[mrestko]

The title is not good--lots of meds are betting than morphine...that's why we have all the other opioids: hydromorphone, fentanyl, remifentinil, sufentinil, oxycododone, etc.

If you look at the Nature abstract linked from the news article, all they claim there is that the analgesic effects can be, "as strong as morphine."

This also a protein which is inherently more expensive and difficult to turn into a drug compared with a small molecule.

[Symbiote]

Also diamorphine (heroine), which has several advantages over morphine and is used medically outside the USA.

[samhw]

Yup, it's used widely in end-of-life care here in the UK (I remember my mum once saying to me, when we were discussing euthanasia, that there's no doctor in the country who hasn't 'accidentally' given a little too much diamorphine to someone who was on the verge of death and in pain).

It's useful, but I imagine it's tainted in the US by the association with street heroin - somewhat curiously, since fentanyl apparently hasn't been tainted by its recreational associations.

[stordoff]

I've no idea how often it is done with the intent to end life, but doctors are legally allowed to give doses of medication that may hasten death, providing their intention is only to relieve pain and suffering - https://en.wikipedia.org/wiki/R_v_Adams_(1957)

It can be argued[1] that only doses that are virtually certain to cause death lead to liability for the death, so no doubt there is some overlap between doses given to relieve pain and those that quicken death.

Diamorphine is also sometimes used for labour pain.[2]

[1] https://www.uhs.nhs.uk/HealthProfessionals/Clinical-law-upda...

[2] https://www.nhs.uk/pregnancy/labour-and-birth/what-happens/p...

[samhw]

Indeed, you're referring to the doctrine of double effect (which the linked Wikipedia article on R v Adams mentions).

That said, I don't think "[only] doses that are virtually certain to cause death lead to liability for the death" is correct. You had it right the first time: the relevant fact is not whether it's likely or even certain to cause death, but rather whether causing death is the primary intention. (I'm not a lawyer, though, I'm just speaking on the basis of my knowledge as a lay person.)

[rich_sasha]

For a popular magazine that seems fine... analgesic as strong as morphine + fewer side effects = better overall ... no?

[mrestko]

It's hard to know what the side effects are since it hasn't been tested in humans and is not in a form where it would be a useful drug. We've had plently of promising drugs turn out to have unexpected and sometimes devestating side effects when tested in humans.

[trutannus]

It's fine, morphine is used as a 'standard' for opiate and other pain killer efficacy. So often that the term 'morphine equivalency' exists in medical documents.

[goldenkey]

Those drugs aren't better, in my experience, as a chronic pain patient. Morphine is way less addictive, longer lasting, with fewer side effects. Not to mention, it's natural, one of the main alkaloids from poppy. Now, I'm not a dolt who thinks natural is better. However, most synthetics are strictly worse from a therapeutic standpoint. This view is based on my experience with them and from my discussions with other patients. From what I understand, the synthetics are pushed on patients for incentives. I had to pretty much demand morphine instead of oxy. Thanks Sackler family!

Morphine XR (MSCont) is also pushed instead of normal morphine, again, I think for similar reasons. Although on the surface, it might seem like an XR would be helpful. Instead it just causes more constipation and doesn't give a great absorption profile.

Morphine IR 30mgs taken throughout the day pretty much vaniquished my pain. These days though, I use Kratom, Mitragyna Speciosa. It's as effective as morphine with less side effects. I also try to work out every day. Having strong muscles in the painful areas seems to help with the pain, either due to increased blood flow or perhaps for other reasons.

Nucynta (Tapentadol) was the most effective synthetic opioid I ever used but without insurance it cost me $3000 a bottle. Kratom is cheap as dirt even without insurance. $70-80 buys 1 kilo / 2.5 pounds of the ground up leaf. I have enough kratom in my cabinets to last a covid apocalypse.

You can get lab tested Kratom that is cGMP certified these days. I have nothing to gain by providing this information, just happy I found a pain reliever that is sustainable and doesn't require talking to a doctor playing a drug pusher every month.

Lots of people have had bad experiences with kratom giving them headaches/nausea. This is largely due to poor quality kratom from head-shops and gas stations or from consuming excessive doses. Never buy Kratom that isn't lab tested with GC/MS. And don't take too much of any opioid unless you want motion sickness.

[tsol]

Surprised this comment is rather downvoted. This view isn't uncommon among pain patients-- such alternatives to opioids are being researched and an article like this appears every so often, but the miracle hasn't panned out. Ziconotide, based on a toxin from a sea snail, is one of the few that have made it through the development process but is still extremely specialized. While it's 1000 times as strong as morphine and non- addictive, there are other considerations with such drugs. Dosing intravenously can cause extremely strong side effects, so the drug is dosed through a pump in the body directly into the spinal fluid. Obviously such an implant must be surgically installed into the patients spine first, which comes with risks of its own. The drug also can cause extreme neurological side effects such as hallucinations, delusions, and suicidal thoughts. For this reason it's contraindicated in those with a history of psychosis, bipolar disorder, or depression. For all these reasons, though it's available it's used as a drug of last resort. Oh and it's quite expensive as well, so it effectively is only available to those who can afford expensive medical treatments. Unfortunately it will still be some time before there are viable alternatives for moderate to severe pain

[goldenkey]

Fascinating peptide, and from snail toxins, amazing, thank you for illuminating it. Apparently metabolism isn't the issue for oral use of Ziconotide, the blood brain barrier is. Researchers are currently working on using viral nanocontainers to transport it past the BBB [1] so that it can be taken less invasively. I find it fascinating that it works on blocking voltage-dependent calcium channels [2], not by agonizing opioid receptors.

It intrigues me that so many natural venoms, toxins, and poisons have analgesic agents as part of their chemistry. What do you think the reason for this is? Would a prey that doesn't realize it is in pain, perhaps struggle and flee less? If this is the case, shouldn't some of these predators have evolved to have pleasurable agents like opioids in their toxins? I suppose it might be hard for their own body to not be affected by it though? I'm gonna have to look into this topic some more. It's really fascinating to see divergent evolution hitting the same motifs.

I'm used to being downvoted, and even flagged. I say things that are deemed too controversial for the average automaton that inhabits HN. Not much can be done, so I've just come to embrace the hate. I'm not a troll but in order to deal with the constant attacks against the truth, one has to develop thick skin and perhaps even some enjoyment over knowing that people are so disturbed and shaken by foreign facts that they instinctively try to bury the newfound knowledge. Such is humanity, and HN has been growing and becoming more and more averse to truth. I hope it does not tip too far, but if it does I'm sure another community will fill the void. All we can do is speak our peace and live to fight another day.

[1] https://www.nature.com/articles/srep12497

[2] https://en.m.wikipedia.org/wiki/Conotoxin

[yung_steezy]

I've read that that stuff is bad for your liver. Worth keeping an eye out for signs of jaundice.

https://en.wikipedia.org/wiki/Mitragyna_speciosa#Liver_toxic...

[goldenkey]

Thank you. Most of that, like plant protein powders, is due to heavy metals in the soil the plant is grown in, or adulterants. I've been using Kratom for over 5 years with no elevated liver enzymes. It's actually made me healthier since it, like other dark green leafy vegetables, has many micronutrients and minerals.

NEVER buy kratom from a gas station or head-shop. That's likely where most of incidents stem from.

[samhw]

To anyone reading this: please ignore what this person is saying. Addicts will rationalise everything, and blame every negative side-effect on 'adulterants' or 'low-quality supply' or other varieties of 'stuff I would never do myself, compared to my perfect and healthful regimen'. Kratom is not good for you.

[tsol]

It's easy to pass judgement.

>Kratom is not good for you

Few effective painkiller are. Ibuprofen causes stomach bleeding, acetaminophen has toxic effects on the liver, prescription opiates are even more addictive than Kratom while running the risk of overdose. Ziconotide, what was supposed to be a miracle drug made from sea snail venom requires an invasive body implant to dose directly, and in long term use has a habit of causing suicide and psychosis. In fact it's a drug of last resort. Kratom has some health concerns but it can and is used as pain management in some people. This thread is full of people complaining it wasn't fun or felt strange-- missing the point which is that the point is pain relief is hard to come by

[tsol]

It's easy to pass judgement.

>Kratom is not good for you

Few effective painkiller are. Ibuprofen causes stomach bleeding, acetaminophen has toxic effects on the liver, prescription opiates are even more addictive than Kratom while running the risk of overdose. Ziconotide, what was supposed to be a miracle drug made from sea snail venom requires an invasive body implant to dose directly, and in long term use has a habit of causing suicide and psychosis. In fact it's a drug of last resort. Kratom has some health concerns but it can and is used as pain management in some people. This thread is full of people complaining it wasn't fun or felt strange-- missing the point which is that pain relief is hard to come by

[samhw]

My point isn't that it "isn't fun or felt strange". My point is that it's dangerous and addictive. It's not honest to equate it to the minor hepatotoxicity of over-the-counter NSAID painkillers. Ibuprofen does not have a 25-thousand-member subreddit for addicts trying to quit (https://www.reddit.com/r/quittingkratom/).

[goldenkey]

It's a pain relieving plant. You got problems mate. Go to the nearest pain clinic and start your protest there. Make sure you slap the opioids out of every patient's hands who are suffering from chronic pain. Call them an addict for kicks, even when they have a perfectly normal life.

[gremloni]

Kratom is such a terrible overall experience. I did it recreationally a few times and it’s always headaches and nausea the next day in some kind of hangover that lasts multiple days.

[samhw]

I haven't heard of kratom being used by non-addicts, so I'm not surprised you wouldn't like it - it's like a non-smoker using nicotine patches. It's mainly used by people detoxing from stronger opioids.

I did it when I was coming off heroin (locked myself in my parents' country house for a fortnight or so, took ibogaine and kratom for withdrawals, came out fatigued but basically well). Even then, I found it extremely acrid and unappetising, and not even the resulting 'high' was particularly pleasant. I wouldn't ever take it if I weren't experiencing brutal heroin withdrawals.

[goldenkey]

You took ibogaine, a drug known to be cardiotoxic. You are a former heroin addict that is projecting your inability to use medicine responsibly onto other folks with medical conditions.

You talk about a high despite me never mentioning getting high, only the pain relieving effects. I could care less about a high. I use Kratom medicinally to help me live a better life.

I am sorry you took pain relieving agents and misused them. I'm sorry you thought street drugs like heroin were suitable quality and safe. I'm sorry for the pain you endured when withdrawing from these drugs. Now, I'm sorry you are projecting all of this on responsible users of much safer therapeutic agents.

[goldenkey]

Lots of people have had bad experiences with kratom giving them headaches/nausea. This is largely due to poor quality kratom from head-shops and gas stations or from consuming excessive doses. Never buy Kratom that isn't lab tested with GC/MS. And don't take too much of any opioid unless you want motion sickness.

There are lots of strains as well. You may have had a racier green strain. Red Mae Daeng would be closer to a conventional opioid.

Don't listen to /u/samhw. He clearly has no understanding of what it is to use something therapeutically versus in a maladaptive way. I on the other hand have a pre-med degree.

With any drug comes a bit of risk of addiction or dependency. Even antidepressants. Having a healthy attitude and lifestyle and avoiding the stronger things like oxycodone, heroin, methamphetamine, etc is wise.

/u/samhw please avoid discussing topics you know nothing about while labeling those who do as 'addicts.'