Dr. Oliver Grunman
Appearances
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The Mystery of the Vape Shop Kratom
Sure. Yes. Hello. My name is Oliver Gruntman. I'm a clinical professor and assistant dean at the College of Pharmacy, University of Florida.
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The Mystery of the Vape Shop Kratom
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. And I've studied it since 2016.
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The Mystery of the Vape Shop Kratom
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.
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The Mystery of the Vape Shop Kratom
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 Korthalis. And Korthalis actually observed the plant being used, both the fresh leaves being chewed
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The Mystery of the Vape Shop Kratom
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.
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The Mystery of the Vape Shop Kratom
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 their cup of joe, so from caffeine or coffee.
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The Mystery of the Vape Shop Kratom
And then others sometimes compare it to a little bit stronger stimulant effect. So I think it depends on the individual who is 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.
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The Mystery of the Vape Shop Kratom
kratom was for? Yeah, so there were a number of different uses for it. 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.
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The Mystery of the Vape Shop Kratom
Now, with the opium trades 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.
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The Mystery of the Vape Shop Kratom
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.
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The Mystery of the Vape Shop Kratom
So at the time, we had the American Kratom 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.
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The Mystery of the Vape Shop Kratom
I didn't ask them for input on how to design the survey, but just to distribute it. The first survey, I capped it at 10,000 responses, thinking that maybe I get 500 if I'm lucky in 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.
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The Mystery of the Vape Shop Kratom
So that was the first survey that was published on Kratom use in the United States.
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The Mystery of the Vape Shop Kratom
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...
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The Mystery of the Vape Shop Kratom
and 7-hydroxymitragynin, 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's It is very difficult to get a DEA Schedule 1 license to begin with.
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The Mystery of the Vape Shop Kratom
So from that perspective, from the research perspective, we were concerned.
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The Mystery of the Vape Shop Kratom
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 DEA does not move forward with placing a drug into Schedule 1. So this was certainly very surprising for a lot of people at the time.
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The Mystery of the Vape Shop Kratom
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.
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The Mystery of the Vape Shop Kratom
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.
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The Mystery of the Vape Shop Kratom
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. Interesting. In general, these withdrawal symptoms are relatively mild for most people, maybe comparable to heavy caffeine use when you stop using it.
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The Mystery of the Vape Shop Kratom
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. And we are not yet sure how somebody can get to very high concentrations in their blood of mitragynine that would cause or would contribute to a fatality.
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The Mystery of the Vape Shop Kratom
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. So it's clear there's a strong suspicion that these high potency extracts and isolates are driving the lethality.
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The Mystery of the Vape Shop Kratom
Yeah. I actually think that what is happening now in the crypto market is exactly mirroring what is happening with cannabis, right? When we look at A decade ago, we had THC concentrations that ranged from like maybe 5 to 12 percent, maybe 15 percent in high quality cannabis products. And now we have concentrates or edibles that contain 40 percent THC.
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The Mystery of the Vape Shop Kratom
So very different ballgame, very different amount that you can get into your body from sometimes ingesting much smaller amounts.
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The Mystery of the Vape Shop Kratom
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.
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The Mystery of the Vape Shop Kratom
But if you look, for example, at some of the ephedrine, 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 the like products are being used in the manufacture of methamphetamine.
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The Mystery of the Vape Shop Kratom
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 US 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 to
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The Mystery of the Vape Shop Kratom
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 and 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...
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The Mystery of the Vape Shop Kratom
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.
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The Mystery of the Vape Shop Kratom
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. Is that how it works in Europe? So I grew up in Germany and I trained as a pharmacist there.
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The Mystery of the Vape Shop Kratom
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 pharmacist needs to grab it at least once.
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The Mystery of the Vape Shop Kratom
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, Ginkgo, that you can actually get as a prescription from your doctor and it is paid by your insurance, by your health insurance.
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The Mystery of the Vape Shop Kratom
So we do have a different system where we value more the expertise of pharmacists beyond their ability to count pills.