how were you conducting the survey? How are you finding the users?

So at the time we had the American Quadrum Association, which still exists to this day. 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. 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? So I didn't ask them for input on how to design the survey, but just to distribute it. 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. 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.

The survey showed that people were using Kratom to treat a comically vast range of American malady. anxiety, depression, ADHD, chronic pain. And not just that, Cradham is a substitute for people trying to break their relationships to other drugs. To alcohol, to fentanyl, to heroin, to benzos like Xanax, stimulants like Adderall. Cradom was even being used by people who just wanted to wean themselves off antidepressants.

Dr. Grunman's survey offered a peek at Cradham's quiet, behind-the-scenes role in America. A substance a lot of people self-medicate with, because either they don't trust or can't access our traditional medical system. Acknowledging this is not the same as saying cratum is an effective remedy. That's actually been the question Dr. Grunman's work has investigated for almost a decade. But with this first survey, he knew that effective or not, safe or not, cradom had become popular.

And at almost the exact same time that Dr. Grunman was sending out his first survey, a U.S. government agency was squinting at a... cratom. The Drug Enforcement Administration, the DEA, in America, decides how much a potentially dangerous drug should be restricted. Whether you need a doctor's prescription to use it, like a prescription painkiller, or whether it's used by citizens is completely illegal. In 2016, when the DEA looked at cratum, they wanted to know how addictive is it, how dangerous is it to the user and to the people around the user, and does it have a legitimate medical use? What did those internal deliberations sound like?

It's unclear that DEA did not respond to search engines' request for comment. But we can guess at what the agency thought by what it did next. The drug is called Kratum, and it comes in powder and pill forms. On Friday, the DEA is expected to make it illegal. And the DEA plans to make it a Schedule One drug as soon as tomorrow. 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 is Alyssa Hyman.

All this hubbub surprised to Dr. Grunman, a researcher just trying to collect some survey data about a new substance he'd just learned of. 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 hydroxymetrogynin, which were known at the time, to act on opioid receptors to place them into Schedule 1, make them basically 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 DEA Schedule 1 license to begin with. So from that perspective, from the research perspective, we were concerned. Cradam researchers were concerned. Cradam users were incensed.

We are cradim 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. The pushback the government got here was pretty extraordinary. Kratum supporters are fighting to keep the plant-based substance from being banned last month. The drug enforcement administration... There's 130,000 people nationwide who have signed this petition to stop the drug enforcement administration from banning Kratum. The DEA... 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.

What's up, y'all? Trey Crowder. This time I want to talk to y'all about something that's deeply personal to me. Pills. 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, this early. I mean, we fucks with them too, but I'm talking about party pills at Hillbilly heroin. This video particularly struck me from this YouTuber Trey Crowder, aka the liberal redneck. He's speaking from his porch in a sleeveless shirt over a chorus of cicadas. At first I thought

the video was a parody, Crowder's a comedian, but he quickly moves into this argument for Cradham. At one point, he holds up a little green mason jar of Cradham tea. It's a mild stimulant. It's 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. And so their lapdogs at the DEA have announced it as of September 30th Cradon will be banned in the U.S. This all-natural herb with hundreds of years of harmless human consumption behind it will be placed on the Schedule 1 alongside drugs like heroin and ecstasy. Sound familiar with people? And the report...

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. Enough of them demanded the government back. back off here, that the DEA actually flinched. 51 federal lawmakers oppose a plan by the DEA to ban a drug that relieves pain and helps wean addicts off of opioids. But 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. 51 U.S. representatives, 22 of them Republicans, banned together and wrote a letter saying

the DEA should do more research before scheduling this drug. They cited work by scientists, including one of Dr. Grunnaman's colleagues, and surprisingly, their argument really mirrored the liberal rednecks. 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. Because while Cradham is an opioid, or if you prefer, exhibits opioid-like effects, overdoses from the drug are pretty rare.

From 2011 to 2017, 13 users died. 11 of them had other drugs in their system. During that same time, over 200,000 users of other opioids died. The crad and ban was to take effect in September 2016. Instead, that October, the DEA posts this very unusual letter into the Federal Register. It was titled, quote, withdrawal of notice of intent to temporarily place metragene and seven hydroxymatrogenine into Schedule 1. Those are the two predominant psychoactive ingredients in Cradam, both opioids.

This letter is government speak for, my bad. As a person who studies drugs, how unusual is this for the DA to back off of a decision like this? Yeah, I have not been involved with other drugs before that were at risk of being placed into Schedule 1, but it doesn't happen very often that the DA does not move forward with placing a drug. into Schedule one. So this was certainly very surprising for a lot of people at the time. 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 the United States. 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. 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. In some states, the ingredients in your cratum product have to match the ingredients advertised, and technically you're not supposed to make medical claims, a rule as respected in vape shops as horn-hawking laws are in New York City. The world these policies have created is one in which our listener Chris would walk into a store and see cratom sold in various forms and under various brand names.

K-shots, MIT-45 Super K, Oams advanced cradam alkaloids. Occasionally, the packaging is sedate, like painkillers you'd get it right 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. The FDA pointed out to us that cradom is locally restricted or regulated in many states, which is totally true. but federally, there are no rules about how much cratim a person can buy, how old that person has to be,

or rules placing limits on how strong cratim can be if it is going to be sold. It's funny. It's like for a moment the federal government treated cradom 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. For someone like Chris, standing in the vape shop bile, he could buy cradam, he could use it, but in a fundamental way, he would not know what he was taking. And the questions the government had said it wanted to answer, was the drug lethal, was it addictive, could it be useful?

Those remained, for most people, open questions. I'm curious, like, as a substance, how addictive is Cradum? What should I compare it to? 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 as a faculty member at Johns Hopkins University, kind of elucidated to some degree what the symptoms of a potential Kratom used disorder are.

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 interesting. What people primarily report is tolerance, meaning they increase the dose of cratum over time. And if they stop taking it, they get withdrawal symptoms. In general, these withdrawal symptoms are relatively mild for most people, maybe comparable to heavy caffeine use when you stop using it. So Dr. Grunman's research suggests that withdrawal from cratom 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, TNMpteen. Of course, when anybody, me, you, the federal government, is evaluating the riskiness of a drug like Cradam, they're not just asking how addictive is it. They're also asking, how easily can this thing kill you? 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 Toxic College. on Kratom, together with a few other folks. And we are not yet sure how somebody can get to very high concentrations in their blood of Mitragynin that would cause or would contribute to a fatality. In other words, Dr. Gronman says it's unclear how someone would take enough Kratom to die from it. Nearly every compound has something called LD-50, lethal dose 50, the dose at which half of the

labrettes died after taking the substance. Alcohol has an LD-50, so does salt, so does water. The LD-50 for metrageny, the star alkaloid of cratum, is high enough that people should not be able to get that much into their blood by taking cratum any of the ways we know that they take cratom. And yet, there have been dozens of deaths in which the only substance found in the only substance found in the person's blood was high levels of metragone. So this is kind of a mystery.

One theory for what might be happening here is that in an unregulated gray market, cradam 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 rule stopping them. So it's possible that the people who are dying of cradom overdoses are taking cradum capsules somehow formulated to give them a way higher potency opioid high than the norm. What's interesting here, and quite sad, is that cratum leaf has been used internationally for hundreds of years, but it appears that it's only when the drug reached America that we discovered how to make it, in some instances, lethal. With this evolution of the crato 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. So it's clear there is a strong suspicion that these high potency extracts and isolates are driving the lethality. It's funny, 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 there's this market incentive for higher and higher and higher concentrations, which can be a really different drug experience. Yeah, I actually think that what is happening now in the Crato market is exactly mirroring

what is happening with cannabis, right? When we look a decade ago, we had THC concentrations that range from like maybe 5 to 12%, maybe 15% in high-quality cannabis products. And now we have concentrates or edibles that contain 40% THC. So very different ballgame, very different amount that. that you can get into your body from sometimes ingesting much smaller amounts. So let's return to our listener Chris. Here is part of what I think went wrong for him.

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 and what the risks are. Chris did not have as full a conversation about Kratom as he might have wished he'd had before he dove in. But if he'd had that conversation, What we now know he might have learned is that

Cradam is an opioid, but it's not particularly lethal. It can give you withdrawal symptoms you won't enjoy, but nothing like what you'd get from a prescription painkiller. 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. So all of these risk calculations could be changing. Of course, Chris really got in trouble not with cratom,

but with another drug he mistakenly thought was. a kind of cradom, TNepdine. And the story of TNeptin, what it is, how it got here, and how much fault lies with the country of France? Those answers surprised me. Mondieu. We will continue our story after a short break. Hey, business owners, the NFL season is a big revenue driver.

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Don't just dream about the trip. Book it with Priceline. Download the Priceline app or visit Priceline.com. Actual prices may vary, limited time offer. You should tell the people who we are and what our new show is. I'm Robert Smith, and this is Jacob Goldstein, and we used to host a show called Planet Money. And now we're back making this new podcast about the best ideas and people and businesses in history. and some of the worst people, horrible ideas, and destructive companies in the history of business.

We struggled to come up with a name, decided to call it, business history. You know why? Why? Does this show about the history of business? Available everywhere. You get your podcast. Welcome back to the show. So what does the internet have to say about TNeptine, the drug that Chris had found after Kratum, which had caused him his real problems?

The vibe on Reddit in the TNeptine community is, is much darker than it is in the cratum subreddit. 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? The top voted reply, quote, I did research before I tried it, thinking I'd be able to control what many others couldn't.

Nope. I was fully addicted after a couple of weeks. I ended my addiction at six to ten bottles of TD Red a day. I spent $20,000. This is Reddit, of course. Anyone can say anything. They often do. But you do notice here many more vivid warnings than celebrations.

Many addicted users cautioning new people from following them down the path. Okay, TNF teen, gas station heroin. Let's talk about it. And it's similar over on TikTok. This shit right here is sold in gas stations. Can you believe that? What they're doing is they're selling it in gas stations and head shops under the name Tia, Red, or Zaza. A lot of times.

it's labeled as Zazaa in the gas station. And people are becoming addicted to them. Zaza at the gas station. Do not start taking this stuff. If you do, you will regret it. We're going to return to Dr. Oliver Grunman with more questions. But for TNepdine, I wanted to start by speaking to a different kind of chemist, someone whose work I've been following for a long time.

My name's Hamilton Morris. I am a chemist. I have a podcast that's about chemistry and pharmacolone. on Patreon. 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, and I'm generally very interested in the chemistry and pharmacology of psychoactive drugs. Dear listeners, I present to you Hamilton Morris. I've never spoken to him before, but I have listened to his hypnotically dry voice for maybe hundreds of hours. 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, fireman's helmets. He's seen a lot. Tieneptine was obscure to me, but I had a suspicion it'd be old hat to Hamilton Morris. What is TNeptine? Like, what is its chemical composition? Where does it call? What is it? Yeah, so TNeptine is a unusual substance. It's not chemically related to any of the botanical opioids or de fentanyl.

It's kind of its own chemical structural class. It's a tricyclic that is closer to a lot of antidepressants, and that is actually the area where it was developed. There's a French pharmaceutical company called Servier that was exploring these tricyclic antidepressant type structures. And this pharmaceutical company, Servie, had a bad reputation already. They were the major supplier of fenfluramine in Europe, which is a very cardiotoxic and potentially neurotoxic diet drug. So, first of all, TNeptine is not a naturally occurring substance like Kratem is. It was synthesized by a company called Servie.

Servie's bad reputation partly comes from their role in France as a major supplier of fenfluramine, half of the drug Fen-Fen-Femps, the famously lethal diet drug, Servier, the company, was also convicted for deception and manslaughter in French court over a different diet drug, which killed approximately 2,000 people. Tieneptine's path to its current life as American gas station heroin, it starts with Servier. In the 1970s, Servier synthesized Tieneptine and sold it as an antidepressant called Stableon. The drug made people feel euphoric, in opiose.

like ways, but for decades, the company insisted it was not an opioid. Into this swirling morass of uncertainty stepped Hamilton Morris. So the first time I tried TNeptine was probably around the first time that I tried matrageny in probably around 2009, and I had to order a box of pharmaceutical stable on tablets from France. And I had a kind of similar... I just say, you're a mailman. These are both to this day legal and certainly legal then. No one had ever even heard of this stuff really outside of, you know, people were really

interest in this at that point. 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. I get it. This is a great antidepressant, I wonder. And so I followed TNaptine with interest after trying it.

And what I noticed was an increasing number of reports of people abusing it, using massive, massive quantities, taking hundreds of these 12.5 milligram tablets. And 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. I get this euphoric nodding effect. I really wonder if this stuff is an opioid. 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. If Servier knew, they weren't telling people.

And so people were taking a drug that may have been an opioid, but the official story for how it was working on its use, users was different. The mechanism that was considered the explanation for its effect was that it was a serotonin re-uptake enhancer, not inhibitor. Oh, not inhibitor. Enhancer. I even wrote an article for Playboy years ago that described all of this, like, gee whiz, isn't it strange that two drugs with diametrically opposed mechanisms, one that enhances serotonin reuptake

and one that inhibits serotonin re-uptake are both antidepressants. 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, the evidence that it seemed to exert, some kind of opioid type of fact, was continuously accumulating. Then there was a medical case report of somebody that had overdosed on TNeptine tablets, and their overdose was reversed with naloxone, Narcan, the opioid blocking medication. A strong indicator that this is an opioid. Yeah, yeah.

So this was kind of like, isn't that odd that this serotonin reuptake enhancer is blocked by an opioid blocker? Huh. 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. Finally, in 2017, a student at Columbia University figured out how to solve this chemical mystery. Hamilton told me that the student sent a sample of TNeptine to UNC Chapel Hill, which has something called the psychoactive drug screening program.

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. 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 TNapting was, in fact, an opioid. 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. A full agonist at the mu-opioid receptor.

A full agonist is a substance that binds to a receptor and fully activates it. Other full agonists at the mu-opioid receptor? Oxycontin. Heroin. This drug was not as potent as them, but it was, was an opioid by anybody's definition. Some untold number of people had been taking an opioid without ever knowing it. And we know how we feel about opioids in this country. They are highly addictive substances that often kill their users. But the strange thing about Tieneptine, 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. For reasons that aren't fully understood, there are opioids, that don't cause profound respiratory depression, relatively speaking. And for that reason, they 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. Few Americans' lives would be improved by the addition of an addictive opioid, 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. I asked Hamilton about this. T aneptine, relative to heroin, if somebody were recreationally deciding to, for instance, 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. That would be my guess. Yes, 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 teeneption. That's not something that I'm saying. But conceivably, that would work. And that's also one of the things that Kratum is very popular for is 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. 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. 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.

To me, what's interesting, and tell me if this analogy feels fast to you, it's like one way you could understand Tieneptine 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. But what also happened is that there were a lot of people who didn't smoke cigarettes, and nicotine vaping was an on-ramp. Like instead of getting them off a drug to something less dangerous, it got them onto a drug. Like, is it possible that T-Neptine could work the same way?

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 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 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 you should use it in the following way, that would potentially make it impossible to sell. Hamilton is pointing to a pretty extraordinary contradiction here, a policy problem I don't know how you begin to fix. Obviously, consumers should know what drugs they're taking. They should know that Kratum is a partial opioid agonist, that TNeptine is a full one.

Ideally, the government would regulate the concentration and purity of these opioids. 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. 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. Some people are struggling with these drugs. Others say they're being helped by them.

There are people who are addicted to more dangerous opioids who appreciate a less lethal substitute. That's the problem I don't know how to fix. Dr. Grunman seemed to think that Tieneptine will likely end up as a prescription-only drug in America, just like in France. But Kratum is tricky. There are people who feel that Kratum is a medicine for them, a medicine that today they can access without having to rely on a health care system that may have gotten them addicted to lethal opioids

in the first place. Looking at this situation, it's hard not to wish that we had to be able to be able to do so. 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. I asked Dr. Grunman if he had any bright ideas. If you had to guess, like, given the research we have right now, I feel like 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.

what would, not thinking about the political realities of life in America, but given how people use them and what we know about the risks and benefits, what would be the best way for these drugs to be distributed based on the available information? Yeah. So I like the way you phrase that because it wouldn't fit in the current regulatory scheme or how this would ever be realized. But if you look, for example, at some of the ephrodrin, pseudoephedrine products that were kind of pulled from the market in regards to just being over the counter. So you could just buy them from a pharmacy without any questions being asked because we know that pseudoephedrine, ephedrine and alike products are being used in the manufacturer of methamphetamine. And instead, they're 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 U.S. states by now. So I think that Kratom and or Tianeptin 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? Do you have a prior substance use disorder to kind of provide a little bit of counseling at a little bit of information and actually utilizing the pharmacist, 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. And they remain the most accessible healthcare professionals out there. If you want to go to a doctor, you need to make an appointment. If you need some help with figuring out, is this medication safe to take or is this substance

and safe to take, you can go into a pharmacy and there will be a pharmacist. Is that how it works in Europe? So I grew up in Germany and I trained as a pharmacist there. And yes, we don't necessarily have over-the-counter, although some medications are now available like Tylenol or so that you can buy in small amounts, small packages in a grocery store. But most of even what is considered over-the-counter here in the U.S. is behind the counter.

So either a pharmacy technician or a pharmacy technician or pharmacist needs to grab it at least and put it on the counter for you in order for you to purchase it. In addition to that, we have certain supplements that are considered supplements here, St. John's word, Ginko, that you can actually get as a prescription from your doctor and it is paid by your insurance, by your health insurance. So we do have a different system where we value more the expertise of pharmacists beyond their ability to count pills. Sometimes you ask a question and you get actually a pretty good answer. Empowering pharmacists 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. Oliver, thank you so much. I feel like I understand this much better than I did before we started talking. Certainly, my pleasure. Dr. Oliver Grunman, clinical professor at the University of Florida College of Pharmacy and President of the American College of Clinical Pharmacology. Search Engine is a presentation of Odyssey and Jigsaw Productions.

It is created by me, BJ Vote, and Shruthy Pinnam and Ani. And is produced by Garrett Graham and Noah John. Fact-jacking this week by Holly Patton. Theme, original composition, and mixing by Armin Bizarrian. Our executive producers are Jenna Weiss Berman and Leah Reese Dennis. Thank you to the team at Jigsawb, Alex Gibney, Rich Perelo, and John Schmidt. And to the team at Odyssey, J.D. Crowley, Rob Morandi, Craig Cox, Eric Donnelly, Kate Rose, Matt Casey, Maura Curran, Josephina Francis, Kirk Courtney, and Hilary Schoff.

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