I work in KY as an SUD provider. Generally I have very few issues with Kratom - anecdotally for a few of my patients, it seemed to generate tolerance really quickly, so it got very expensive very fast, but I haven’t seen data to support. 1/5
The bigger issue some of my patients have had is that they don’t always know that they’re using it - it has a bunch of different names and is even in some workout supplements, etc. I’ve had a couple of people referred to me for naltrexone “allergies” when they 2/5
Tried oral or IM naltrexone for alcohol use. Turns out it was actually precipitated opioid withdrawal, which was a really crummy way for them to learn what’s in their supplements. :/ 3/5
Banning it doesn’t fix that, natch. But I’m a big fan of people controlling what they put in their own bodies, so they have to know what those things are. Especially so we don’t make things worse! 4/5
Ultimately, we (and KY leg in particular, because good God, they’re a huge part of this problem) need to make management of SUD a ton less stigmatizing, a lot more accessible, and entirely open to multiple pathways to use and recovery. 5/5 💜

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More from @Jessnimm

Mar 25
This DEA case against a pharmacist lists three “red flags” that are laughable. Ready #TwitteRx? Let’s go!!
1. As Bev notes - DEA claims pharmacist should have seen a patient’s naloxone Rx as a red flag. Naloxone is the standard of care for most patients who receive and use opioids. In many, many states, it is now mandated to be co-prescribed with opioids.
2. DEA complaint identifies use of “immediate release opioids” as a red flag. Sure. Ok. They’re also explicitly preferred in the only part of the abominable 2016 CDC Opioid Guidelines that reference dosage formulations. Weird!
Read 5 tweets
Mar 17
I think a lot about the time that a former colleague said to me about patient care (this was with respect to urine drug screens) - “trust is a two-way street.” Which, like many platitudes, has a nugget of truth. But, to me, it’s a huge part of what is wrong in SUD treatment. 1/
Because here’s the deal: I absolutely have to earn my patients’ trust. They have to trust that I have the training, background, and ongoing interest in updating my knowledge base to help them reach *their* goals. 2/
They need time to build a relationship with me - to learn how to share vulnerabilities with me and overcome the exceedingly rational worry about whether or not I am going to care for them as a whole person who matters. 3/
Read 10 tweets
Sep 24, 2021
🚮 tweet alert! Let’s talk why. #TwitteRx #MedTwitter
Pharmacists are highly trained HCPs who are the subject matter experts in medications and treatment. *However* because of really effective MD lobbying, many of us are unable to practice independently, particularly re: decision making on therapeutics 2/
Because of that, when pharmacists practice - especially in the community - they’re doing so under INCREDIBLY strict protocols and standing orders. Literally not allowed to make decisions outside of those - even if those decisions are correct, medically 3/
Read 9 tweets

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