Talk:Mitragyna speciosa/Archive 3

Archive 1

Archive 2

Archive 3

Respiratory depression

From Rech, the main relevant statement is "Adverse effects are similar to opioids including nausea, vomiting, constipation, respiratory depression, itching, sweating, dry mouth, increased urination, anorexia, and palpitations. Neurologic effects include hallucinations, psychosis, seizures, and agitation.47"

Rech mentions respiratory depression from Krypton (O-desmethyltramadol) deaths but that should not be generalized to a kratom side effect.

Rech's reference 47 is Forrester MB. Kratom exposures reported to Texas poison centers. J Addict Dis 2013;32:396–400.

Forrester says "Adverse side effects reported with kratom use include nausea, vomiting, diarrhea, hallucinations, psychosis, seizures, palpitations, dizziness, agitation, respiratory depression, itching, sweating, dry mouth, constipation, increased urination, anorexia, and weight loss. 1,2,16,18,21–25

Reference one (cached here) https://webcache.googleusercontent.com/search?q=cache:BkLkj3tL-iQJ:https://www.deadiversion.usdoj.gov/drug_chem_info/kratom.pdf+&cd=1&hl=en&ct=clnk&gl=us does not list respiratory depression

Reference two is a Forbes article that does not list respiratory depression as a side effect.

Reference 16 is a UN article that does not list respiratory depression as a side effect. https://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1975-01-01_3_page003.html

Reference 18 is a local news story that does not list respiratory depression as a side effect (original link is down but copied version is here: http://www.txwclp.org/2012/08/new-warning-about-kratom-use/ )

Reference 21 is another local news story not relevant for classifying respiratory depression as a possible side effect.

Reference 22 is a national news story that features an interview with a poison control practicioner who claims to have seem respiratory depression in kratom users. However, an anecdotal interview published by the news media and not by a journal is not a Wikipedia caliber source.

Reference 23 is a case study of someone that suffered a seizure after kratom use. Their respiratory rate is listed at 14/min, within the normal range of 12-20/min for adults.

Reference 24 does not list respiratory depression as a side effect.

Reference 25 lists a diagnosis of aspiration pneumonia, but aspiration pneumonia is different than respiratory depression.

I have exhaustively researched all of the references from the secondary source. The only primary source that they cite that claims respiratory depression is a mainstream media interview with someone. Mainstream media stories (and interviews) often distort information and they are certainly not allowed when making medical claims on Wikipedia. For this particular reference to kratom's respiratory depression to stand, I would like someone to claim that Wikipedia's policy on medical information is that mainstream media citations are allowed when filtered through a secondary source, which I do not believe to be the case. Secondary sources are preferred, but if their citations do not follow through when exhaustively examined, they should be disqualified for the particular references that are fully researched. You can see that another literature review cited in this article propagated an error by citing another literature review, in my section on the talk page about Warner. Kevin143 (talk) 18:38, 2 October 2016 (UTC)

We reflect good sources, not the original research of Wikipedia editors. Alexbrn (talk) 19:35, 2 October 2016 (UTC)

This is not original research but my own followup of the citations of an article. This is looking at the listed references of a cited paper. I am telling you that the source is not good because it cites a mainstream media article to make a medical claim. I would like to take this to arbitration if necessary. Thank you for the comment on my user page. I am not new to Wikipedia. You can see that my first edits to Wikipedia were made in 2004. I believe the policy is that if an edit is reverted back and forth three times, it goes to arbitration? I won't revert your edit yet, but I ask Jytdog, who seems to be the local expert on Wikimedia source policy, if a literature review is still considered valid if it cites mainstream media instead of scientific literature. If that is true, I think it is a mistake in the Wikimedia source policy, but I would then let the citation stand while I take my dispute to the source policy itself. Kevin143 (talk) 19:40, 2 October 2016 (UTC)

You're asking us to elevate the say-so of a Wikipedia editor over a well-published peer-reviewed secondary source. I'm sure you can see why policy forbids that. You are also edit-warring and risking a block. Alexbrn (talk) 19:52, 2 October 2016 (UTC)

If none of the evidence the review cites mentions respiratory depression, would that make the review a primary source for the respiratory depression claim? (Not that this will really matter if Doc's source is adequate). Sizeofint (talk) 22:38, 2 October 2016 (UTC)

I have been going through all the sources cited in Doc's reference book and don't believe any of them specifically show evidence for kratom showing respiratory depression. That book propagated an error because one of its sources stated that kratom is a mu opiate agonist and that mu opiate agonists cause respiratory depression. I have not been able to track down a 1973 edition of Archives internationales de pharmacodynamie et de therapie that was cited but I'll email a librarian if I can't find it myself with a more thorough search. I will post my response to Rosen's Emergency Medicine shortly, but I do not believe it makes an accurate statement because of the "telephone" effect of different secondary sources reciting a primary source that didn't actually make the claim in question. I'll post my exhaustative listing of the relevant quotes from the references in Rosen's Emergency Medicine by the end of the day tomorrow. Kevin143 (talk) 06:21, 3 October 2016 (UTC)

We have other good sources that also say it can cause respiratory depression. This book lists it as an opiate / opioid[1] This major medical textbook says it has "respiratory depressant effects"[2] Doc James (talk · contribs · email) 20:50, 2 October 2016 (UTC)

Following up on the textbook's citation for the claim that kratom causes respiratory depression, it says in Babu 2008, "The mu- receptor mediates analgesia, euphoria, and respiratory depression, which accounts for the analgesia activity of mitragynine, as well as its amelioration of opiate withdrawal symptoms." They make a claim about the mu receptor, but do not claim that mitragynine causes respiratory depression via the mu receptor. They also say "In animal models, mitragynine has been shown to cause less respiratory depression than other narcotics (46)." This citation, Jansen 1988, says "much less of a respiratory depressant" via Macko 1972. Macko 1972 is an issue of Archives internationales de pharmacodynamie et de therapie which I could not trivially find online, but given the state of the research into kratom in 1972 (which was before 7-hydroxymitragynine was discovered and kratom's pharmacology was at all accurately understood), I think it unlikely that Macko made a strong claim about kratom having a true side effect of respiratory depression. I will email a librarian though to dig up that issue of Archives internationales de pharmacodynamie et de therapie. Kevin143 (talk) 06:36, 3 October 2016 (UTC)

• what do you all think of this? Jytdog (talk) 06:15, 3 October 2016 (UTC)

Thank you! This is great and I believe accurately summarizes the state of the scientific literature on respiratory depression on kratom. That was tricky, right? Given this paragraph, I think "respiratory depression" should be moved out of the major side effects in the intro section on the wikipedia article, since respiratory depression is not a documented side effect of kratom use in people. My best case as to what is actually happening, is that while kratom does cause respiratory depression, it also has a respiratory stimulant action that ends up balancing out towards mostly not causing noticable respiratory depression... but taken as extract in dangerously high doses, kratom's weird multiple combinations of agonists and antagonists can cause seizures. Kevin143 (talk) 06:32, 3 October 2016 (UTC)

I agree with Kevin143 that the piece about respiratory depression should be removed. I think because kratom acts on mu opiate receptors, people have been making assumptions that it causes respiratory depression like morphine derived opiates, which is not an unreasonable assumption to make, but it does not seem to be supported by the evidence. Ingenium (talk) 23:00, 3 October 2016 (UTC)

Please slow down; we need to see how everybody thinks about it. What I did there is a bit dicey, but is generally how we handle it when MEDRS sources conflict. It is not surprising that the picture is unclear, as we don't understand how kratom acts in people very well due to the lack of clinical trials. As I have noted to you before, nobody here cares what any editor's theories are about what is going on in the underlying science. Please refrain from writing that kind of stuff. Thanks. Jytdog (talk) 06:37, 3 October 2016 (UTC)

OK, sure. I will keep my own unpublished scientific theories out of Wikipedia talk sections. :) Kevin143 (talk) 07:46, 3 October 2016 (UTC)

Great thanks. :) Jytdog (talk) 07:49, 3 October 2016 (UTC)

Having respiratory depression listed in the lead is perfectly appropriate. Did you read the refs? The emerg textbook definitely supports [3] Doc James (talk · contribs · email) 02:21, 4 October 2016 (UTC)

I read the refs in detail. The emergency textbook supports, but I followed all of the references back from the emergency textbook's citation, and the primary sources do not support kratom or mitragynine as respiratory depressant. I replied with my more detailed analysis of this elsewhere on this talk page. Kevin143 (talk) 02:33, 4 October 2016 (UTC)

User:Doc James are you OK with the edit I made to the body? thx Jytdog (talk) 02:27, 4 October 2016 (UTC)

Seems reasonable. We do say "may" for respiratory depression. This is a new poorly studied drug. Everything is tentative. Doc James (talk · contribs · email) 03:48, 4 October 2016 (UTC)

I don't think we should include respiratory depression in the lead listing on side effects, even if we say it "may" cause respiratory depression. Haven't all of the other side effects listed actually be documented in humans at this point? Per the article, CDC and DEA do not list respiratory depression as a possible side effect, FDA does. Kevin143 (talk) 10:23, 9 October 2016 (UTC)

Kevin143 (talk) 10:23, 9 October 2016 (UTC)

FDA says "Consumption of kratom can lead to a number of health impacts, including respiratory depression, nervousness, agitation, aggression, sleeplessness, hallucinations, delusions, tremors, loss of libido, constipation, skin hyperpigmentation, nausea, vomiting, and severe withdrawal signs and symptoms."[4] Doc James (talk · contribs · email) 04:09, 4 October 2016 (UTC)

Thanks for going over that carefully like you did, including the more nuanced dose-related adverse effects content. I think the body is pretty good now, reflecting the best refs we have. I think we can now update the lead to reflect more nuance, yes? Jytdog (talk) 06:39, 4 October 2016 (UTC)

Sounds good. Alexbrn (talk) 06:56, 4 October 2016 (UTC)

Sure so update the lead to say what? Doc James (talk · contribs · email) 19:36, 4 October 2016 (UTC)

Thanks. will propose something tonight or tomorrow... Jytdog (talk) 20:22, 4 October 2016 (UTC)

• For another update in the body, this primary source provides a mechanism by which mitragynine causes less respiratory depression than conventional opiates, via reduced activation of beta-arrestin pathways. Pretty sure we could add a sentence on this in the respiratory depression section.

References

--Kevin143 (talk) 20:15, 4 October 2016 (UTC)

as i mentioned above, we can use primary sources only for stuff like receptor binding, and explicitly not to make health claims. "this is why it doesn't cause respiratory depression" is very much a health claim. and if you are trying to "connect the dots" and not make the health claim explicitly, that is what we call WP:SYN and not ok. Jytdog (talk) 20:21, 4 October 2016 (UTC)

Right, right, sorry about that. Kevin143 (talk) 20:42, 4 October 2016 (UTC)

Also, one more source we can use for this that's already used elsewhere in the article: Eisenman's https://www.crcpress.com/Kratom-and-Other-Mitragynines-The-Chemistry-and-Pharmacology-of-Opioids/Raffa/p/book/9781482225181 has a section on respiratory depression that claims some respiratory depression, but less than other opiates, and that a cat was killed via administration of IV mitragynine. Kevin143 (talk) 21:31, 4 October 2016 (UTC)

proposed change to lead

Sorry have been distracted with other things.

proposing making the following changes to the "side effect" section of the lead, to better reflect the body (shown with strikeouts for removal and underline for addition):

Minor side effects may include itchiness, vomiting, and constipation. More severe side effects may include respiratory depression (decreased breathing), seizure, addiction, and psychosis. Other side effects include high heart rate and blood pressure, liver toxicity, and trouble sleeping. When use is stopped withdrawal may occur. Respiratory depression (decreased breathing) is a major risk with all opiates; the medical literature is divided on whether it is a significant side effect of kratom, with some authorities not mentioning it and others emphasizing it. When mixed with other substances, kratom use has resulted in death. In the United States, there were fifteen kratom-related deaths between 2014 and 2016.

References

Thoughts? Jytdog (talk) 05:03, 15 October 2016 (UTC)

Seems like an improvement. Sizeofint (talk) 05:21, 15 October 2016 (UTC)

Overly complicated IMO. We use the term "may" already. Not all sources mention psychosis or seizures either. Not sure why resp depression is controversial. Doc James (talk · contribs · email) 20:47, 15 October 2016 (UTC)

Respiratory depression should be controversial on here because kratom really, truly, does not cause respiratory depression. The original sources that claim it causes respiratory depression (One medical textbook and the FDA) are making that claim via association with conventional opiates. Kevin143 (talk) 09:25, 19 October 2016 (UTC)

I feel like you did a good job working with the references we have. My only suggested change is to say "nausea" instead of "vomiting" which seems like more parallel construction under the minor side effects start to the sentence. Kevin143 (talk) 09:41, 19 October 2016 (UTC)

I have no concerns with using nausea instead of vomiting in the lead. Doc James (talk · contribs · email) 22:19, 19 October 2016 (UTC)

Hi, can we go ahead and make this change? Kevin143 (talk) 08:59, 3 November 2016 (UTC)

Edit

Have reverted this[5]

This ref is claimed to state that it does not cause respiratory depression[6] yet it says no such thing. Doc James (talk · contribs · email) 06:32, 25 November 2016 (UTC)

so biased

This article is so biased and some users here actively push negative content and their pro-DEA beliefs. It is mainly a plant, and the article should be more similiar in structure to other articles about plants. Why do we need information about ingestion and side effects in more than half of the lead section? It should be shortened or deleted. It is horrible that even some experienced Wikipedia users stand for this nonsense. Wikipedia should be neutral not tool for propaganda. --77.38.133.111 (talk) 22:15, 2 October 2016 (UTC)

Heroin, cannabis, and cocaine are also from plants? Doc James (talk · contribs · email) 22:19, 2 October 2016 (UTC)

They are chemicals. Compare better to Papaver somniferum, Cannabis, Coca articles. Whatever, even heroin article has more positive main section than kratom (more precisely, neutral). --77.38.133.111 (talk) 22:35, 2 October 2016 (UTC)

I imagine that you and others who show up here care about kratom because - and only because - of its use to treat addiction or pain or its use as a recreational drug. We rely on MEDRS precisely to avoid becoming a tool for anyone's propaganda. Jytdog (talk) 23:22, 2 October 2016 (UTC)

MEDRS doesn't make statements about the style and organization of articles, and what content is best for the intro of an article and what content is best for the detailed subsections of the article. I think anonymous user is correct in that cannabis, coca, and opium have articles that do not lead with a list of side effects. However, none of those articles are rated as above C-class, so I don't think their structure is necessarily a good model. Are there any plant medicines that have "Good" rated Wikipedia articles? I still think it is reasonable for the third paragraph of the intro section on the kratom article to be moved into the "adverse effects" section where that information is covered. Kevin143 (talk) 06:27, 3 October 2016 (UTC)

Agreed. Sticking to WP:MEDRS-compliant sources is one of the best things that can be done for this article. Flyer22 Reborn (talk) 06:27, 3 October 2016 (UTC)

Kevin, style/organization is driven by WP:MEDMOS. Content is driven by sources, and content that is biomedical information is sourced per MEDRS. The underlying logic in the world of WP is all very clear and well-defined. As I noted to you above, advocates come here who don't understand or really care about how the community has determined that things are done, here in WP. Jytdog (talk) 06:31, 3 October 2016 (UTC)

I have never used kratom nor I live in the USA. I have made over 10 000 edits on Wikimedia projects (but not so much on English Wikipedia). I just write anonymously because I don't want my username to show up on this topic. No matter how you look some people actively try to push negative tone on this article since August 2016. This isn't just article about medicine (kratom isn't even approved for medical uses). Even if this article isn't about plant but medicine (so WP:MEDMOS should be applied) there are no demographic usage data (even at least 1 million people has been used kratom), no media coverage (recent criticism on DEA ban is big). Most of article is just about health hazards. Something I haven't seen on other botanical articles. --77.38.133.111 (talk) 08:17, 3 October 2016 (UTC)

The fact that humans use this plant and health benefits/hazards should be in one section at most. Others sections should be about geography, cultivation, varieties etc. If someone want to write so much about drug or human use maybe it is good idea to have a two separate articles (Mitragyna speciosa and kratom)? --77.38.133.111 (talk) 08:46, 3 October 2016 (UTC)

Thanks for your notes. We follow sources and pretty much every reference on this plant is about its use to affect health; what you are suggesting violates the basic policy NPOV. We follow sources, so MEDMOS applies here. I don't believe your suggestion to restructure the article will get any consensus due to that. Jytdog (talk) 14:06, 3 October 2016 (UTC)

@Kevin143: Salvia divinorum is Good rated article about a psychoactive plant. Wikipedia:WikiProject_Plants/Template provides general advice about how to structure a plant article, but doesn't really consider cases where extensive medical and legal content would be included. Verbascum thapsus is a Featured Article about a plant with medicinal uses, where the medical content in a minor component of the article (a more typical case as far as the Plants Template advice goes). Plantdrew (talk) 16:57, 3 October 2016 (UTC)

The Salvia divinorum article has terrible medical sourcing and should probably be reviewed - no way is it GA-worthy. Alexbrn (talk) 17:23, 3 October 2016 (UTC)

I do not speculate who is writing what for this article. It wouldn't surprise me if people get paid by special interests to mislead people in Wikipedia articles. I'll often come across information that sometimes has no source or when I look the source up it's nonexistent, or worse, does not in any way back up a statement. For instance there is technically a source stating that it has 13x greater antinociceptive effect than morphine. One the study does little to actually back up that statement as it was performed on mice an pain is subjective. The study also has numerous other flaws in it. And two it's a misleading statement that a typical undereducated reaader would take as meaning its psychological effects are 15x greater (basically people misread it as stating you can get that much higher off it. But in reality even if that were a true statement, which is highly doubtful, it would only mean it lessens pain by that amount and nothing more). Many studies show ketarolac to be equilanalgesic to morphine. But it's an nsaid so produces no high from its use. Whether it's risk is worth using is a different topic. But you could mislead people to think it's addictive like morphine. Yet I see no mention of its ability to reduce pain compared to any other drug. I've looked through half he sources for this article. Some are fake. Some are taken out of context. And some fail to mention the study did not produce statistically meaningful information due to design flaws, biasness on researchers part, too small of a population to apply it, the subjective nature of pain relief, the subjective nature of psychological effects (some people think you can get high on just about anything) and the fact that there's been so few studies on it that very little is actually known about it. And if it's being compared to morphine then it should be compared to other substances as far as known health risks which are also sadly not very well known. However compared to other legal substances it statistically is almost zero for poison control calls, overdose, emergency room visits, and only one confirmed death from krakow alone. Caffeine I've comparison causes 3000 overdoses per year and has (by itself) killed dozens of people. Vending machines are a larger menace by numbers when it comes to confirmed health related death and injury. It also focuses on the DEAs stance that it has no medicinal uses. Which cannot be determined without studying it. Not to mention the DEA does not have legal authority to schedule substances. I think the article is a bit biased based on questionable to non credible sources. Perhaps not heavily biased but it could be written much better in a nonbiased tone. Case in point doc James compares it to heroin, cocaine, and cannabis. Only one of which is a plant. Cocaine is used medically in hospital settings if he did his h/w and both heroin and marijuana easily have legitimate medical uses. Heroin on the basis that it's a proven good postoperative in hospital drug (in other countries) and cannabis sadly has many medical uses with the lowest potential for harm then a majority of scheduled substances. But like this scare tactics easily prevail over calm and calculated assessments. If anything for now it's probably best to make it a behind the counter substance. That way it's regulated without a knee jerk reaction ban to cases that involved mixing it with other drugs. That way it can be studied. At some point where does banning or scheduling drugs and herbs stop? Should dextrometnorphan be scheduled because a few misguided souls drink entire bottles of it to get what I'm lead to believe is a terrible hallucinatory trip? Should we ban cooking spices that can have effects as well if taken in large amounts? You may make the argument that I'm making unrelated arguments to the issue. But I am in fact pointing out flaws in the way the article is written. It passes it off as a much more psychoactive opiate than it appears to be. It's arguable to even call it an opiate or opioid or any other name in the family. Imodium is an opoiod but there isn't talk of doing anything to regulate it because it causes few issues. Some misguided souls will take incredible amounts of it or experiment with ways to get it to cross the blood-brain barrier and succeed. The article is unquestionably biased against kratom the only argument is by how much and how much of it is justified. — Preceding unsigned comment added by 2601:8D:8800:173C:9838:1C29:F716:42E9 (talk) 18:17, 25 December 2016 (UTC)

Most of our articles about plants are pretty short. If we ever get enough content about Mitragyna speciosa as a plant (rather than its use as a drug) then yes I expect we would split the drug use stuff off. Until then there is no reason not to keep all the content in the same place.©Geni (talk) 00:57, 4 November 2016 (UTC)

Who wrote this entry for Kratom?

Seriously this whole thing is so negative. It's like the director of the DEA and Pfizer came in and just wrote all the fear mongering they could muster into this whole wiki entry. The whole entry needs wiped and done in a more neutral voice. Kratom is about as scary as a cup of Matcha Tea, ffs. Ohidontknow (talk) 00:43, 9 November 2016 (UTC)

we follow reliable sources, per WIkipedia's policies and guidelines. Please read the sources cited. If you write more general commentary as above, it will be removed. Jytdog (talk) 00:59, 9 November 2016 (UTC)

The second-to-last sentence in the third paragraph is misleading. It reads: "When mixed with other substances, kratom use has resulted in death.[6][7]". Kratom use has not been shown to result in death whatsoever. Kratom has been identified in persons who have died, all of which had multiple other substances in their blood-work. Therefore, it is incorrect to say that "kratom use has resulted in death" as there is no causal relationship established, only coincidence. — Preceding unsigned comment added by Zkrudy (talk • contribs) 05:39, 17 November 2016 (UTC)

 Fixed (several months ago) Sizeofint (talk) 14:27, 29 December 2016 (UTC)

What does this mean?

"The FDA started working with other US agencies to seize shipments of imported kratom in 2014, as the product was being marketed as a dietary supplement but had never been shown to be part of the US diet nor to be Generally Recognized as Safe."

It's not part of the US diet? What is the US diet? How is this allowed to be published? — Preceding unsigned comment added by Professionalsciencedoctor (talk • contribs) 09:08, 29 December 2016 (UTC)

read the sources, professional doctor person. Jytdog (talk) 09:14, 29 December 2016 (UTC)

Article as a whole.

I put forward that the article should be written again by someone who can write a disapassionate article based on facts and evidence. Not hearsay, anecdotes, or sources that don't exist, don't state what is written in this article, or have no statistical relevance to make any claims about Kratom. The author should fact check every source as a lot are as I have stated numerous times bogus or there is no such reference. And the article be locked to letting just anyone edit it. Especially since there exists a decent amount of people employed by special interests to at the very least write statements online to muddy up the water and create controversy where none exists among educated people. — Preceding unsigned comment added by 2601:8D:8800:173C:9838:1C29:F716:42E9 (talk) 18:23, 25 December 2016 (UTC)

Have you read the above discussions? The article has gone through substantial editing to remove unreliable sources. What reliable sources is the article missing or how has the article mis-summarized the sources? Sizeofint (talk) 14:25, 29 December 2016 (UTC)

Ususally used

User:Kolyvansky thanks for your recent edits -- some of them were great improvements.

About this and the restoration here where you added the underlined bit: Respiratory depression (decreased breathing) is a major risk with all opioids (usually by single intravenous injection, not how kratom is used) -- where is it supported in the sources that route of administration for kratom has anything to do with the risk of respiratory depression with respect to kratom?

Also please note that this language was the result of some fairly intense negotiation -- please see talk archives here. The issue is that some important sources name respiratory depression as a risk of kratom and some do not. Jytdog (talk) 20:37, 29 March 2017 (UTC)

One more

Thanks User:Doc James - one more dif - this one, needs to be revdelled. thx Jytdog (talk) 22:25, 29 March 2017 (UTC)

User:Jytdog Done Doc James (talk · contribs · email) 22:46, 29 March 2017 (UTC)

thx Jytdog (talk) 23:21, 29 March 2017 (UTC)

DEA not a reliable scientific source

The DEA is a law enforcement agency, not an agency for scientific research. As such, it should be cited only for law enforcement aspects, not science, especially here since it provides no scientific backup in the ref. cited for its claims. It is not a reliable source on the scientific aspects of drug abuse.

"The DEA is concerned about the research working out and contradicting their propaganda about marijuana."

References

Kolyvansky (talk) 18:08, 31 March 2017 (UTC)

That's a naive uninformed view of how the DEA creates a case for drug enforcement. As shown here, part (c) Factors determinative of control or removal from schedules, the Department of Justice (Attorney General) interacts with the Department of Health and Human Services (scientific resources of the CDC, FDA or NIH) to develop criteria for enforcement. Bottom line: all the collective resources of government for scientific assessment of a drug are applied in a DEA action, making it a highly informed scientific decision. --Zefr (talk) 18:43, 31 March 2017 (UTC)

What you've cited is its own description (circular, hence unreliable) of its law enforcement function, not how it conducts scientific investigation (which, in fact, it does not do). Also, it provides no backup for its claim of liver toxicity, therefore it should not be cited here. The DEA has always had a propagandistic purpose, beginning when Nixon created it while seeking to suppress much of his own presidential commission (Shafer Commission) report on recreational drug use. Kolyvansky (talk) 19:17, 31 March 2017 (UTC)

• This is drama. Knock it off.

a) With respect to actual content, all Kolyvanksy's edit did was remove an extra citation - the content there remains fully supported, so I don't care about it being removed, and reverting it as meaningless as removing it.

b) With regard to Kolyvanky's opinions about the DEA in their edit notes and above, if this kind of SOAPBOXING continues they will be swiftly topic banned from health topics. End of story. Jytdog (talk) 19:27, 31 March 2017 (UTC)

• No, the DEA announcement is very short (426 words) with no references. Yet you cite it six times. What are you doing? Here and elsewhere the DEA should only be cited as an authority on its mandate for drug law enforcement, not scientific research ...which it does not do in any sense. Kolyvansky (talk) 19:54, 31 March 2017 (UTC)

If you want to challenge the validity of the DEA ref, you will have to bring that to WT:MED or WP:RSN. Jytdog (talk) 20:48, 31 March 2017 (UTC)

Liver tox

The content added after this dif (now revdelled) and semi-restored this are redundant to what was already there. The new source is great tho and i had kept it hereJytdog (talk) 20:07, 31 March 2017 (UTC)

• Yeah? and here's another diff showing the scientific doubt about liver toxicity in the original papers that you guys killed. Kolyvansky (talk) 20:57, 31 March 2017 (UTC)

The content you added is not significantly different from what was already there. Jytdog (talk) 21:02, 31 March 2017 (UTC)

No, what I added shows the scientific doubt (mainly from so little data) which one would see only if reading the originals. More study's needed which definitely is not evident in the DEA announcement. Kolyvansky (talk) 21:11, 31 March 2017 (UTC)

content currently says:

In rare cases, chronic use of kratom has been linked to acute liver injury with associated symptoms of fatigue, nausea, itching and jaundice. Liver injury is associated with cholestasis and may involve acute renal failure.

your version:

In rare cases, chronic use of kratom has been linked to acute liver injury with associated symptoms of fatigue, nausea, itching and jaundice. Liver injury is associated with cholestasis and may involve acute renal failure. "The cholestasis can be prolonged, but usually resolves spontaneously."

"Chronic recreational use of kratom has been associated with rare instances of acute liver injury", but "causality has not yet been accurately established". "Only two papers reported cases of hepatotoxicity" following kratom consumption. The authors of both studies were cautious in confirming the association.

References

-- not only bad writing (not summarizing) but larding on de-emphasizing of risks by digging into details from ref which we don't get into. The existing content is fine. Has word RARE first in fact. Jytdog (talk) 21:40, 31 March 2017 (UTC)

No, again. My version doesn't replace current content but adds onto it, showing how rare and questionable the conclusion it. The DEA announcement gives no such warning. It's not bad writing to use the authors' own summary for that. Also, you deleted a quote about self-healing. Are you an MD? Kolyvansky (talk) 23:24, 31 March 2017 (UTC)

Too many issues at once. One at a time. Where is DEA used as a ref here? Jytdog (talk) 03:24, 1 April 2017 (UTC)

Article says "Other side effects may include high heart rate and blood pressure, liver toxicity, and trouble sleeping." in the lead.

Source from DEA says "The Center for Disease Control (CDC) found that kratom abuse leads to agitation, irritability, tachycardia, nausea, drowsiness, and hypertension. Health risks found in kratom abusers include hepatotoxicity, psychosis, seizure, weight loss, insomnia, tachycardia, vomiting, poor concentration, hallucinations, and death. DEA is aware of 15 kratom-related deaths between 2014 and 2016."[7]

Doc James (talk · contribs · email) 17:03, 1 April 2017 (UTC)

The lead just summarizes the body. The DEA ref is not used to source any content about liver tox in the body or other adverse effects either other than deaths - we use stronger sources there. Nothing wrong with DEA ref but using stronger sources is always better and this was just a matter of deploying sources in a standard way. I fixed it. Jytdog (talk)

15 deaths

That same DEA announcement, containing no references, is used to source a statement of 15 deaths from '14 to '16, in three separate places in the article. Here's my recommended edit, removing two of them (also containing Jytdog's edit above removing DEA liver tox claims). https://wiki.riteme.site/w/index.php?title=Mitragyna_speciosa&type=revision&diff=773315666&oldid=773179718

I leave the DEA claim, as such (a claim), under a law enforcement section, which is the only place it arguably should appear, if at all. Kolyvansky (talk) 18:56, 2 April 2017 (UTC)

The DEA is completely reliable for that statement. We do not do peer review on already-reliable sources; the analysis you are doing is invalid in WP. Jytdog (talk) 20:39, 2 April 2017 (UTC)

...The DEA is NOT a reliable source on scientific matters, since it bends the truth towards its law enforcement objectives...

...in science...

"Critics of the DEA (including recipient of the Nobel Memorial Prize in Economic Sciences, Milton Friedman, prior to his death a member of Law Enforcement Against Prohibition) point out that demand for illegal drugs is inelastic; the people who are buying drugs will continue to buy them with little regard to price, often turning to crime to support expensive drug habits when the drug prices rise. One recent study by the DEA showed that the price of cocaine and methamphetamine is the highest it has ever been while the quality of both is at its lowest point ever.[20] This is contrary to a collection of data done by the Office of National Drug Control Policy, which states that purity of street drugs has increased, while price has decreased.[21][22][23] In contrast to the statistics presented by the DEA, the United States Department of Justice released data in 2003 showing that purity of methamphetamine was on the rise.[24]" - Drug_Enforcement_Administration#Impact_on_the_drug_trade

"The Science behind the DEA's Long War on Marijuana ... Experts say listing cannabis among the world’s deadliest drugs ignores decades of scientific and medical data." https://www.scientificamerican.com/article/the-science-behind-the-dea-s-long-war-on-marijuana/

...and even in court (!)

"Special Operations Division fabricated evidence trails." - Drug_Enforcement_Administration#Special_Operations_Division_fabricated_evidence_trails

However, it's OK with me to present its claims, as claims, only under law enforcement/regulation, but not as science. Kolyvansky (talk) 05:39, 3 April 2017 (UTC)

As I said if you want to challenge some specific statement supported by a DEA ref, RSN or WT:MED are thataway. Jytdog (talk) 10:06, 3 April 2017 (UTC)

to be found at Wikipedia:Reliable_sources/Noticeboard#DEA_as_a_source_for_deaths Kolyvansky (talk) 15:26, 5 April 2017 (UTC)

... where consensus is clear. Time for the WP:STICK to be dropped methinks. Alexbrn (talk) 16:57, 5 April 2017 (UTC)

How is clearly identifying sources like a government agency, the DEA, part of some "conspiracy theory"? That is just insane. Wikipedia really needs to stick to its policy of neutrality and not allow biased editors with an agenda to hijack articles to push their own views, and identifying sources is absolutely appropriate and valid. Please do not allow this obviously biased person to bully those who are simply trying to maintain Wikipedia's editorial standards. Dramatastic (talk) 13:03, 6 April 2017 (UTC)

Also be aware of WP:SOCK. Alexbrn (talk) 17:40, 6 April 2017 (UTC)

and the source is identified, via the citation. oy. Jytdog (talk) 20:08, 6 April 2017 (UTC)

And reading WP:NPOV might be a good idea. Sizeofint (talk) 03:01, 7 April 2017 (UTC)

Suggestion for organization

This is a complicated issue and I hope that I can be helpful.

It is clear that the reader needs to understand the difference between correlation and causation to better evaluate the information. If the same case studies were run on people who experienced death or liver failure after aspirin consumption, and reported the way that they have been, in peer reviewed medical journals, one would find similar results. Indeed, you can pick bad outcomes in the way that case studies are often chosen, and link death to anything...a limitation of case studies and correlations data. The implications of this for the wikipedia page are profound. They mean that zero deaths have been conclusively linked to kratom. Case reports are documented coincidences. Similarly, all of our kratom data are correlational. A huge limitation. This is hinted at where it's stated that no clinical trials have been conducted. Further, explaining what scientific data actually suggest is better than saying an entire agency (dea) is trustworthy. If they want to make claims that are unsubstantiated - that psychosis is a potential adverse effect of kratom use, they will need to present evidence to be evaluated. The evidence against is more compelling than the evidence for.

How about this, clunky but more accurate §language (for example): "Some individuals who have been treated for psychosis have reported histories of kratom use. There is no evidence to suggest that the kratom caused the psychosis." This is actually true if you review the literature. We need to make it clear on this page because, as you can see, the page suggests that kratom may well cause psychosis!

No deaths can be said to have been caused by kratom.doi 10.1080/02791072.2015.1096434

Public health importance of kratom and DEAs decisions Doi 10.1016/S0262-4079(16)31929-7

Thanks for your consideration. — Preceding unsigned comment added by Mako7717 (talk • contribs) 05:01, 9 April 2017 (UTC)

-I agree with all of this. --Hyladean (talk) 16:05, 1 May 2017 (UTC)

Wikipedia articles summarize the reliable sources. We actually strive not to cherry pick. If you look at the referencing you will see that the article is mostly cited to recent reviews in the medical literature and notes carefully where there is disagreement (e.g. risk of respiratory depression) Jytdog (talk) 17:00, 1 May 2017 (UTC)

Citation #14

The link to this citation is broken. I suggest it be corrected or removed.

Preferably removed as stated by many other people citing the DEA as a scientific body makes no sense and damages the credibility of this article. — Preceding unsigned comment added by Hyladean (talk • contribs) 15:59, 1 May 2017 (UTC)

if by ref 14 you mean this -- "DEA Announces Intent to Schedule Kratom: SE Asian drug is imminent hazard to public safety". US Drug Enforcement Administration. 30 August 2016. Retrieved 31 August 2016. -- the link works fine. Maybe you are talking about a different ref? Jytdog (talk) 16:53, 1 May 2017 (UTC)

It does not load for me, it may be on my end though. --Hyladean (talk) 17:20, 1 May 2017 (UTC)

Growing Concern

In the sentence:

  "As of 2015 there was a growing international concern about a possible threat to public health from kratom use."

Citation # 15 does not support this and I believe should be removed as such. In the entire article the only thing that comes close to mentioning this is:

  "In the USA, kratom is not controlled though considered as a ’drug of concern’."

This is a quote and does not support the statement in the wiki article nor does it suggest in any form that Mitragyna speciosa or kratom is "a possible threat to public health" — Preceding unsigned comment added by Hyladean (talk • contribs) 15:53, 1 May 2017 (UTC)

There are two refs there, and they both support it. Jytdog (talk) 16:57, 1 May 2017 (UTC)

I am aware there are two references there. The second one does not support it. I just read the whole thing --Hyladean (talk) 17:17, 1 May 2017 (UTC)

You quoted the part that does support it. The US is part of the international community. Jytdog (talk) 17:22, 1 May 2017 (UTC)

And in no place does it suggest that the concern is "growing" or that it is a threat to public health. You are referencing an article and imposing your opinion on it. Go back and read the article.--Hyladean (talk) 17:32, 1 May 2017 (UTC)

the growing concern thing is from Warner. Everybody here gets it that you don't want the DEA cited. Jytdog (talk) 17:36, 1 May 2017 (UTC)

Not sure what this has to do with the DEA (its your choice to use them as a scientific reference however obviously wrong it is). Two references for the same statement we used, the second reference does not support the statement. If growing concern only applies for reference # 7 then it needs to only be attributed to reference #7. The second reference makes no mention of it being considered a "public health concern" and therefore is misattributed.--Hyladean (talk) 17:42, 1 May 2017 (UTC)

Biased

This article is biased. This article has 50 cites and cites 1 article 30 times, it is essentially just a wiki page for the article cited. I came here for botanical information about a plant and I got the re-hashing of a journal of medicine article written by medical doctors and completely un-reviewable by anyone who doesn't subscribe to that journal and cant afford the $38 fee. This wiki should be about the plant Mitragyna speciosa. There needs to be separate wiki's (Mitragyna speciosa & Kratom). 1 for medical doctors to do bad research and 1 for botanist to get un-propgandized information about a plant. — Preceding unsigned comment added by Hyladean (talk • contribs) 15:10, 1 May 2017 (UTC)

It would be helpful if you would identify, specifically, what botanical information you were looking to find, that is not here. Thanks. Jytdog (talk) 17:01, 1 May 2017 (UTC)

Most people are interested in how the plant is used rather the plant itself (in part due to the attention kratom received last fall). My impression is there are not many review articles on this plant so we are somewhat limited in the available WP:MEDRS articles we can cite. The use info will likely remain in this article until there is sufficient content to justify a separate article. You are welcome to add the missing botanical content. Sizeofint (talk) 17:06, 1 May 2017 (UTC)

I will work on adding missing botanical information. It is just discerning to me to come a wikipedia page for botanical information and instead get what is essentially a politcal argument. There are no recorded accounts of people dying because of the use of this plant. But this article is written in a way to lead the reader to believe that its happened many times because it happened to be present during what is obviously a fetenyl overdose. It's misleading and damaging to the credibility of wikipedia as a whole. And further helps support an agenda to get yet another plant banned stopping the ability for actual non-biased research to be conducted. I would like to open a vote to move the contents of this page to a wiki titled "Kratom" so that everyone can do their psuedo medical referencing away from the plant itself. How do i do that? — Preceding unsigned comment added by Hyladean (talk • contribs) 17:31, 1 May 2017 (UTC)

Sounds like you are talking about a WP:SPLIT. See that link. The chances of that succeeding are vanishingly small. Jytdog (talk) 17:38, 1 May 2017 (UTC)

Sizeonint, information that is really just botanical (and not about any effects) wouldn't come under MEDRS; it would be best to source that from reviews or scientific organizations per WP:SCIRS of course. I am sure this is what you meant... just clarifying for Hyladean Jytdog (talk) 17:41, 1 May 2017 (UTC)

The bias throughout this article stems from political roots regarding Kratom and drugs as a whole and I don't think its fair for a very important plant to get swept up in that mess. Im going to read the thing and figure out how to re initiate the vote. Thanks — Preceding unsigned comment added by Hyladean (talk • contribs) 17:49, 1 May 2017 (UTC)

responding to the OP. The use of statistics there is not good. The article has 155 citations, to 50 different sources. The most cited sources are recent reviews in high quality journals or statements by major medical /scientific bodies. Warner is very heavily used - it is the most comprehensive source available at this time, so is cited throughout the article. It is almost always used in conjunction with others (that is done to make sure that Warner is in line with other sources). Jytdog (talk) 17:57, 1 May 2017 (UTC)

This statement: "In the United States, there were fifteen kratom-related deaths between 2014 and 2016,[14] although in none was kratom the sole factor.[7]" is a biased opinion. None of the journals have stated that that they show evidence that kratom was at all a contributing factor in any of those deaths and nearly all of those deaths involved fetenyl.--Hyladean (talk) 18:12, 1 May 2017 (UTC)

That statement summarizes what multiple MEDRS sources say, and has been carefully worked over. Please review the Deaths section more carefully. Jytdog (talk) 18:19, 1 May 2017 (UTC)

I did review the death section and it is at least worded better. If there is no evidence that Kratom was a contributing factor in the death then listing it as being involved in the death is irresponsible — Preceding unsigned comment added by Hyladean (talk • contribs) 18:23, 1 May 2017 (UTC)

USER TESTIMONIALS

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

These should be mentioned. Online testimonials can be viewed on sites that both sell Kratom as well as sites that do not. "Ratings" can also be viewed. The testimonials and user ratings are overwhelmingly positive as a whole and often contradictory to the propaganda and false/flawed statements/arguments presented by law enforcement, big pharmaceutical, etc.. If I am to look at this "side" or "stance" firmly opposed to KRATOM use that IS NOT linked to science then I should get to view some INFORMATION (facts--scientific ones) and personal testimonies from PEOPLE WHO HAVE ACTUALLY CONSUMED IT!!!! Furthermore--it should be pointed out that states that are involved in opioid-medication production have banned it--that is to say, states who have a bigger financial stake in the treatment of pain have banned Kratom. Finally, if Kratom is to be contrasted to opioid medications and we point out the so-called death claims 'involving' Kratom then the statistics for deaths caused DIRECTLY from opioids should be there, too! Finally, the attempts to ban Kratom are driven by the opioid producers and peddlers who have left their mark in politics for decades. My rating for Kratom: 5/5 stars--just like the other >90% of personal reviews I have seen across multiple sites--this information needs to be compiled, sourced, and reported. Obviously, alcohol, heroin, and opiates are far more dangerous than Kratom and are DIRECTLY responsible for DEATH in a way Kratom never will be associated with in any world grounded in fact, truth, and reality. Unfortunately for Kratom users, alcohol and opiates are much more profitable and controllable which makes Kratom a threat to them from a financial profit standpoint which leads to the propaganda and hysteria being spewed from any source associated with the political system. These factless scare tactics come from sources overwhelmingly associated with all levels of law enforcement, opioid players, and medical systems that are both "for profit" and "not for profit". Many people die every year from opioid overdose--both from medication and heroin. Many people die every year from alcolhol abuse and car accidents. Do our governments and powers to be see this as a public health problem? Will they ban alcohol? Will they say opioids have no medical use? No--too many profits are at stake and if you don't think it is all about money I pray you wake up. — Preceding unsigned comment added by 76.188.137.98 (talk) 17:39, 5 May 2017 (UTC)

This is not a forum for general discussion of the topic. Please read WP:TPG. Jytdog (talk) 17:44, 5 May 2017 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

NPOV | COI | Possible Harmful Misinformation

This article has some serious problems, it is blatantly obvious to persons familiar with the topic that someone has been subtly manipulating the wording and is using dubious and irrelevant references. After reviewing the history of the talk page apparently it is being guarded as well. Numerous logical fallacies are present, in an almost ignoratio elenchi alarmist reefer madness -esque type of manifestation. While the statements in themselves may be true they are being misused in a deceptive manner which may cause harm to the reader. The entire article should be checked for NPOV and contributors for COI as well as all the references vetted by a third uninterested party preferably a physician, research scientist or similar professional.

References

ilken 2602:63:C3E6:4400:7B9:E1E3:1DE3:23DE (talk) 00:54, 23 September 2017 (UTC)

This effort wasn't much better than your first. You clearly arrived here with strong feelings. We follow sources, not feelings. Please:

1) read WP:MEDRS, and if you don't understand anything in it, please ask

2) review the kinds of sources used in this article.

3) Check to see if there are more recent MEDRS sources that we have omitted

4) Read all the MEDRS sources (the ones in the article, and any additional ones you found)

5) listen to those sources

6) check the content against them

7) let us know about any discrepencies you find. Jytdog (talk) 01:13, 23 September 2017 (UTC)

FDA did not ban import or manufacturing of kratom

"... and in 2014, the United States Food and Drug Administration (FDA) banned imports and manufacturing of kratom as a dietary supplement because there was no history of safe use amid concerns about its potential toxicity."

Nowhere in the import alert is manufacturing even mentioned, and they did not ban imports of kratom, they put up an import alert. "This import alert represents the Agency's current guidance to FDA field personnel regarding the manufacturer(s) and/or products(s) at issue." — Preceding unsigned comment added by 107.199.128.249 (talk) 21:33, 15 February 2018 (UTC)

Under Regulation, United States: "The FDA coordinated with other US agencies to seize shipments of imported kratom in 2014, as the product was being marketed as a dietary supplement, but had never been commonly used in the United States or to be confirmed as safe" Kratom was not banned from being imported, this is a fact. Will update second paragraph of article to reflect this statement.

From the Nov 2017 FDA statement: "The FDA has exercised jurisdiction over kratom as an unapproved drug, and has also taken action against kratom-containing dietary supplements. To fulfill our public health obligations, we have identified kratom products on two import alerts and we are working to actively prevent shipments of kratom from entering the U.S. At international mail facilities, the FDA has detained hundreds of shipments of kratom.... Kratom is also banned in several states, specifically Alabama, Arkansas, Indiana, Tennessee and Wisconsin and several others have pending legislation to ban it." Summary of other FDA actions. --Zefr (talk) 23:15, 15 February 2018 (UTC)

For now, I'll agree that maybe it can be interpreted as an import ban, but nonetheless, manufacturing is not mentioned. They only have taken action against kratom-containing dietary supplement imports. — Preceding unsigned comment added by 107.199.128.249 (talk) 21:43, 16 February 2018 (UTC)

Kratom

The American Kratom Association has 9 scientists who have actually studied it. 1) The FDA has not studied it at all Scott Gottlieb had a pc program made to show what he wants to. 2) He sits on the board for a major pharmaceutical company. 3) He wants Kratom banned so he can come out with a patented synthetic version of it. 4) Kratom is not an opioid or opiate. It's related to the coffee plant actually. Ave.Maria (talk) 00:33, 10 February 2018 (UTC)

As conscientious editors, we're not here to defend or criticize government agencies, but the above error-filled comment is misleading, and needs to be refuted by numbers I added. 1) The FDA does not conduct original scientific (laboratory or clinical) studies itself, but may refine methods - such as PMID 27951469 for analyzing kratom samples. Rather, it relies on research from universities, medical organizations, and collaborative, research-centered US agencies, like NIH and the CDC, such as this concerning kratom incidents. 2) No FDA official can sit on the Board of a pharmaceutical company. 3) The FDA does not pursue intellectual property on any drug; it processes new drug applications, drug approval, and post-market surveillance, among numerous other regulatory programs. Particularly for kratom incidents in the US, the FDA works closely with the DEA, such as this DEA release from 2016 when kratom became a more visible concern. 4) From Gottlieb's letter this week: "the FDA developed the Public Health Assessment via Structural Evaluation (PHASE) methodology – a tool to help us simulate, using 3-D computer technology, how the chemical constituents of a substance (such as the compounds/alkaloids found in kratom) are structured at a molecular level, how they may behave inside the body, and how they can potentially affect the brain." Using this method and available published science, he stated that the FDA scientists found that "22 (including mitragynine) of the 25 compounds in kratom bind to mu-opioid receptors. This model, together with previously available experimental data, confirmed that two of the top five most prevalent compounds (including mitragynine) are known to activate opioid receptors (“opioid agonists”). The new data provides even stronger evidence of kratom compounds’ opioid properties." --Zefr (talk) 01:25, 10 February 2018 (UTC)

'No FDA official can sit on the board of a pharmaceutical company' Just like no politician can become a 7-figure consultant days after office. In many nations of the world a report by a government agency would engender more skepticism and doubt than one from an individual scholar without ties to politics. Nevertheless, granting that the FDA is always reliable, let's weigh any publications they have made against other reliable sources. I'm confident the result will be a lack of consensus, and again, the article will read more like one on a plant that needs more studying to fully understand its benefits and dangers, and less like a US drug/supplement warning label.Ptb011985 (talk) 15:50, 11 February 2018 (UTC)

Since lengthy passages are now being cited from FDA publications, I'll cite some sources of my own: "Demonstration of high opioid-like activity in isolated peptides from wheat gluten hydrolysates" Huebner FR, Lieberman KW, Rubino RP, Wall JS. "The opioid effects of gluten exorphins: asymptomatic celiac disease." Leo Pruimboom and Karin de Punder. "Food-derived opioid peptides inhibit cysteine uptake with redox and epigenetic consequences" Malav S Trivedi, Jayni S Shah et al. There are many non-lethal substances that exhibit opiod-like behavior, things as apparently innocuous as wheat bread among them.Ptb011985 (talk) 16:18, 11 February 2018 (UTC)

On February 8th, 9 scientists who specialize in sent a letter to Kellyanne Conway, who oversees the effort to combat the opioid overdose epidemic, with a rebuttal of the FDA's recent statement. The letter strongly criticized the FDA’s recommendation to label kratom as a Schedule I drug. This will be added under Regulations, United States. — Preceding unsigned comment added by 107.202.225.207 (talk) 22:19, 15 February 2018 (UTC)

That letter by 9 scientists is here, stating that "placing kratom into Schedule I will potentially increase the number of deaths of Americans caused by opioids because many people who have found kratom to be their lifeline away from strong opioids will be vulnerable to resumption of that opioid use, whether their prior opioid use was for relief of pain or due to opioid addiction", a reasonable argument, I would agree. However, this position would not be seen as majority science per WP:MEDSCI, so is WP:UNDUE for the encyclopedia. It is likely to be debated further, so remains for now as WP:RECENTISM. --Zefr (talk) 17:51, 16 February 2018 (UTC)

In December 2017, 17 Members of Congress sent a letter to the Commissioner of the FDA, Scott Gottlieb, asking the agency to reconsider its stance on kratom. Also, in January 2018, 25 Members of the House of Representatives sent a letter to the DEA urging the agency to adhere to the requirements of the Controlled Substances Act in their review of kratom. This information has been added under Regulations, United States.

The issues of the Dec 2017 letter were essentially answered publicly by the Feb 2018 FDA release of the Gottlieb statement. The DEA's position on kratom hasn't changed since 2016: "Intent to Schedule Kratom; SE Asian drug is imminent hazard to public safety". --Zefr (talk) 17:51, 16 February 2018 (UTC)

That is false, the DEA withdrew it's intent to schedule kratom and opened up for comments from the public and chose to wait for further scientific review regarding its safety. https://www.federalregister.gov/documents/2016/10/13/2016-24659/withdrawal-of-notice-of-intent-to-temporarily-place-mitragynine-and-7-hydroxymitragynine-into This letter was sent to the DEA *after* they had withdrawn their Intent to Schedule kratom, and so should remain in the paragraph. Please change the current paragraph to include "in January 2018, 25 Members of the House of Representatives sent a letter to the DEA urging the agency to adhere to the requirements of the Controlled Substances Act in their review of kratom."

Our Congressmen's reactions to an executive agency's highly debated "science" in order to influence the regulation of the plant, absolutely belongs here, and we can still keep the FDA's response. This is a current regulatory dispute. Withholding these two letters from being mentioned, when a large amount of lawmakers and tens of thousands of Americans thought it necessary to be sent to the FDA and DEA, would be biased in the executive branch's favor. Readers deserve to know that there are contradicting views regarding kratom within the different branches of our government, not just these two executive agency's positions. Please change the current paragraph to include "In December 2017, 17 Members of Congress sent a letter to the Commissioner of the FDA, Scott Gottlieb, asking the agency to reconsider its stance on kratom." — Preceding unsigned comment added by 107.199.128.249 (talk) 21:21, 16 February 2018 (UTC)

This means very little, for the following reasons:

1. 17 Members of Congress is not "...a large amount of lawmakers..." It is, in fact, less than 4% of the body (or a touch over 3% if you consider Congress as a whole instead of just the House of Representatives) and 25 signators is either under 6% (or about 4.5%, depending), so this is not "large" by any reasonable interpretation of that word.
2. Congresspersons send letters or sign letters sent by other Congresspersons to executive agencies daily. It is part of their normal functions of office and getting Congresspersons to send such letters is part of the normal business of lobbying groups. They are not notable in our terms until they receive significant coverage in independent sources, which this letter has not.
3. "...Tens of thousands of Americans..." is, again, a tiny number and part of normal lobbying
4. The mere existence of such a letter does not indicate this is "highly debated." That a marketing/lobbying group working with a group of users has resorted to to challenging a scientific finding through exclusively political means shows, in fact, just how little scientific debate there is.

• In sum, all this demonstrates is that the normal, routine process of interest groups lobbying on behalf of their constituents is taking place. That is not merely unsurprising but also not notable enough for inclusion under the standards set by this project's content guidelines. Eggishorn (talk) (contrib) 19:35, 17 February 2018 (UTC)

'Kratom-related'

In the intro it reads that there are 44 'Kratom-related' deaths. The sources do not use this wording, and the sources demonstrate that in all death cases the patient was also using illegal drugs (often heroin), or using pharmaceutical opiates (Tramadol, Oxycontin, etc.) that are known to cause death, and often using them beyond prescribed levels.

We need 'potentially related' 'partially' etc. Related implies causation.2601:80:C201:1910:1C5C:7801:CBA1:F73 (talk) 19:49, 7 February 2018 (UTC)

According to our most recent review, PMID 29255059, "Thirty-six deaths have been attributed to kratom, and the Food and Drug Administration issued a public health warning about the substance in November 2017.". Alexbrn (talk) 19:53, 7 February 2018 (UTC)

What if the sources mischaracterize their own evidence, which is the case here? When you look into the nature of the alleged kratom-attribution, the use of illegal drugs (known to cause death) or abuse of pharmaceuticals (known to cause death when abused) is present in every case. This must be mentioned, without just saying 'not sole.' Very misleading, well beyond line of propaganda. And what does 'bis' mean, which you have used to revert two of my edits?2601:80:C201:1910:1C5C:7801:CBA1:F73 (talk) 20:00, 7 February 2018 (UTC)

We reflect reliable sources. It's not our job to inexpertly "look into" things. Bis means again - your edits won't stand and you're edit warring. Alexbrn (talk) 20:09, 7 February 2018 (UTC)

OK, then let's say for clarity that 'the FDA reports.' Since there is no primary content underpinning their claims. You must look into sources. If they do not support the claim, the claim must be removed. If you look at the original claim, the source doesn't even report, it says "the FDA is aware of reports" without citing the individual reports. FDA awareness of reports means nothing. A report can be a crank call or anonymous email. The reports themselves must be both reliable and reviewable. 2601:80:C201:1910:1C5C:7801:CBA1:F73 (talk) 20:17, 7 February 2018 (UTC)

I'm not edit warring at all; I'm trying to make constructive edits, and getting swarmed within seconds by editors who are trying to protect the current version. Manically reverting my edits, then warning me for 3RR or edit warring. Sadly not atypical. It's OK though, as more articles are protected and clique-controlled, the site will lose credibility as another establishment rag; if that hasn't already happened. 2601:80:C201:1910:1C5C:7801:CBA1:F73 (talk) 20:19, 7 February 2018 (UTC)

Yesterday, FDA updated their investigation into kratom-related deaths, including these case reports showing what was found in the environment of the victims, i.e., kratom/mitragynine materials were present for each. Multiple drug abuse is common among the victims, making it difficult to specify the lethal substance, but "kratom-related" seems a fair description. Explained further here. --Zefr (talk) 20:22, 7 February 2018 (UTC)

To provide an analogy, are heroin overdose deaths (heroin being a substance known to regularly cause death) where the victim smoked cigarettes, had a cup of coffee, or drank a beer in the hours or days before death - i.e. consumed normal amounts of legal substances not known to cause or contribute substantially death at reasonable levels - termed as 'attributed to tobacco' or 'coffee-related.' No, they aren't, so they shouldn't be here. And it actually isn't difficult to specify the lethal substance: in every case, there is a substance involved that is known to cause death by itself, usually heroin or prescription opiates. Kratom has never been known to cause death by itself, in spite of two centuries of use by tens or hundreds of millions of people over that time period. The reasonable conclusion is that Kratom was not responsible.2601:80:C201:1910:1C5C:7801:CBA1:F73 (talk) 20:25, 7 February 2018 (UTC)

FDA closely monitors emerging agents of drug abuse with scientific methods not currently applied to kratom incidents elsewhere. The report yesterday indicates new methods being applied, and reveals "These reports underscore the serious and sometimes deadly risks of using kratom and the potential interactions associated with this drug. Overall, many of the cases received could not be fully assessed because of limited information provided... the information we have so far reinforces our concerns about the use of kratom. In addition, a few assessable cases with fatal outcomes raise concern that kratom is being used in combination with other drugs that affect the brain, including illicit drugs, prescription opioids, benzodiazepines and over-the-counter medications, like the anti-diarrheal medicine, loperamide. Cases of mixing kratom, other opioids, and other types of medication is extremely troubling because the activity of kratom at opioid receptors indicates there may be similar risks of combining kratom with certain drugs." Such information could not be ascribed to tobacco or coffee. --Zefr (talk) 20:40, 7 February 2018 (UTC)

"indicates new methods being applied" (what methods?) "many of the cases could not be fully assessed" (yep...yet your "concerns are reinforced," and you're "extremely troubled"? huh?) Yes, caffeine and nicotine do affect the brain, and are used daily, worldwide in combination with illegal substances that also affect the brain. Again, where is the evidence the use constituted combination, rather than just coincident use? People drink coffee and smoke daily; are these people said to be "combining" these substances with whatever other substances they take, or do they just happen to consume both in the same set of hours or days, where they would both show in a toxicology report? Do you know what else is an opiate that activates opiod receptors? Wheat bread. Consuming coffee around the same time as an illegal stimulant or alcohol around the time of an illegal depressant has been shown to increase death risk, and the substances affect the brain similarly in a number of ways, yet these deaths are not said to be attributed or 'related' to the legal substances. 2601:80:C201:1910:1C5C:7801:CBA1:F73 (talk) 20:50, 7 February 2018 (UTC)

I have drafted the following, which was reverted by user DavidinDC. I think it is an improvement that seems to balance concerns here: "Kratom has been detected in fatalities that also involved illegal and pharmaceutical opiates. The US Food and Drug Administration has noted reports of 44 potentially kratom-related deaths in the United States between 2011 and 2017" Previously this just said 'fatalities that have involved substances,' which is far too vague. I have also changed the following: According to the US Food and Drug Administration there is no evidence kratom is safe or effective for treating any condition. 'There is no evidence. . .safe or effective' is the opinion, using the standard label tagline found on all non-synthetic products, of the FDA, which is one agency of one nation, and is not representative of the overall literature, which is divided. It needs to be qualified. Lastly: The US Food and Drug Administration has voiced concerns that kratom has contributed to deaths involving the use of illegal opiods or abuse of prescription opiates. This is a much more accurate reading of the secondary sources. The FDA has said they are 'aware of reports' of overdose deaths where kratom has been detected and are 'concerned' that kratom's opiod nature may be a contributory factor, but acknowledge that they do not understand how kratom has contributed to the deaths due to 'limited information.' Much better than the vague/weasel 'there is evidence,' (what evidence? and why not just identify its single source?) which again smacks of FDA-speak.Ptb011985 (talk) 17:26, 8 February 2018 (UTC)

References

There is no consensus for this sort of POV, fringe editing, which devalues fact-based science and degrades the accuracy, usefulness and value of this wikj-article. Please stop re-inserting it. The two edit-warring templates you've dropped on my talk-page over this are inappropriate, as well. I've replied to them there. David in DC (talk) 19:11, 8 February 2018 (UTC)

@Ptb011985:You are misrepresenting the source you are referencing and this therefore fails verification, a core content policy. The FDA report did not say that the deaths "also involved illegal and pharmaceutical opiates." In point of fact, the FDA report specifically highlighted at least one death of an "..individual had no known historical or toxicologic evidence of opioid use, except for kratom." It goes on to say that kratom contains its own opioid compounds. The full context of the safe and effective statement is: "Kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids. There is no evidence to indicate that kratom is safe or effective for any medical use. And claiming that kratom is benign because it’s “just a plant” is shortsighted and dangerous." which makes your "it's only one opinion" statement above a blatant attempt to skirt the Neutral point of view policy. Further attempts to reinstate misrepresent the source with such edits may well be seen by administrators as disruptive editing. Eggishorn (talk) (contrib) 19:12, 8 February 2018 (UTC)

The FDA's report that stated that kratom contained "opiod compounds" was based on an unpublished computer model, not actual science. Just because the FDA says something doesn't make it science, they have to go through peer review too.2601:140:8980:106F:90CC:39CF:96D8:2F29 (talk) 23:35, 20 February 2018 (UTC)

David in DC: At this time there are multiple editors in favor of changes, and multiple against them. There is currently no consensus for preserving the current version. Instead of repeatedly crying 'no consensus,' how about substantively answering the points made, and providing specific, detailed rationale for your reversions of new edits, which now number 5-6?Ptb011985 (talk) 19:15, 8 February 2018 (UTC)

Eggishorn The source shows that in every case, high levels of illegal or pharmaceutical drugs [that are known to cause death], usually opiates, but also benzodiazepines (responsible for 4% of all single-cause OD deaths) and other lethal-in-excess drugs were detected. Recent 'Kratom-related' deaths in Sweden were all tied to Tramadol, a prescription opiate. We need more detail than just 'other substances,' which is as vague as you can get. The boilerplate 'safe and effective statement' is the opinion of one agency, and should be noted as such. No other reliable source has echoed the opinion with comparable wording, and many reliable sources disagree with the 'no evidence' claim. Why hide that it is the FDA, and not the overall literature?Ptb011985 (talk) 19:21, 8 February 2018 (UTC)

@Ptb011985:, mis-stating something multiple times does not magically actualize your version of reality. The FDA report does not say that "every case" had high levels of illegal or pharmaceutical drugs. It says the exact opposite as demonstrated by the quote from the source I posted above. Stop this misrepresentation now. Eggishorn (talk) (contrib) 19:44, 8 February 2018 (UTC)

The FDA reports linked contain the toxicology findings in all the fatalities. In every case I reviewed, potentially lethal compounds mentioned above were found alongside kratom, which is why they maintain that kratom was not the sole cause. That these are compounds that frequently cause death must be mentioned, and they should be identified; vague references to 'other substances' are not enough.Ptb011985 (talk) 19:51, 8 February 2018 (UTC)

Per WP:MEDRS "Cite reviews don't write reviews". We relay what expert sources say, rather than basing content on the inexpert writings of random Wikipedia editors. So your "I reviewed" is completely irrelevant in the context of our WP:PAGs. Maybe you should blog about it somewhere rather than trying t skew the article here? Alexbrn (talk) 20:10, 8 February 2018 (UTC)

The information he reviewed is publicly available, and anyone who looks into them will see that in the vast majority of cases, kratom was not the sole factor in a person's death. One of the death's "associated with the use of kratom" is a suicide case where the teenager had hanged himself after suffering from a history of depression and prescription drug abuse. He had kratom in his system. Another case involves a man who fell out of a window, broken his arm and refused treatment before dying. He was ultimately found to have had nine different substances in his bloodstream, one of them being kratom. Most of these deaths are linked to kratom by a very thin thread, so to speak, and they're being highly contested by many in the media and by scientists as evidence of kratom's "dangerous" safety profile. And finally, also considering that only one out of the 44 deaths had kratom as a sole factor, I agree with Ptb011985's proposed edit. — Preceding unsigned comment added by 107.199.128.249 (talk) 21:39, 16 February 2018 (UTC)

This is not difficult: While Ptb011985 is perfectly free to write whatever he wants on a blog or some other outlet for his "analysis", this website has explicit rules against what he's trying to state: Do not combine material from multiple sources to reach or imply a conclusion not explicitly stated by any of the sources. Similarly, do not combine different parts of one source to reach or imply a conclusion not explicitly stated by the source. Eggishorn (talk) (contrib) 02:36, 21 February 2018 (UTC)

Suggestion to name FDA as source of information in lead

Currently, one line in the lead reads: "There is no evidence kratom is safe or effective for treating any condition." I would advocate changing this line to "According to the FDA, there is no evidence kratom is safe or effective for treating any condition." This qualifier ensures that the line reads as a statement by the FDA rather than as a consensus from the wider medical community. The FDA, an exclusively American institution, is not a global authority in pharmacological research. Until a more rigorous study or meta-study of kratom by an independent research institute is made, I think it's wise to include the qualifier of the source of the statement. And even if one accepts that the FDA is a global authority, including the name of the source of the claim only adds information to the article, and takes nothing away, and removes any potential for non-neutrality. Thoughts? Voyaging^talk 03:22, 9 February 2018 (UTC)

I think you need to provide a citation to back up your view that the FDA is not mainstream. I suggest we source this to PMID 29255059 also, to quell any doubts. In general. per WP:ASSERT attributing something when there is no real dispute (i.e. in RS) has the non-neutral effect of creating an impression of doubt. Alexbrn (talk) 07:40, 9 February 2018 (UTC)

There certainly is dispute here, and saying "According to the FDA,..." adds doubt? The FDA is the only organization saying these things, so why not attribute their statements to them? 2620:103:A000:A02:D9A4:E08D:3834:4768 (talk) 20:14, 9 February 2018 (UTC)

FDA routinely draws on current world scientific information for its position statements, reflected here. Until there's a more authoritative source, which is unlikely, the existing statement is definitive. --Zefr (talk) 20:30, 9 February 2018 (UTC)

Well there are currently 69 other supplement/pharmaceutical articles on English wikipedia right now that feature that very phrase. https://wiki.riteme.site/w/index.php?title=Special:Search&limit=500&offset=0&profile=default&search=%22according+to+the+fda%22&searchToken=brxfoy22v3bfnvbfeowbx0m1u Who exactly determined that the FDA is the "most authoritative source" found so far? Wikipedia is supposed to be neutral, not government agency biased. 2620:103:A000:A02:D9A4:E08D:3834:4768 (talk) 20:37, 9 February 2018 (UTC)

Agree. Why not just name them? It adds little bulk to the article and is relevant information. The FDA's absolutist position may or not be 'mainstream,' but it does have substantial dispute among reliable sources, i.e. there are sources who would dispute to varying degrees their 'no evidence' claim. The 'no evidence. . .any disease' thing is a boilerplate tagline that the FDA adds to every non-synthetic label. The FDA's stance is that no complete, un-synthesized, natural substance can help to cure, treat, or prevent any disease, and that only regulated, approved, patent-able 'drugs' can do that. That is not a mischaracterization: see FDA letter to walnut vendor: “Based on claims made on your firm’s website, we have determined that your walnut products [i.e. walnuts] are promoted for conditions that cause them to be drugs because these products are intended for use in the prevention, mitigation, and treatment of disease." This is certainly not broad-consensus terminology or understanding on the potential for natural/whole-substance prevention and treatment of disease. If people want to go tit for tat in citing reliable sources that endorse, dispute, and suspend judgment on the FDA's position, we can do that, but it will be a waste of time. Many reliable sources do disagree with them or overtly decline to endorse, so qualification must be added: either name the FDA, or use 'according to some.' But that would become weasel-y, so just name the FDA, especially since few/no scientists have staked such a sweeping claim as does their label tagline. The resistance to doing this is very strange. If the FDA is so authoritative, credible, and consensus-representative, shouldn't attribution to them bolster the 'no evidence' claim even further, rather than introduce doubt as suggested by the detractor above? The effect on individual readers may vary, but attribution to the FDA in any case adds credibility and objectivity to the article by identifying the source(s) of claims (in a manner that it not unwieldy or wordy). As for their 'world scientific review' process, any RS can make claim to that, and most do; you don't see any aspiring RS saying "no, we don't look at everything here, we just pick and choose what suits us." The FDA remains a single source. Ptb011985 (talk) 20:23, 10 February 2018 (UTC)

"there are sources who would dispute to varying degrees" <- Such as? For the reasons given in WP:ASSERT we will not be attributing uncontended facts. Alexbrn (talk) 02:11, 11 February 2018 (UTC)

Some of them were attempted to be posted, but you and your cohorts (who reverted more than new 30 edits from 6-7 different editors on 10 or so occasions in the past week alone under the banner of an invented consensus; none of the edits inaccurate, unconstructive, or poorly written) pounced and deleted them immediately. If we're going to go there, let's go there, but the end result will be two distinct and wholly conflicting perspectives, and a total overhaul of the article in a way you don't like. I really don't want to spend the time on that, but will if necessary. For now we are talking about minor qualification of a few sentences (adding adjectives such as 'potential' where certainty does not exist even in the mind of the FDA) and identifying the source of claims where they are single, e.g. the 'no evidence for any' claim, which is limited to the FDA according to my reading on the issue and the sources in this article. If you want to say it goes beyond the FDA, that onus is on you as well. Opaque claims by the FDA of a 'world review' are certainly not enough; we're to take the word of a blurb on the website of one agency? Again, this isn't a PR project or PSA for the FDA, it's an encyclopedia article. Ptb011985 (talk) 03:29, 11 February 2018 (UTC)

An encyclopedia - quite so. One that reflects accepted knowledge as found in decent sources. You have given no source that "disputes the FDA" I see, just personal opinion. We're not going to change the article purely because of the POV of a few drive-by socks and WP:SPAs. Alexbrn (talk) 07:49, 11 February 2018 (UTC)

'We're not going to change' Who is we? There are several users at play here, on both sides of the issue. Eggishorn initiated a failed sock investigation that had nothing to do with me. Again, among reliable sources, who are you to designate the FDA as 'most decent' or special? They are not; they are one RS, and nothing more. They're the only RS with the "no evidence. . .for any" claim, so they should be named. Again, it's extremely strange that you're so attached to this specific point (nobody has tried to fundamentally change the article; the 30 edits I mentioned were very minor and amounted to a small handful of short clauses and one or two sentences), when all things being equal, it just seems like better, more intellectual writing befitting an adult-level encyclopedia to name the [single] source.Ptb011985 (talk) 13:14, 11 February 2018 (UTC)

Are you at any point going to provide some actual reliable sources which “dispute the FDA”, or will you be continuing the handwaving and the FUD campaign? --Calton | Talk 16:20, 11 February 2018 (UTC)

I'll cite them when time allows. The point of the OP is that the FDA is the ONLY source with the unique 'no evidence. . .to do anything beneficial. . .with respect to any condition.' No other RS has taken that stance, and it's boilerplate label language that is mandated to be on literally every natural/food-based dietary supplement on the market. The debate here is simply on whether to attribute the unique FDA claim to the FDA, or to hide that it is only the FDA who is behind the claim.Ptb011985 (talk) 16:25, 11 February 2018 (UTC)

A few to start

https://www.scientificamerican.com/article/kratom-drug-ban-may-cripple-promising-painkiller-research/

https://www.urmc.rochester.edu/news/story/5202/study-pokes-holes-in-kratoms-bad-rap.aspx

https://news.olemiss.edu/new-hope-for-addicts/

https://pubs.acs.org/doi/abs/10.1021/jacs.6b00360 (evidence for kratom as pain reliever with minimal side effects)

https://www.painnewsnetwork.org/kratom-survey/ (survey of kratom users; I see no reason to dismiss this as non-RS; and surveys are evidence)

https://www.ncbi.nlm.nih.gov/pubmed/28521200 (another survey)

https://www.researchgate.net/publication/276063865_Social_Functioning_of_Kratom_Mitragyna_speciosa_Users_in_Malaysia (study contradicting claims of anxiety, psychosis; report no social- or mental health-related adverse effects)

https://www.researchgate.net/publication/269114439_Ramanathan_S_and_Mansor_SM_Toxicology_of_Mitragynine_and_analogues_In_Kratom_and_Other_Mitragynines_Edited_by_Robert_B_Raffa_CRC_Press_2014_Print_ISBN_978-1-4822-2518-1_eBook_ISBN_978-1-4822-2519-8 (study claiming no deaths substantially caused by kratom as of 2015)

https://www.forbes.com/sites/davidkroll/2016/09/28/top-kratom-researcher-discusses-potential-medical-use-in-opioid-withdrawal/2/#7b308715598c (Christopher McCurdy, president of American Association of Pharmaceutical Scientists, compares addiction potential to coffee)This is a tiny sampling, and provides evidence for its value in pain relief, opioid addiction relief, and treatment of anxiety disorders.

Though again, that's not the point for now. The point is that only the FDA is staking out the 'no evidence for value' claim, while most reliable sources involved are either claiming evidence for value or suggesting value may exist and needs further study. This supports attributing the claim to the FDA, which would just be normal practice for a single-source-backed claim anyway. Ptb011985 (talk) 17:17, 11 February 2018 (UTC)

The FDA is a top source per WP:MEDRS. No RS-based good reason to doubt it has been given. We shall keep the text as-is, simply asserting their mainstream view as fact. Alexbrn (talk) 02:52, 15 February 2018 (UTC)

'We shall' no we shall not. You are basically saying the FDA overrides any and all other reliable sources, that they are the absolute arbiters of what is mainstream. That view is insanity; you have lost credibility and shown your hand. Instead of substantive argument, you and Zefr have now fallen back on 'good' as basis and explanation for edits. Multiple RSs above have already contradicted the FDA position (which is not hard to do, given how absolutist it is; even a shred of RS evidence forces FDA-attribution to the statement, which is a silly, unscientific statement anyway), and many more are available. Additionally the Ramanathan source contradicts the FDA 'kratom-related' assertion. You have to establish that it is more than just the FDA holding to the no-evidence, allegedly mainstream claim. The FDA and DEA have also long claimed that marijuana has no medical use (only synthetic, patented compounds like marinol); not mainstream, a minority viewpoint, and contradicted by reliable sources in spades. In spite of the multiple failed investigations by your cohorts, consensus still lacks and your version of it has already been debunked by reliable sources. Ptb011985 (talk) 04:22, 15 February 2018 (UTC)

To repeat, other MEDRS discuss kratom-related death too e.g. PMID 29255059. You have produced no "other reliable sources" to contradict the FDA, and MEDRS explicity says weak sources (like Forbes or surveys) must not be used to contradict strong MEDRS. In short, your arguments are based on editorial conspiracy theorizing and not in the WP:PAGs, which is why they don't have weight. Unless/until strong WP:MEDRS are produced I shall not respond further. Alexbrn (talk) 07:58, 15 February 2018 (UTC)

To repeat, medical reliable sources contend that deaths are not substantially kratom-related. You are cherrypicking the lower-quality sources and ignoring the others. If the game is that more and more must be produced (when you have provided zero and I ten or so), you will lose. As explained below to Doc James, the kind of statements in question are only made by governments, where absence of a statement on a substance presumes reasonable safeness, and few national governments (around 10%) have declared kratom unsafe. And again, we can use marijuana as an analogy, where unsafe/no-use declarations by multiple governments including the US do not constitute fact or mainstreamness. As there is no strong consensus among governments or scientists, we should attribute statements. I'd be fine with 'Kratom is illegal in 20 countries, and in February 2018 the US Food and Drug Administration stated. . .not safe or effective. . .'

Real scientists and medical researchers do not use phrases like 'has no use' 'no evidence for any,' etc. They conduct studies and report their findings, which may collectively reach a preponderance where a no-evidence claim might be made, as long as no RS evidence exists (already produced, and ignored by the FDA); at that point it becomes limited or conflicting evidence. Since I know you won't approve those terms, attribution is the best resolution.Ptb011985 (talk) 15:08, 15 February 2018 (UTC)

I've added the concerns of other governments to the lead, which should ease worries that there is an intention to discredit or single out the FDA as having concerns.Ptb011985 (talk) 15:36, 15 February 2018 (UTC)

Can anyone provide one MEDRS compliant source which says (1) this stuff is safe (2) that it has an approved medical use? Doc James (talk · contribs · email) 08:03, 15 February 2018 (UTC)

Approving substances for use and declaring them unequivocally safe (an absolutist, unscientific notion, frequently disproven after little time has passed) are functions of government, not science or medicine. Unsafe plants are scheduled as drugs or may be described as poisonous by environmental agencies. The overwhelming majority of governments have done neither with kratom. There are many RSs that substantiate medical uses for kratom. If kratom were unsafe, let alone lethal, the sources would conclude that cost exceeded benefit and that it had no medical use.Ptb011985 (talk) 14:46, 15 February 2018 (UTC)

Just say, "No, I don't," next time. It's much simpler and the faux philosophical argument fools no-one. Eggishorn (talk) (contrib) 17:43, 15 February 2018 (UTC)

There's nothing faux about the argument, you're just apparently too dense to understand it.Ptb011985 (talk) 05:23, 25 February 2018 (UTC)

First of all, please read this. Second of all, your statement above begins with a completely nonsensical statement that is so off the mark that it is not even wrong. Third of all, your continued attempts to misrepresent sources in the text of this article are so highly-biased as to make you attempts to call out bias on the part of others the height of hypocrisy. You may not have been using sock puppets, but that doesn't mean you aren't still being disruptive here. You still don't have any MEDRS-compliant sources for your edits or claims. Eggishorn (talk) (contrib) 17:46, 25 February 2018 (UTC)

Give me a break. So disingenuous; as if your prior comment here and your last comment in the section above don't amount to personal attacks. My statement isn't nonsensical at all; it's reflective of reality. Scientists may reach conclusions based on experimentation, but rarely stake out sweeping 'no...for any' claims like the one in question. Secondly, there are MEDRS-compliant sources. Repeatedly claiming otherwise and posting MEDRS guidelines in response to evidence "isn't fooling anyone."Ptb011985 (talk) 14:04, 26 February 2018 (UTC)

Controversy section

Putting the socks away. Dennis Brown - 2¢ 05:58, 1 March 2018 (UTC)
The following discussion has been closed. Please do not modify it.
The section "Controversy over FDA fatality claims" is unacceptable in my view. While it can be ok to have a separate section discussing the pros and cons of an issue, this section is entirely one-sided, starting with the title. Peter coxhead (talk) 14:59, 28 February 2018 (UTC) Controversy is controversy, and the words of the reliable sources who (almost categorically) disagree with the FDA are strong. What do you propose we call it? Non-agreement, disagreement, dispute, challenge? Controversy (defined as public, prolonged, strong disagreement) seems to be the best word choice. The FDA claims of 44 deaths are 'one-sided,' the side of the FDA and those who cite them. This paragraph is some of the other side. Your phrase of 'pros and cons' reveals your agenda and/or ineligibility to edit. This isn't a warning label, guidebook, or opinion piece. It's an encyclopedia article that includes important information and current, notable developments about a topic, which the controversy around the FDA stance is. Ptb011985 (talk) 15:10, 28 February 2018 (UTC) @Peter coxhead: Agreed, it's undue and weakly sourced; removed. Basically we're not going to query the FDA and strong reviews with a bunch of scratched-up weak sources. The WP:SPA has been try to do this for a while now. Add: Ptb011985 has now been blocked for edit-warring. Alexbrn (talk) 16:25, 28 February 2018 (UTC); amended 16:35, 28 February 2018 (UTC) I disagree the entire section should be removed. Questions on whether kratom is actually lethal or dangerous or not are at the crux of the buzz around it, and weigh heavily on its therapeutic potential. The relevance level and 'due-ness' therefore seem high, but the content doesn't fit elsewhere. I restored the controversy paragraph but took out claims backed by sources with overt biases (e.g. Reason.com). And sorry, how are major medical journals and prominent scientists from major universities weak? And why shouldn't the FDA be queried? It's not like the FDA necessarily attracts the brightest minds or is beyond reproach or dispute; the FDA has been wrong many times (https://usrtk.org/the-fda-and-food-companies-have-been-wrong-before-they-have-assured-us-of-the-safety-of-products-that-were-not-safe/), and many FDA and federal agency positions generate enormous controversy today (e.g. on medical marijuana, food pyramid, pesticides, GMO foods, etc.); yet they have already been given deference in the lead.CoosaGA1 (talk) 01:23, 1 March 2018 (UTC)

Ref

This was suggested as a ref[8]

Have not had a chance to look at it much but is a review article, has an impact factor, published by Springer. Doc James (talk · contribs · email) 23:38, 17 March 2018 (UTC)

Substantial review by authors of a Bethesda health policy firm. Key conclusion: "The absence of an imminent threat to public safety does not imply that the status quo with respect to regulation is adequate to appropriately protect public health; nor does it imply that there is no need for further research. To the contrary, as suggested by the research summarized in this review, kratom-related research is at an early stage with many key gaps in knowledge. Similarly, regulation is vital to help ensure that lawfully purchased products are what they claim to be, are not adulterated, and are appropriately packaged and labeled. At the time of this writing, however, the threat of placement of kratom (specifically, MG and 7-OH-MG) into Schedule I of the CSA would serve as a major obstacle to research due to the barriers by the statutory requirements of such scheduling." --Zefr (talk) 23:49, 17 March 2018 (UTC)

And this is concerning "Through Pinney Associates, the authors have consulted and/or are presently consulting to the American Kratom Association and other sponsors of kratom products"

Though maybe best to leave it out. Doc James (talk · contribs · email) 00:00, 18 March 2018 (UTC)

Agree. There has been a big kratom lobbying effort underway[9] and so this article must make scrupulously careful use of sources. Alexbrn (talk) 05:37, 18 March 2018 (UTC)

There has also been a huge lobbying effort AGAINST kratom, so everyone must be careful of some of the statements being made by the FDA. The FDA is heavily lobbied by the pharmaceutical companies, who have a very strong financial interest in making kratom illegal. They want people to buy the vicodins, the oxycodones, the fentanyl patches. They don't want anyone to have access to a plant that could potentially be equally as effective at treating pain as their drugs. For those who have used kratom to wean off other opioids, the pharmaceutical companies don't want that either! They want people hooked on suboxone and methadone, which are much harder to quit and have far worse withdrawal symptoms.

It's truly sad, the people in charge of the pharmaceutical compabies don't care as much about treatment as they do about the profits.

The most responsible course of action would be to invest in researching kratom and the alkaloids contained within it prior to maing anything illegal.

The same thing that happened with marijuana is now happening with kratom. It is being demonized and slandered by the people who have vested interest in making it illegal. It is very sad, and a disservice to the millions of people who use and have benefitted from kratom.

The alleged deaths from kratom are weak links at best. A full 20% of them were from adulterated kratom which actually had o-desmethyltramadol in it. All others except a single case had other substances present in the blood alongaide kratom at the time of death (other opioids, benzodiapines, alcohol, etc). There is no evidence that kratom has the potential to cause death on its own.

Please see this article for insight into the cases: https://www.huffingtonpost.com/entry/kratom-deaths-fda_us_5a7a3549e4b07af4e81eda8b — Preceding unsigned comment added by TrueDoctor (talk • contribs) 16:06, 18 March 2018 (UTC)

Kratom does not depress cns.

Kratom does not depress the central nervous system the third reference is cited to say it does which is incorrect. 1stplebian (talk) 21:51, 1 April 2018 (UTC)

Kratom doesnt have any of side effects listed except higher heart rate and blood pressure in the exact ways that coffee does.

None of the side effects listed are correct except for higher blood pressure and heart rate increase along the same lines that coffee or tea does as it has caffeine like compounds in it. 1stplebian (talk) 21:56, 1 April 2018 (UTC)

Regulations - United States

I can't edit this page myself, so I just wanted to suggest one presumably rather uncontroversial (although admittedly perhaps somewhat insignificant) edit. Namely under the "Regulations" section ("United States" subsection), it says:

"The FDA coordinated with other US agencies to seize shipments of imported kratom in 2014, as the product was being marketed as a dietary supplement, but had never been commonly used in the United States or to be confirmed as safe."

If you haven't noticed, towards the end of the sentence there's a rather obvious grammatical error. I Just wanted to suggest changing it to, e.g., ". . . but had never been commonly used in the United States or confirmed as safe." Sorry, I don't want to be nit-picky or pedantic or anything, but saying "[it hasn't] been commonly used or to be confirmed as safe", just sounds very strange.

On 4/3/2018 The FDA has issued a full mandatory recall on Kratom — Preceding unsigned comment added by Kelhosseiny (talk • contribs) 17:34, 3 April 2018 (UTC)

Extended-confirmed-protected edit request on 4 April 2018

Append to the end of the United States portion of the Regulation subsection, the following:

In early April, 2018, the FDA instituted a mandatory recall of all kratom-containing products marketed by Raw Form Organics (manufactured by Triangle Pharmanaturals) which it stated was due to an outbreak of salmonella cases related to its use. The FDA reported this was the first time in its history that it had issued a mandatory recall because a company was non-responsive to their requests for a voluntary recall. The FDA emphasized that this action was not related to the alleged medicinal, side effects, nor recreational uses of kratom. The recall was solely based on the salmonella outbreak.

Source: https://www.npr.org/sections/thetwo-way/2018/04/04/599443476/fda-orders-an-unprecedented-recall-after-kratom-company-ignored-its-requests BalanceUT (talk) 17:25, 4 April 2018 (UTC)

 Done Not exactly the same text but substantially similar information added per WP:MEDRS-compliant sources Eggishorn (talk) (contrib) 18:33, 5 April 2018 (UTC)

There has been no deaths from kratom.

There have been no deaths from kratom, nun from Kratom being used on its own and none from any mixture with other substances. All assertions to the contrary are ridiculous libel ultimately from vested interests. The deaths they have tried to pin on kratom, are like blaming coffee for a heart attack where the person was on a crystal meth binge. 1stplebian (talk) 21:59, 1 April 2018 (UTC)

• Unless you present sources that pass WP:MEDRS, you are wasting your time by complaining here. Dennis Brown - 2¢ 22:03, 1 April 2018 (UTC)

Here is a source for that claim: "To date, there have been no reports of fatal overdose that may be categorized as kratom-caused poisoning deaths, by criteria used by medical examiners and in emergency medicine reports although several deaths in the US may have involved kratom" https://link.springer.com/content/pdf/10.1007/s00213-017-4813-4.pdf — Preceding unsigned comment added by 69.120.135.171 (talk) 07:47, 17 May 2018 (UTC)

Talking about vested interests, did you read the COI declaration on that Springer article? Here, I will copy/paste it: "Conflict of interest: Through Pinney Associates, the authors have consulted and/or are presently consulting to the American Kratom Association and other sponsors of kratom products as well as to pharmaceutical products including opioid and nonopioid analgesics and other CNS acting products concerning their abuse potential, appropriate regulation, and medicinal application."

Just above that, in acknowledgements, it says " This report draws from an analysis of the eight factors of the US Controlled Substances Act that was supported by the American Kratom Association and was filed on the public docket of the Food and Drug Administration. The content is solely the responsibility of the authors and does not necessarily represent the official views of the American Kratom Association."

One wonders who paid the open access fee. Jytdog (talk) 08:20, 13 June 2018 (UTC)

The FDA certainly made claims that there were deaths links to kratom, however, just as you ask for sources, the FDA has no sources to back up these claims. A Freedom of Information Act (FOIA) request was filed in order to force the FDA to release any sources they may have. Unfortunately for them, they made it all up. The FOIA request for records was entitled: "ALL EVIDENCE AND DOCUMENTATION RELIED UPON IN THE DRAFTING AND PUBLICATION OF THE AFOREMENTIONED PRESS RELEASE, TO SUPPORT THE FOLLOWING STATEMENTS, MADE BY THE FDA." The FDA's response to this request was: "The Center Food Safety and Applied Nutrition (CFSAN) [which is a branch of the FDA that handles these types of requests] conducted a search and did not locate any records responsive to your request." They made it all up. The FDA lied, and the FOIA source is proof. The FOIA request can be found here: https://www.muckrock.com/foi/united-states-of-america-10/fda-evidence-of-claims-in-kratom-press-release-45861/ — Preceding unsigned comment added by 2600:1006:B142:484F:DDE:54A4:6F9:58D7 (talk) 08:00, 13 June 2018 (UTC)

The Muckrack page is WP:USERGENERATED and we will not be using that. Jytdog (talk) 08:22, 13 June 2018 (UTC)

Recent refs

I just did a search for reviews. New ones we are not using fully or at all include:

• PMID 29255059 from AJHPS 2018 - (i just added some stuff in pharmacology from this) -
• PMID 29248691 on mental health effects of kratom
• PMID 28911631 brief review of kratom and 4 other naturally-derived drugs of concern now (open access)
• PMID 28868040 - new review by Hassan whom we already cite from a 2013 review (open access) unfortunately in a Frontiers journal
• PMID 28830758 - med chem review in Neuropharmacology
• PMID 28544011 - trends in use in SE Asia

-- Jytdog (talk) 08:50, 13 June 2018 (UTC)

Content from PMID 28830758 - med chem review in Neuropharmacology was added by an IP, which I just further revised.

That leaves the following still unused:

• PMID 29248691 on mental health effects of kratom
• PMID 28911631 brief review of kratom and 4 other naturally-derived drugs of concern now (open access)
• PMID 28868040 - new review by Hassan whom we already cite from a 2013 review (open access) unfortunately in a Frontiers journal
• PMID 28544011 - trends in use in SE Asia

-- Jytdog (talk) 02:06, 16 June 2018 (UTC)

Pharmacology

Mitragynine and 7-OH-mitragynine are partial, not full agonists of mu-opioid receptors, and antagonize the delta and kappa subtypes.

Sources for subject claim: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5189718/ https://www.sciencedirect.com/topics/medicine-and-dentistry/mitragynine https://pubs.acs.org/doi/pdf/10.1021/acsmedchemlett.7b00298

I am sure countless more can be provided. This article has a general issue with bias, but this is a glaring factual error. This information used to be accurately presented in the article in the past. — Preceding unsigned comment added by 68.132.203.26 (talk) 23:08, 29 March 2018 (UTC)

I addressed this "full" business. None of those three refs are great (the first is a primary source, the 2nd is a search result, and the third is unfortunately a "perspective" piece. I used a recent high quality review, PMID 29255059. Jytdog (talk) 08:44, 13 June 2018 (UTC)

• IP 108.21.105.120, about

• this
• this
• this ...

We always prefer reviews to primary sources. We don't edit based on abstracts per WP:NOABSTRACT. The body of PMID 28830758 has a great discussion of the literature on opioid receptors - human, animal, and guinea pig. If you don't have reference cited, please ask for it. Jytdog (talk) 14:34, 16 June 2018 (UTC)

...Reviewing Wikipedia's policy on primary sources I do not see what the issue is. I am not interpreting or deriving anything from any primary source, only relaying the straight facts. I have made citations that explicitly state in the abstract that mitragynine is a competitive antagonist of kappa and delta opioid receptors, and also explains that it does not recruit beta-arrestins, thought to be involved in side effects with traditional opioids, through its activity at the mu receptor. I have thus far seen nothing that indicates anything to the contrary, so I'm not quite sure where the issue lies.

Additionally, as far as your complaining about my having noted that this information was available in the abstract (and not exclusively so), I have read the entire paper thoroughly and have found none of this "interesting talk" that you speak of as despite there being variances mitragynine and 7-HMG are consistently described as kappa and delta antagonists, and the lack of recruitment of beta-arrestins does not come into question. Furthermore, I had a second source which corroborated this information, which you removed arbitrarily despite it conforming with Wikipedia policy on primary sources. Now it seems you're just going to ignore this and threaten to ban me, lock the article etc. I'm only trying to make this article more accurate, but I guess since you're the one with greater authority here you can do whatever you want. 108.21.105.120 (talk) 15:06, 16 June 2018 (UTC)

Thanks for responding here. Please thread your posts. (see WP:THREAD - basically you just type one or more colons in front of your comment - always one more than the person to whom you are responding; the software here converts the colons into indents)

As I said we tend to avoid primary sources and for something like this, where things are very uncertain and there are conflicting findings in primary literature it is unwise to cite them. (In general, there is a lot that people can do here; the question is what should be done.)

The 2017 Keugel review is very good as discussing how messy the science is at this point. There are few "straight facts" at this point, with the data being so messy.

In any case, please be patient and wait to see what other editors will say. Jytdog (talk) 16:06, 16 June 2018 (UTC)

On the kappa and delta receptors, here is what PMID 28830758 says about the in vitro pharmacology:

The activity of the major Mitragyna alkaloids have also been profiled at the human kappa-opioid receptor (hKOR) and human delta-opioid receptor (hDOR) (Kruegel et al., 2016). Both mitragynine and 7-OH bind to hKOR (Ki mitragynine = 772 nM; Ki 7-OH = 188 nM) and in functional assays, act as competitive antagonists with IC50 values in the micromolar range. In the case of hDOR, binding was observed for 7-OH (Ki = 219 nM), but was negligible for mitragynine (Ki > 10 μM), while both alkaloids exhibited only weak antagonist activity in functional assays at this receptor (IC50 > 10 μM). Interspecies and interassay differences have again been observed at these receptors. For example, reported affinities of mitragynine for mouse DOR in transfected cells (Ki = 1.0 μM) and DOR in guinea pig brain (Ki = 60 nM) are much stronger than observed with the human receptor (Kruegel et al., 2016, Takayama et al., 2002, Váradi et al., 2016). Similarly, for 7-OH, submicromolar mDOR antagonism has been demonstrated in the [35S]GTPγS displacement assay (Váradi et al., 2016). Therefore, the contribution of KOR and DOR antagonism to kratom's in vivo effects remains unclear at this time.

-- Jytdog (talk) 16:17, 16 June 2018 (UTC)

Okay, thank you. It would be most accurate to state that how the activity at these receptor types contributes to the overall effect of kratom in humans is unclear, with perhaps a note following the bit regarding beta-arrestins that this does not mean a lack of abuse potential or dependence liability. Regardless, the nature of the activity at these receptor types as previously described is itself well-established. 108.21.105.120 (talk) 17:22, 16 June 2018 (UTC)

Extended-confirmed-protected edit request on 9 August 2018

In order to take note of the controversy about whether reported deaths resulted from kratom itself or adulterants, include the following at the end of the paragraph with the sub-heading "Death"...

The National Institute on Drug Abuse answered the question, "Can a person overdose on Kratom?" by stating "Kratom by itself is not associated with fatal overdose, but some forms of the drug packaged as dietary supplements or dietary ingredients can be laced with other compounds that have caused deaths." That statement was removed in 2018. The website now reads: "Note: Information on kratom overdoses is currently being updated." Kolyvansky (talk) 01:49, 9 August 2018 (UTC)

References

 Done. CLCStudent (talk) 20:14, 16 August 2018 (UTC)

 Not done I reversed this. Giving such prominence to the wording the Institute has withdrawn is problematic. Alexbrn (talk) 20:45, 16 August 2018 (UTC)

Extended-confirmed-protected edit request on 19 August 2018

This introduction has clear bias. The FDA's announcements do not constitute valid medical data since they are not based on any valid medical data. Looking at the documentation of deaths and issues related to kratom, each one is also mixed with another drug that the user was taking on his/her own. Wikipedia's own policies state that biases should not play a role in the facts of a subject. If you want to put such information on the page, it should be clearly listed as opinion and not yet based on any strong evidence. CavinSays (talk) 07:10, 19 August 2018 (UTC)

 Not done Please only use this template after consensus for an edit has been achieved. This particular point has been discussed at length here before. Alexbrn (talk) 07:13, 19 August 2018 (UTC)

Top right "Legal Status" in United States is incorrectly listed "US: Drug of Concern,[4] sale is illegal[7]"

The sale of mitragyna speciosa, when not marketed as a drug (per the FDA's definition), is currently legal in the United States. The recent FDA announcements (see: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm608447.htm & https://www.fda.gov/newsevents/publichealthfocus/ucm584952.htm ) concern kratom's (mitragyna speciosa's) sale with advertising/claims about its efficacy for problems such as opioid withdrawal and pain management, among others.

Reference #7 does not contain information stating that sale of mitragyna speciosa is illegal; referenced PDF is just a letter from the FDA about the supplement, based on a mitragynine extract, "Mitrasafe" http://www.mitrasafe.us/ and its illegal marketing as a drug "because it is intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease."

My account does not have the necessary history to make this change, but please edit:

US: Drug of Concern,[4] sale is illegal[7]

to

US: Drug of Concern[4]

or perhaps "sale as a drug is illegal[#]" with reference to above-mentioned FDA release: https://www.fda.gov/newsevents/publichealthfocus/ucm584952.htm — Preceding unsigned comment added by Chase2534 (talk • contribs) 02:22, 9 September 2018 (UTC)

Extended-confirmed-protected edit request on 6 November 2018

I think a comparison needs to be noted in the 'adverse effects' section to better conform with the pages for the constituent molecules; i.e. mitragynine and 7-OH-Mitragynine. The respiratory depression subsection could be enhanced. Here is suggestion with reference code:

In murine models, the extracted alkaloids of the Kratom plant are shown to cause an insignificant amount of drug induced respiratory depression, unlike full μ-opioid agonists.

Thanks Callahan82 (talk) 17:27, 6 November 2018 (UTC)

References

 Not done see WP:MEDRS / WP:MEDANIMAL. Alexbrn (talk) 17:34, 6 November 2018 (UTC)

Extended-confirmed-protected edit request for Photo on 6 November 2018

The main photo at the top of the page is not powdered kratom. It's chopped leaves called stem-and-vein. An exxcelt example of kratom leaves and powder is shown in this article (about half-way down): https://www.huffingtonpost.com/entry/kratom-death-overdose-reports_us_5b6c8ce7e4b0530743c82c60

Thanks Callahan82 (talk) 17:37, 6 November 2018 (UTC)

yep, not powder. Jytdog (talk) 18:27, 6 November 2018 (UTC)

There is no available image of powder at Wikimedia Commons. This one is an advertisement. --Zefr (talk) 18:45, 6 November 2018 (UTC)

* Adverse Effects (addition): Pregnancy

CNN article, November 8, 2018: "She drank kratom tea while pregnant. Then her newborn went into withdrawal" The mother was rehabilitated from addiction to opioids and she had "no other drugs" in her system at the time of the child's birth, other than the kratom. "Her husband told doctors that she drank kratom tea daily to treat her withdrawal symptoms and help with sleep." Her son was born "in withdrawal: jittery, screaming and requiring an infusion of morphine to stay alive", termed neonatal abstinence syndrome. LaEremita (talk) 11:10, 8 November 2018 (UTC)

Not a reliable source for adverse effects. Alexbrn (talk) 13:24, 8 November 2018 (UTC)

Reference [18] leads to an error page - and some notes.

The evidence you people have put forth that one can overdose off of Kratom is quite spurious and is not provided in any of the references you have given. Nor the references within those references. — Preceding unsigned comment added by 65.88.88.75 (talk) 16:11, 5 October 2018 (UTC)

The sources are also fine per WP:MEDRS and WP:RS as is relevant. Fixing the Mitragynine toxnet link, thanks for that...Jytdog (talk) 16:19, 5 October 2018 (UTC)

To add to the comment made on Oct 5, it appears the link has been fixed, however neither of those sources say that "Deaths have occurred with kratom... by itself" as the article states. This is an issue as anyone that reads this fake news and checks the sources will rightly become suspicious of anything that indicates that Kratom is deadly, which it may be. False information has been a major issue with recreational drug use in the past ("can't that stuff kill you?" "No, that's just hype- I double checked"). Additionally, anything citing this article can be quickly identified as false. Please try to keep Wikipedia credible, and understand that factual accuracy is paramount on subjects of life and death. — Preceding unsigned comment added by 76.92.162.68 (talk) 19:01, 15 November 2018 (UTC)

Extended-confirmed-protected edit request on 27 October 2018

"in 2014, the FDA banned importing and manufacturing of kratom as a dietary supplement" This is not true as it was not taken off of dietary supplement list. Article states that kratom was illegal in Tennessee. That was true until July 2018 when it became legal for anyone over the age of 21. 216.170.4.230 (talk) 03:27, 27 October 2018 (UTC)

 Not done: please provide reliable sources that support the change you want to be made. --DannyS712 (talk) 03:43, 27 October 2018 (UTC)

Your list of states in which kratom is not legal is inaccurate. In December 2017 the TN Attorney General issued an official opinion that, "Possession of the Kratom plant in its natural botanical form should not subject a person to potential criminal prosecution under Tennessee law. The Kratom plant in its natural botanical form is not a prohibited controlled substance under Tennessee law". As of July 2018 kratom in TN is legal for adults over the age of 21. As of April 2017 kratom in RI is on their list of controlled substances.

Please change "As of March 2018, Alabama, Arkansas, Indiana, Tennessee, Vermont, and Wisconsin had made kratom illegal," to "As of March 2018, Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin had made kratom illegal. In December 2017, the TN Attorney General stated that kratom in its natural botanical form is legal and in July 2018, TN mandated that kratom must be properly labeled and the minimum age to purchase is 21." OR simply remove Tennessee and add Rhode Island "As of July 2018, Alabama, Arkansas, Indiana, Vermont, Rhode Island, and Wisconsin had made kratom illegal."

SECTION 10. Tennessee Code Annotated, Section 39-17-452(a), is amended by adding the following as a new subdivision (a)(3): (A) lt is an offense for a person to knowingly: (i) Sell, or offer for sale, Kratom unless labeled and in its natural form; (ii) Distribute, sell, or offer for sale, Kratom to a person under the age of twenty-one (21) years; or (iii) Purchase or possess Kratom if under the age of twenty-one (21) years. (B) For purposes of this subdivision (a)(3) (i) "Labeled" means a label containing the manufacturer's information and a warning that includes, at a minimum, 'Warning: Do not use if you are pregnant or nursing. lt is illegal to possess Kratom if under 21 years of age. Consult your healthcare professional before using. Do not combine with alcohol or medication. Consult a doctor prior to usage if you have any heart disease, liver disorder, high blood pressure, or medical condition or take medication."; and (ii) "Natural form" means dried, cut, and sifted Kratom leaf or raw Kratom leaf powder. Tarragonfizz (talk) 22:26, 17 December 2018 (UTC)

References

 Done -- /Alex/₂₁ 23:51, 23 January 2019 (UTC)

under =Death=

"In one autopsy, substantial levels of mitragynine and the psychostimulant, propylhexedrine, were found in the blood sample."

In my opinion this is misleading. The case report mentions the presence of mitragynine as well as numerous other drugs. The cause of death was ruled propylhexedrine toxicity. "Mitragynine may have contributed as well, but as there are no published data for drug concentrations, the medical examiner did not include mitragynine toxicity in the cause of death."

References

"Mitragynine may have contributed as well" <- this is why it's relevant. Alexbrn (talk) 07:07, 2 March 2019 (UTC)

Kratom

https://www.sciencenews.org/article/herbal-supplement-kratom-comes-risks

It was stated on the Wikipedia page that mitragyna speciosa(Kratom) causes respiratory depression, it is a opiate. These are not true facts. I came across this article that states otherwise. Please update and fix. You could say it could be a opiate but still not known. Just a little consideration because this medicinal plant is life saving. Not for me personally but family and friends that are still here after a long standing battle with opiate addiction. All deaths related to Keaton were just as , related. Not the cause and if you mix any kind of drugs that are going to adversely interact or slow breathing it can kill you. Kratom itself doesn't cause this. Thank you so much and have a good day. Any of people want to chime in feel free. — Preceding unsigned comment added by 96.245.24.225 (talk) 01:41, 23 April 2019 (UTC)

The above was left at WP:AN. A talk page watcher may be interested in responding to it. --Izno (talk) 01:55, 23 April 2019 (UTC)

The article section on Respiratory depression here gives a balanced view about the increased risk that high-dose kratom may cause through its activity at mu-opioid receptors (making it an "opiate drug"): "Respiratory depression is a major risk with opioids, especially those that have activity at the mu-opioid receptor." Systematic research of this kratom mechanism in the brainstem (controls breathing) has not been done extensively, as explained in the Pharmacology section. But respiratory depression as a serious adverse effect (or death) from excessive or high-dose kratom use does occur, and has been discussed as a concern by the FDA in a 2018 statement, and as shown in this 2019 poison center report (See under Clinical effects and therapies). The Discussion of this report makes it clear that high-dose use increases the risk for respiratory depression. --Zefr (talk) 02:48, 23 April 2019 (UTC)

A look through the talk page archives shows that this issue keeps being brought by various IPs and new accounts but never gains any traction. Do you have anything new to add? --Calton | Talk 01:58, 25 April 2019 (UTC)

Are we sure Kratom causes psychosis? See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5138496/

Impossible to Verify Sources

20. Mari A. Schaefer (April 13, 2019). "CDC: Kratom linked to 91 U.S. overdose deaths". Lodi News-Sentinel. The Philadelphia Inquirer. p. 16.

There is no link to this document, if it exists. Suggest it be removed unless a link can be provided. Given the recency of the article (April 2019) this shouldn't be a problem if the source is indeed legitimate.

Further, are "Lodi News-Sentinel" and "The Philadelphia Inquirer" being presented as the same source or is this just sloppy sourcing intended to direct the reader to two (2) different sources, both of which allegedly make the same claim? 72.182.56.62 (talk) 21:48, 7 May 2019 (UTC)

72.182.56.62 (talk) 21:44, 7 May 2019 (UTC)

Re: "Sale is illegal"

Where in the FDA warning letter does it indicate that Kratom is illegal in the US? It says that new drugs are not supposed to be sold for interstate commerce, but intrastate commerce (i.e: commerce at the state level) isn't mentioned. — Preceding unsigned comment added by 192.69.253.115 (talk) 06:06, 9 April 2019 (UTC)

Addendum to the above edit:

This is a recurring issue dating back to 2016 with Wikipedia editors on this particular topic. There are more than a few problems with the "fact" as it is presented as well as the citation and FDA correspondence letter provided (Link #7 in footnotes). I will list them in the order of their importance to Wikipedia's stated and implied mission of providing bias-free, encyclopedic content based on sound sources, valid science, and good faith reader/editor participation in service to the general public.

1. First and foremost, contrary to the "fact" provided in the table on the right margin of the page, kratom is not illegal according to the federal government of the United States of America. A few states have passed legislation in favor of criminalizing it, and others have passed legislation protecting it. Wikipedia is presenting one-sided and incomplete information and, despite rules to assume good faith, that is no longer possible for this particular article/entry - at least with the editor or editors who have refused to make/allow this change - given the number of times it has been pointed out and requested since 2016.

2. A word search of the letter to/regarding the vendor in question does not return any mention of the words "illegal", "not legal" or any variation thereon, and makes no claims to the legality of kratom in a general or specific sense. This letter is presented out of context and in bad faith.

Further, the FDA is a regulatory agency with the purview to approve or deny product across a range of categories access to the national market. It does not have the unilateral power to declare plants or substances "legal" or "illegal" nor can they unilaterally place "controlled substances" on the existing schedule or impose direct criminal penalties. Nevertheless, even if they had these powers, they did not make the claim that "kratom" was illegal in any form or fashion in the letter.

3. The vendor correspondence from the FDA is only intended to address a 99% pure extract of some kind, not . To wit:

This letter responds to recent correspondence regarding the new dietary ingredient (“NDI”) notification for the ingredient “Mitrasafe,” submitted by Industrial Chemicals, LLC, on behalf of INI Botanicals on September 8, 2016, to which FDA responded on December 20, 2016 (the “Response Letter”). The notification described Mitrasafe as a greater than 99% purity extract of mitragynine from the dried leaves of Mitragyna speciosa Korth, commonly known as kratom. Mitragynine is one of the principal bioactive alkaloids in kratom.

In fact, it was also inferred that the manufactured product in question contained adulterants (meaning substances other than those which would naturally occur in kratom leaf or that would be expected in such a product if it were pure):

As a result, the Response Letter warned your client that “your product may be adulterated” and that introducing an adulterated product into interstate commerce would violate 21 U.S.C. §§ 331(a) and (v). Id.

This article is due for a re-write and inclusion of other information that is countervailing to the claims made herein, and which is peer reviewed and/or accepted by a range of medical professionals, and/or which comprises recognized expert opinion on the kratom leaf from a highly regarded research-based position in addiction and abuse science. Please allow an unbiased editor access to make the suggested changes and ensure that another editor is not going to unilaterally remove them with no discussion on the matter.

72.182.56.62 (talk) 22:09, 7 May 2019 (UTC) 72.182.56.62 (talk) 22:14, 7 May 2019 (UTC)

Biased

Over 20 observational studies published in respected, peer reviewed journals are excluded presumably because they do not fit the narrative. These are authored by Oliver Grundmann, Darshan Singh, Marc Swogger, Jack Henningfield, and others and refute some of the information spouted by non-scientific sources. Mako7717 (talk) 14:33, 23 July 2019 (UTC)

Mako7717: There is no bias, but rather objectivity based on reviews and government regulations. This is an encyclopedia, not a manual or journal article collating the primary research on kratom; WP:NOTMANUAL #6-8. See the left pyramid at WP:MEDASSESS: observational studies are early-stage, inconclusive, primary research. It is difficult - if not impossible - to conduct thorough, high-quality clinical research on kratom because (as a natural compound) it cannot be patented and remains under restrictive control in most countries, meaning there is no source of the substantial funding needed for the high cost of clinical trials. We rely on the best available reviews in reputable journals. You can add them, if they are not present already. --Zefr (talk) 14:55, 23 July 2019 (UTC)

US legal sales status

The citation does not back up the claim that the sale of kratom is illegal in the United States. It does not even deal with the topic, being an FDA letter that is talking about the legality of making specific health claims about kratom. The FDA doesn't ban drugs, the DEA does. 65.183.175.130 (talk) 18:05, 8 August 2019 (UTC)

As shown in this summary of FDA actions and in this April 2019 agency statement, kratom products are potentially unsafe and are not approved for marketing as a prescription drug or dietary supplement product for which case anti-disease claims are commonly made. Quoting from the first source: "Selling unapproved kratom products with claims that they can treat opioid withdrawal and addiction and other serious medical conditions is a violation of federal law." Fyi: the FDA regulates the drug approval process and monitors marketing of supplements (like those containing kratom), shown here. The DEA is the policeman for enforcing FDA drug regulations and violations, shown here. --Zefr (talk) 20:21, 8 August 2019 (UTC)

I had the same reaction as 65.183.175.130 when I read the article. The single cite of the FDA letter regarding the Mitrasafe extract far from established the completely absolute "sale is illegal" claim. I've changed "Drug of concern, sale is illegal" to "Drug of concern, subject to import bans, and sale for consumption is illegal". I also added cites of the existing FDAImportAlert and fda4-3-19 refs, though it's still not cited as definitively as it really should be. For instance, count how many weasel words appear in this paragraph of the Import Alert:

Districts should be on alert to the possibility that the labeling, marketing, and/or promotion of kratom and kratom-containing products may indicate that such products appear to be unapproved and/or misbranded drugs. For such products, Import Alert 66-41 may be applicable.

It appears to me that sale of kratom or its extract as, say, a paint pigment, would not automatically be illegal on the basis of the product being adulterated, a non-GRAS dietary ingredient, or an unapproved drug.

Also, in the lead, I tagged "In 2019, the FDA warned consumers that kratom remains unapproved for interstate commerce" as {{not in citation}} (nothing about interstate commerce on that page; I didn't check all the articles linked to from there). I also changed "which would lead to confiscation" to "which can lead to confiscation", as per my reading of the Import Alert, product detainment is only automatically approved for the specific named suppliers. --Dan Harkless (talk) 11:14, 30 September 2019 (UTC)

1988

This 1988 paper is too old IMO.

"Researchers have suggested that given Food and Drug Administration approval, kratom could be valuable as an alternative to methadone."

Jansen, Karl L.R.; Prast, Colin J. (1988). of Psychoactive Drugs "Psychoactive Properties of Mitragynine (Kratom)". 20 (4): 455–457: 456. doi:10.1080/02791072.1988.10472519. ISSN 0279-1072. Retrieved 2020-01-10. {{cite journal}}: Check |url= value (help); Cite journal requires |journal= (help)

Doc James (talk · contribs · email) 12:29, 13 January 2020 (UTC)

Weak literature is unencyclopedic

This edit reverted content based on journals with negligible impact factors (i.e., weak and unreliable), and so is justified to remove unencyclopedic content. The Journal of the American Osteopathic Association and International Journal of Drug Policy are listed as unreliable by WP:CITEWATCH; the Journal of Psychoactive Drugs has a low impact factor of 1.6; other sources used were primary research on limited subject numbers.

The topic concerns medical content which needs support by high-quality WP:MEDREV reviews which are absent from the literature. It doesn't matter if weak journals are "peer-reviewed": if they don't pass muster for quality, then the content they represent shouldn't be included. --Zefr (talk) 03:35, 16 January 2020 (UTC)

Statement by major medical organization

This was in the lead "In February 2018, the United States' Food and Drug Administration (FDA) stated that there is no evidence that kratom is safe or effective for treating any condition."

I have restored it as it should be there IMO. Doc James (talk · contribs · email) 07:45, 11 January 2020 (UTC)

The FDA is a politicalaw enforcement organisation and a leading force on the war on drug (Drug prohibition). It is not a "major medical organization".

--37.228.239.167 (talk) 00:39, 14 January 2020 (UTC)

No they are a major medical organization. Doc James (talk · contribs · email) 04:26, 17 January 2020 (UTC)

Reevaluating respiratory depression claims in the wake of 2019 metastudy and Jytdog's resignation

Hi, I argued extensively with Jytdog about various parts of this article and essentially gave up in trauma after constructing awkward "show both sides of the controversy" sentences, like many wikipedians before me. With Jytdog gone, I would encourage editors to be brave as now when following the rules, you won't have to confront Jytdog's anti-plant medicine bias and infinite time to rules lawyer you on wikipedia.

I want to link to my own research previously posted here on the talk page showing that a medical textbook made an error in claiming that kratom causes respiratory depression which was the key citation here for a while.

https://wiki.riteme.site/w/index.php?title=Talk:Mitragyna_speciosa&oldid=prev&diff=742628626#Respiratory_depression

Given wikipedia policy to prefer metastudies/secondary studies strongly with regards to all things medical, I believe the 2019 "Preventative Medicine" study allows us to fix the article and remove respiratory depression as a list of side effects from the lead of the article, and clean up the respiratory depression section of the article in the wake of a Wikipedia ready secondary source. The sentiment I suggest is to keep in the mitragynine causing respiratory depression in animals in high doses section, and to still say that respiratory depression is a concern with all opioids, but a recent scientific review concludes that kratom does not actually cause respiratory depression even though that is to be expected.

I'm still kind of afraid of someone like jytdog showing up and shouting me down and then endlessly stalking me on wikipedia if I boldly make edits so I'll let this sit in discussion for a few days before I start editing. As always, I intend to do so in good faith and hope others that got scared off will join me in trying to make this article better. Kevin143 (talk) 04:36, 29 January 2020 (UTC)

This kind of WP:GRAVEDANCING is rather distasteful, but looking back I am reminded you were attempting to introduce unreliable sources and of course got push back from many editors. Do that again and you'll get the same pushback because the WP:PAGs have not changed to allow unreliably-sourced content (if anything, the mood has got stricter). On the other hand good, well-sourced content is always welcome. Alexbrn (talk) 14:25, 4 March 2020 (UTC)

I maintain that I was helpfully trying to show that a source that continues to be cited on wikipedia is in fact fatally flawed as science. When sources are in fact wrong, it's unhelpful to declare them as canon, just because they are from a source that is normally treated as reference grade. Kevin143 (talk) 05:32, 26 April 2020 (UTC)

If you keep up with the POV-pushing of unreliable content and idiotic edit summaries, you can expect to get sanctioned. Alexbrn (talk) 05:40, 26 April 2020 (UTC)

“Adverse effects” section

I tend to mind my own business on here and try to avoid stepping on anyone’s toes, but what is going on with this section?

The first six paragraphs seem to repeat the side effects over and over. I feel this could be condensed into 2-3 paragraphs that list all the possible side effects (common and rare) and the health effects of long-term usage.

Additionally, regarding overdose and death, wouldn’t it make more sense to make an aggregate of the CDC and AAPCC reports along with the “Death” subsection? Similar to the side effects in the first six paragraphs, this information is very repetitive and could be condensed into a new subsection titled “Overdose and death”.

The salmonella outbreak doesn’t belong in this section, as it’s not an adverse effect. It’s technically an adverse event. Plus, it’s already mentioned in the regulation section, which is the most appropriate place for it.

Lastly, why are there individual subsections for “Respiratory depression” and “Liver toxicity”? It says they are rare/low risk and poorly studied/lacking evidence, so wouldn’t it be more appropriate to mention them along with the other rare side effects?

Again, I’m not here to step on any toes or start an argument, so I won’t be upset if no one agrees with anything I said. Just wanted to add my 2 cents. MiddleAgedBanana (talk) 16:51, 21 March 2021 (UTC)

Agree it seems a bit baggy. This may be a result of previous conflicts on this article with Mitragyna boosters trying to remove mentions of side-effects, and a countevailing push-back. Would be good to see things fettled. Alexbrn (talk) 17:21, 21 March 2021 (UTC)

Misleading and inaccurate information

First of all, thanks to everyone who has contributed to this page. There is a lot of great information here. However, some statements on this page are, in my opinion, misleading and/or not providing the full picture of the current state of research on kratom. As some examples:

1) The article claims that kratom causes psychosis, and cites a DEA report that in turn cites a 1975 paper that describes five cases of psychosis in people with a history of using kratom. However, according to a 2017 toxicology textbook, causality has not been established in these cases. Likewise, a 2018 systematic review found that "Apart from kratom dependence, available studies give no indication that kratom causes psychopathology." Moreover, a 2019 study found no causal association between kratom use and psychosis in a sample of 150 people who use kratom. I think that this page would be improved if we at least qualify the claim that kratom causes psychosis by mentioning that evidence for this claim is mixed.

2) The article claims that kratom causes respiratory depression, which does appear to be possible in overdose. However, I think that it would be more accurate and more neutral to mention that respiratory depression associated with kratom is relatively rare (less than 3% prevalence according to one study), and generally less severe than that associated with classical opioids. As a 2017 paper writes, "Although there has been little systematic study of the pharmacodynamic effects of kratom, there is little clinical or scientific evidence of respiratory depression, and this would be consistent with the absence of documented overdose deaths attributable to kratom." According to a 2014 toxicology textbook, no studies have directly examined the effects of kratom on respiration in humans. I think it would be helpful to qualify the claim that kratom causes respiratory depression by mentioning some of these sources so that this article is more scientifically and medically neutral.

3) The article implies that kratom may cause death, but this claim is highly controversial in the scientific literature. As a 2019 article in the journal Pharmacotherapy writes about this claim being made in a different paper, "First, the authors note that kratom has been used for centuries in Southeastern Asia but ignore the fact that there has never been a reported kratom-related death in the region. [...] This is particularly important since kratom, unlike classical opioids, has no known mechanism for causing death." According to a 2018 paper, "Kratom exposure alone has not been causally associated with human fatalities to date." A 2019 paper writes that "Kratom-poisoning deaths have not been confirmed but are suspected." A secondary source (2018 phytomedicine book) contains the following sentence: "While a picture is emerging of the dependence potential of kratom, how toxic it may be and whether kratom has the ability to kill users is still a matter of debate." So, while the current page is not exactly wrong in claiming that kratom use has been associated with death, it is in my opinion highly misleading and not fully representative of the current state of research on this subject. I think that it would be helpful to qualify the claim that kratom causes death by mentioning some of these different perspectives in the literature.

I could go on, but I hope that anyone reading this can understand why it is my opinion that this article does not seem very neutral. You can see from the edit history and earlier Talk pages that I am not the first to notice this. Is there any way we can find a way to agree about how to incorporate some of this research while making sure that sources are reliable? Thanks, A122045fma (talk) 01:43, 17 June 2021 (UTC)

References

If the article needs updating and there are good WP:MEDRS sources, great! But what you are doing is edit warring piling primary research into the article, which is not acceptable. I shall raise a query at WT:MED. Alexbrn (talk) 15:36, 17 June 2021 (UTC)

I certainly do not mean to have started an edit war and apologize for the disruption. Let's find a way to work together to resolve our editing conflict. I have seen many Wikipedia pages with Research sections that allow primary sources to keep the page up-to-date with current research, and would like to include a Research section on the kratom page. I am doing my best to try to keep this section neutral by following the guidelines for primary sources. It seems unreasonable to state that I cannot include any primary sources at all in a page on a subject with active research. What can I do to compromise so that we can allow this page to have a Research section? All the best, A122045fma (talk) 16:51, 17 June 2021 (UTC)

If active research is worthy of inclusion, generally it will be mentioned in secondary sources. WP:WHYMEDRS and WP:MEDFAQ, although not part of the WP:PAGs, may be useful background reading. It's true other articles contain primary sources, but there are many problem articles on Wikipedia. Alexbrn (talk) 04:08, 18 June 2021 (UTC)

Thanks again for the help, I appreciate it. I'm still noticing some major issues with the scientific neutrality of the current page, though. As one example from above, the current page claims that "More severe side effects may include [...] psychosis." It appears that the references provided for this claim are a 2013 DEA report and a 2014 literature review. However, a more recent secondary source (2017 toxicology textbook) explains that it is unclear whether kratom use can directly cause psychosis. Because of this discrepancy between reliable sources, I think it would be a good idea to add a sentence like the following: "However, in case reports associating kratom use with psychosis, it remains unclear whether kratom use directly caused psychosis." By claiming that kratom use causes psychosis, the current page is taking a non-neutral position in an active scientific debate involving much uncertainty. In other words, this page is not as scientifically neutral as possible regarding the ability of kratom to cause psychosis. That's my opinion, at least. All the best, A122045fma (talk) 13:02, 18 June 2021 (UTC)

References

Updating the article with good sources would be great, and if different reliable sources say different things give both views and attribute the. The article also cites pmid:26511390 for the psychosis claim. All we need to do is reflect the sources faithfully and NPOV will naturally improve. Alexbrn (talk) 13:10, 18 June 2021 (UTC)

True, thanks for being open-minded about these changes. The paper you mention raises another point. According to this paper, "Some reports indicate that users may become addicted to kratom. However, contradictory data exists concerning the degree of addiction that is experienced due to kratom use. [...] Despite being opiate-like, withdrawal symptoms are generally nonexistent to mild, even for heavy users." I think that we should somehow mention this point somewhere in the article, since the relatively mild nature of withdrawal symptoms compared to those of classical opioids is often reported to be a major reason for kratom use in opioid use disorder. This paper also lists increased alertness, physical energy, talkativeness, sociability, sedation, mood relief, and pain relief as possible effects at various doses. I think that mentioning some of these effects in the lead section would help the current page seem more balanced, as the current page seems to focus almost entirely on the negative effects while omitting many of the positive or neutral effects reported in this paper and elsewhere. I think that the lead section would be more balanced if we list some of the other effects mentioned in this paper, as they seem to be popular reasons for kratom use. Thanks, A122045fma (talk) 15:57, 18 June 2021 (UTC)

Cool - WP:SOFIXIT. It doesn't matter what we say about this topic except that claims, especially health claims, ideally need to be backed by reliable sources (high-quality, secondary, peer-reviewed and reputably published). If it's different from what the article says now, fine - Wikipedia is only meant to be a summary of accepted knowledge as found in reliable sources. I'll add too that the WP:LEDE should be nothing more than a summary itself of points already discussed and sourced in the article body. Alexbrn (talk) 16:06, 18 June 2021 (UTC)

I went ahead and made some of the changes I'd like to see for neutrality, so feel free to let me know if you see any problems with what I've written. I'd rather talk about them here than get into an edit war or participate in disruptive editing. All the best, A122045fma (talk) 23:00, 18 June 2021 (UTC)

RfC: Is the kratom page as scientifically neutral as possible as of 2021?

The following discussion is an archived record of a request for comment. Please do not modify it. No further edits should be made to this discussion. A summary of the conclusions reached follows.

Resolved. A122045fma (talk) 22:51, 25 June 2021 (UTC)

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Should the "Death" section note that there is scientific controversy about the precise mortality risk of kratom? Some sources describe deaths associated with kratom but other sources state that causality has not been established in these cases. Should we explain that different sources make different claims about this subject? Thanks, A122045fma (talk) 14:39, 19 June 2021 (UTC)

References

Discussion

• Not sure why there's an RfC about this since there seems to be no dispute. Follow the sources and if different good sources say different things, then WP:YESPOV is your friend. Alexbrn (talk) 15:06, 19 June 2021 (UTC)

  Thanks -- this RfC wasn't directed at the earlier editing dispute, since I agree that we've resolved it. I thought that an RfC could be used to request outside feedback before making potentially contentious edits, not only to resolve editing disputes. Is this an incorrect understanding of the RfC process? If I'm trying to get more outside feedback on the kratom page for neutrality, what would be the normal editing process for this? Should I end this RfC and ask for feedback at a related WikiProject? Sorry if I'm going about this in the wrong way. A122045fma (talk) 16:23, 19 June 2021 (UTC)

  I'm not aware of contentious edits in dispute (unless you're planning to make them!) The policy at Wikipedia is to be WP:BOLD and if that gets pushback then discussion may be necessary. Edits backed with unimpeachable sources are rarely problematic. Alexbrn (talk) 16:29, 19 June 2021 (UTC)

  agree w/ Alexbrn--Ozzie10aaaa (talk) 23:11, 20 June 2021 (UTC)

  @A122045fma: Yes, WP:BEBOLD but if you are unsure then by all means keep the discussion going and advertise it to any or all of the WikiProjects tagged at the top of this page (use {{fyi|pointer=y}} or similar), but please read WP:RFCBEFORE. --Redrose64 🌹 (talk) 07:43, 20 June 2021 (UTC)

  @Alexbrn: No contentious edits planned at the moment, just trying to be careful. :) @Redrose64: Thanks for the help, will do. A122045fma (talk) 19:59, 20 June 2021 (UTC)

  @A122045fma: I removed your {{fyi|pointer=y}} from this page, because that's not how it is used. You would put it at the beginning of a notice on another page, together with a link back here, in order to notify that other page of this discussion. See for example Wikipedia talk:WikiProject Doctor Who#Deriving an episode/serial number, Wikipedia talk:WikiProject Accessibility#RfC about the colour schemes used for professional wrestling navigational templates or Wikipedia talk:Requests for comment#Merge proposals. --Redrose64 🌹 (talk) 11:14, 22 June 2021 (UTC)

  @Redrose64: Makes sense (still new and learning how to format things here). Thanks for the examples. A122045fma (talk) 13:21, 22 June 2021 (UTC)

• Thanks for being cautious but I agree that an RFC does not seem to be needed at this point. North8000 (talk) 11:22, 25 June 2021 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Preclinical research

The current page writes that "There is no scientific evidence that kratom is safe or effective for any medical condition, as of 2021, and concerns remain about its safety." However, a 2021 systematic review writes the following: "Since six preclinical studies gave evidence for two potential therapeutic uses, the related content will be described in each specific section of the results. [...] Among the records included in this analysis (N = 75), 24% provided data in humans, while 76% supported its potential therapeutic use in the treatment of either acute and chronic pain (41%), substance use disorders (25%), such as morphine withdrawal and dependence, ethanol withdrawal, seeking behavior and intake; and other medical conditions based on several kratom effects (46%). Two out of the 18 clinical studies reported evidence of potential therapeutic application in pain. [...] Taken together, our findings help to explain, but not endorse, the empirical medical use reported by kratom users in non-medical settings in both Asian traditional and Western countries, suggesting that kratom could be a useful aid in the treatment of acute/chronic pain, opioid and substance use disorders, and psychiatric disorders. [..] Although the initial (pre)clinical evidence on kratom's therapeutic potential and its safety profile in humans is encouraging, further validation in large, controlled clinical trials is required."

Therefore, I'd like to change the statement on the current page to reflect the fact that kratom is being studied for therapeutic potential. I think that it would be more scientifically neutral to write the following: "A 2021 review of preclinical studies concluded that evidence on kratom's safety profile and therapeutic potential is encouraging, but noted that further clinical research is required to validate these findings." This statement is very close to the conclusion of the cited source. I would like to make this edit so that this page is both accurate and scientifically neutral as of 2021. I've attempted to make this edit, but it was quickly reverted to a statement that I do not find to be accurate as of 2021. Clearly, there is evidence for therapeutic potential as of 2021 according to this systematic review. Should this page be updated with the proposed edit? Thanks, A122045fma (talk) 11:47, 7 August 2021 (UTC)

We shouldn't include FRIN-type content per MOS:MED, and that's all this really amounts to (with the added problem of smudging "pre-clinical" research into sounding like it's clinically applicable). Alexbrn (talk) 12:00, 7 August 2021 (UTC)

You're right, thanks for the feedback. Perhaps we can compromise with the following statement: "A 2021 review of preclinical studies concluded that evidence on kratom's safety profile and therapeutic potential is encouraging, but there is no clinical evidence that kratom is safe or effective for any medical condition as of 2021." The main problem I see with the current version of the page is that there is in fact scientific evidence that kratom could be relatively safe and effective for certain medical conditions. Nine out of the eighteen clinical studies in this review found no safety issues, and those that did often reported relatively minor safety issues (see Table 2). Many of these studies found that kratom was more effective than placebo for various medical conditions. I think it's fair to mention this research as long as we do not make medical claims, and distinguish between preclinical and clinical research. What would you think about this edit? A122045fma (talk) 12:20, 7 August 2021 (UTC)

The source doesn't conclude that the safety profile is encouraging, rather the opposite. It also says "Until now, mitragynine and kratom's benefits and safety profile remain largely anecdotal", which doesn't make any sense. This is not a great source. Alexbrn (talk) 12:29, 7 August 2021 (UTC)

I respect your opinion, but this seems like a disingenuous statement. As a word-for-word quote from the conclusion section of this study, "Although the initial (pre)clinical evidence on kratom's therapeutic potential and its safety profile in humans is encouraging, further validation in large, controlled clinical trials is required." This is a peer-reviewed systematic review published in a reputable scientific journal. It's perfectly okay to have the personal opinion that this is not a great source, but I'd like to keep this page neutral by reflecting what secondary sources actually say. There are other sources used in this page that I feel are not great sources, but I'm letting them be since they are reputable secondary sources. We can open a request for comment if needed. Thanks, A122045fma (talk) 12:39, 7 August 2021 (UTC)

I think before you start throwing around words like "disingenuous" you should make sure you aren't saying untrue things. Those words are not in the conclusion, but the abstract. Please read WP:NOABSTRACT and refrain from trying to go personal. Let's see what other editors think. Alexbrn (talk) 12:45, 7 August 2021 (UTC)

You're right. As a word-for-word quote from the conclusion from the manuscript, "[...] kratom could be a useful aid in the treatment of acute/chronic pain, opioid and substance use disorders, and psychiatric disorders." I don't understand how WP:NOABSTRACT relates to this. I am not citing the abstract without reading the rest of the paper. According to WP:NOABSTRACT, "However, when it comes to actually writing a Wikipedia article, it is misleading to give a full citation for a source after reading only its abstract; the abstract necessarily presents a stripped-down version of the conclusions and omits the background that can be crucial for understanding exactly what the source says, and may not represent the article's actual conclusions." This article clearly concludes by suggesting that kratom may have therapeutic potential, so I do not feel as if I am misrepresenting the article's actual conclusions. I'm wondering if I should post this to the dispute resolution noticeboard or neutral point of view noticeboard. All the best, A122045fma (talk) 12:56, 7 August 2021 (UTC)

The abstract has the usual[10] problems. The article's conclusion is more circumspect without any "encouraging" embellishment, and its "could be a useful aid" tells us little more than we already say about drug investigations is progress. Let's give it a day or two to allow other editors to give a view, and then see if further resolution is needed. Alexbrn (talk) 13:10, 7 August 2021 (UTC)

Sounds good. I'll wait to see what others say before posting this anywhere or starting an RfC. Sorry for making a comment that sounded personal. We're both doing our best, and "disingenuous" probably wasn't an ideal word to use here. Thanks again for the help, A122045fma (talk) 13:20, 7 August 2021 (UTC)

https://wiki.riteme.site/wiki/Mitragyna_speciosa#Death

in the death section the wording is unclear or there is a factual mistake. below are quotes that highlight this: "Between 2011 and 2017, forty-four deaths were kratom-related" "Over 18 months in 2016 and 2017, 152 overdose deaths involving kratom were reported in the United States"

92.29.239.14 (talk) 17:02, 22 January 2022 (UTC)

References

 Not done for now: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format. casualdejekyll 02:25, 3 February 2022 (UTC)

Kratom is not 'opioid like', it is an opioid as it is exclusively acting on the opioid receptors in brain.

Kratom is not 'opioid like', it is an opioid as it is exclusively acting on the opioid receptors in brain, that's explicitly defined as being an opioid. Am i allowed to change the description of Kratom appropriately or do i need to add sources that will back this up? I am not that familiar with Wikipedia rules even though i read them, so i am not sure. This definition is already present on Wikipedia, does it still require an external reference? LatekVon (talk) 18:03, 15 July 2023 (UTC)

@LatekVon: Hi there, thanks for wanting to edit Wikipedia! You will need sources to back up a change like that, see WP:MEDRS for guidelines on what counts as reliable sourcing for biomedical information (I am not an expert in the topic area, but I believe your changes would fall under that). Thank you! GnocchiFan (talk) 13:50, 27 July 2023 (UTC)

Requested move 27 July 2023

The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: not moved. (closed by non-admin page mover) – MaterialWorks 20:35, 3 August 2023 (UTC)

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Mitragyna speciosa → Kratom – Usage has changed significantly since last move request - compare ngrams English (2012) and English (2019). By far now the common name. GnocchiFan (talk) 13:46, 27 July 2023 (UTC)

• Oppose per WP:FLORATITLES and because the WP:BESTSOURCES generally use the scientific name. Bon courage (talk) 14:23, 27 July 2023 (UTC)
• Oppose: I would favor converting "kratom" from a redirect to a separate article that exclusively discusses the leaf product, its pharmacology, and other such details. There is ample precedent for this, including the articles Nicotiana tabacum versus Tobacco, Cannabis versus Cannabis (drug), Vanilla (genus) versus Vanilla, Yerba mate versus Mate (drink), and so on. The Nicotiana/tobacco dichotomy is an especially close parallel, where the plant and its leaf product are given separate articles (kratom is a product made from the leaves of Mitragyna speciosa, tobacco is a product made from the leaves of Nicotiana tabacum). It's genuinely helpful to have separate articles in cases like this. One place where this was not done - if you look at Salvia divinorum - the article is a mess. In fact, if others agree that a split into two articles is preferred, I'd be happy to do that if no one else is. Dyanega (talk) 15:17, 27 July 2023 (UTC)

  Thanks for your detailed reply, very much appreciated! I agree that a split here is probably the best way forward. GnocchiFan (talk) 20:13, 27 July 2023 (UTC)

• Oppose, move, supporting splitting an article on the leaf product at the title kratom. Plantdrew (talk) 18:50, 1 August 2023 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Split

Given the discussion closure, I'm going ahead now with the split. I intend to remove almost all of the material referring to the leaf product from the article about the plant. I'll do my best to make sure that no content is lost, though there may be a little duplication. Dyanega (talk) 21:30, 3 August 2023 (UTC)

Revertd. While I think such a split could be a good idea (though it's unclear if there's consensus for it), what happened was that although the edit summary said content was 'moved' to the new location, it was substantially altered in transit giving a weak too-short lede. If it's going to be done it needs to result in a decent initial article without obvious problems like this. Also note that copying within Wikipedia requires certain forms of wording to avoid copyright violation. Bon courage (talk) 04:44, 4 August 2023 (UTC)

Frankly, that was very rude. If you didn't like the new article(s), the proper way to address it would be to edit them, not revert them without discussion. Basically, what you just did was to merge two articles without ANY discussion of your proposed merge. Also, I did not add any content, so if there were copyright issues, they were already present in the existing article. Dyanega (talk) 15:16, 4 August 2023 (UTC)

Please read the link carefully about copying within Wikipedia, and note that WP:BRD is standard practice and not "vey rude". While the split may be a good idea, unilaterally creating an entirely new kind of article with which loses most of the lede is another thing entirely, and would need discussion. Bon courage (talk) 15:24, 4 August 2023 (UTC)

Family of US woman who died from ingesting kratom wins $11m damages

This article could be referenced https://www.theguardian.com/us-news/2023/jul/30/florida-woman-kratom-damages-judgment Chipotle (talk) 12:54, 30 July 2023 (UTC)

Odd. Don’t the bottles/containing packages of Kratom say “not tested/safe for human consumption” ?¿ 2600:6C55:7EF0:8E20:C588:B9D3:70FC:C9DC (talk) 17:06, 23 August 2023 (UTC)