Kirsten Smith on Kratom

any type of drug. Hello, Psychoactive listeners. You know, one of the subjects that gets asked about often by our listeners is the plant, the drug called cratum or cradum, and so I thought we'd do an episode on that.

I'm curious. I don't know a hell of a lot about it, and so I was looking around for who to have on and one of the names that just pops up everywhere, whose name is on you know, probably half of all more of the articles you see being published in the academic literature about creatum is Kirsten Smith. And she's now a postdoctoral fellow at night at the National's Tute on Drug Abuse, and so I asked her to join us. So, you know, Kirsten, thanks very much

for coming on Psychoactive. Thank you so much for having me. I'm really excited to be here. Well, first of all, the issue of creatum or Cradham or what do we call it? What's your take on that. I go with the people. So so long as most people using it say creat um, I'm going to pronounce the creatum. And when we get us the change of people who call it crowdham, I'll switch to the camp but grudgingly. Okay, well, well I mean I'll tell you so, so I'll try

with creatum, I may revert to Cradham. And actually I was having dinner a couple months ago in London with a few friends of mine. One is in Foredom who heads i d PC, the International Drug Policy Consortium, and who's half Taie, and she said, Ethan, forget creatum, credum,

it's creaton. That's what people call it in Thailand. Um, So let me just start by saying, obviously, this is another one of these plants, you know, like coca, like cot right, that is growing that has been growing outside the United States, in this case in um Southeast Asia. Right for Thailand, Malaysia, Indonesia. I think Miamar, Papua New

Guinea um that's been indigenous there. And what can you tell us, I mean, is this something that goes back thousands of years or just a hundred or two hundred years? Thought us in on that. Yeah, it's a really unteresting story because when create I'm appeared in the United States, people are like, oh, this is a novel substance, and you know, to the United States it's new. You know, that's kind of like anocentric and relatively speaking, it's not

new um in other place. So you're correct, m Southeast Asia is where it's indigenous too. We do know that at least in the early nine hundreds there were some you know, case reports of creative use by Westerners of people you know, indigenous to those regions that you described using it in chewing the leaves primarily, or as a

tea or beverage. So we can say for sure it's been documented for a hundred years, but as far as how it's been traditionally used, it's you know, not just similar to many other botanicals that are you know, are

indigenous to to regions. So hayin Kelly and effects, trying to reduce fevers, but also and this has been well documented as well, being used as kind of a stimulant for people who are doing pretty harsh labor out in fields and oftentimes in that since it's chewed, but you know, it can be prepared with fresh leaves in in juice

or tea. So the reasons for use are kind of like any psycho active substance or botanical in that people are using it in those areas to self treat medical symptoms UM and substance use UH disorders, So people who have been addicted to heroin, methaphetamine, an alcohol. Those are the three we've seen most often in um Asia, where creative has been used to basically substitute those harsher drugs

in the region there. If you're looking at who's using it there in Southeast Asia, is it like working class people? Is a college students? Is a young people? Is it the elderly? I can speak to the fact that it is used far more often by males than females, and that the average age of uth initiation is typically older than other substances like nicotine or alcohol or heroin or methophetamine, and it seems to be that a lot more people

in rural areas are using it. But as far as any sort of a no demographic breakdown, I can't speak the right. And so now we look at the creater that's being sold in the US. Is that basically being imported from these countries in Southeast Asia primarily? Yes, So that's the short answer most people, and this has been born out in the majority of the survey data. Most creative coming in the United States is from larger vendors

that have changed over time. We have some entities that are are larger than others, a lot of mid level players. So people who I would say, you know, they do

almost exclusively online sales. They get it from their connection in Southeast Asia and then they package it and promote it and sell it here in the United States, either direct to consumer sales on the internet or through wholesale into shops that are then retail shops at gas stations, head shops, tobacco smoke shops, babe stores, and I expect to see it in other types of stores as well

in the future. Well, I'm christ I have to tell you so in anticipation of your being on Psychoactive what I did right before the show was I walked around the corner where a new Creatum CBD shot just opened on like seventy one and Amsterdam, just a five minute walk from my apartment, and I bought some capsules and a chocolate bar and a tea. And so while we're having this conversation, UM drinking some Creatum tea. So I'm gonna see if it has any effect on me by

the end of the show. But uh, you know, I have to say it doesn't taste that good. Um. It's dank, but not in a good way like dank, because usual I usually said that stank in a good way. This is dank in a not as palatable way. It is very pungent, is how I like to describe. If you break those capsules open and smell the raw flat matter, it's um kind of funky. Yeah. And I purposely didn't buy the straight out powder because I figured with a

capsule you can barely taste it. Here we don't have fresh leaves, so any tea is going to be with dry leaves, or it's going to be already packaged in some kind of energy shot looking extract or juice like thing. But over there they can actually brew the fresh leaves. We don't have people growing creatum trees in the United

States in their backyard. In mass I've heard some anecdotes of a few people trying to grow creatum trees, and even if they do, it doesn't mean that they're going to get ones that have leaves that are matragen in varying um at first, which I should say that's the alkaloid that has a lot of the non psychoactive activity.

But as far as the importing itself, I mean, by the time it gets the United States, who knows what's going on because we have all of these different vendors, and then they're going to be handling it in the ways that get to consumers differentially. So we have some vendors who might be trying to just take one or two alkaloids and put it into an extract or. Oftentimes you'll see if you go online, especially are are the packets of pulverized plant matter or capsules that have the

plant matter. And I think part of this is a function of just how Americans probably want to consume there their creatum. That's not to say people don't consume it by brewing tea. I knew I've seen people drink creatum tea. There are there are bars that are selling freshly made tea, but I think a lot of other people just want to have the convenience of some kind of powder or capsule or something like that. Let me ask you a

few questions about that. So, so, for you've mentioned matragine, I think that's the pronunciation um a number of times, right, And it sounds to me that like there's dozens of alkaloids in creatum, that matragy is the key one. And the way I imagine it is like, you know, matragy is to create a more or less what th HC is to cannabis or nicotine is to tobacco. Um in the sense that it's the dominant variable in this stuff.

It's the principal cycleactive one. But that there are these other alk lloyds that you know, color the picture a bit. Is that accurate? Um? Or would you change what I said? We don't know yet, right, So it seems like, okay, here's this leave the percentage of alkaloid content. More of it is metrogany, right, But that doesn't necessarily mean that

it's doing all the heavy lifting. So seven hydroxy um matrogyny is also it's a very small amount that is in leaves, and it's a metabolite of metrogany, but it does heavy lifting, right, So just because there's more of something doesn't necessarily mean it is the dominant thing. I like to use the kind of metaphor that Christopher Curty, my colleague at Florida, has said in some of his talks, which I think is very succinct and and elegant, which is to say that this leave is kind of like

a symphony. Right, So we have the symphony with all these different instruments playing different notes. We know from the pre clinical and when I say that, I just mean the animal on human animal work. How some of these act in isolation, so that doesn't translate to a lot of human use because most people are taking things that probably have more than one alkaloid. That's changing a bit, but at least in the short time it's been in the US, people have been taking more diversified products than

more isolated products in terms of the alkaloid content. So we don't know. For instance, maybe if we only take metrogenin and you know, give some purified form to humans, how that is going to produce an effect when in reality it's always been mixed with something, right, And if we want to understand these alkaloids, it's important to look at them in isolation, but also to look at them in combination, and we really don't have clearly. With human studies,

we don't have any of that. But with the animals, we we do see that matrogeny has very specific effects at certain doses in certain species in certain routes of administration. But we know that there's four alkaloids that act as

seevenly partial agonists AMU opioid receptors. However, there are at least two of these alkaloids plus several others acted delta kappa opioid receptors as well as mut opriod receptors as well as serotonin and dopamine and allergic So there is a lot going on with this leave And to Chris's metaphor, you know, we don't know the note or the tenor, or the tune or the tempo of all of these different instruments yet um let alone how they work in concert. And I think that that that's where we we have

a lot of work to do right now. That what I'm saying is that affair been about what we know or think we know is actually coming from surveys. And then I saw, you know, there's that website errol wod e r O w I D, which is a spectacular website for people sharing information about, you know, their experience of various psychoactive substances. So it seems like there's a

growing amount of survey stuff out there. Can you sum up the state of knowledge or aareness from these surveys to date or in terms of the surveys you're working on, is there stuff that you can share? Ye? You're correct, We've gathered data that suggests okay, yes, there's a self treatment narrative. People are absolutely using to decrease their anxiety, to decrease their depression symptoms, either in combination with medically prescribed drugs or because they don't want to take certain

prescribed drugs because they couldn't tolerate them. And um also because they tried pupen orphe and tried methodone or tried to get all the alcohol, tried to stop using many different drugs and they fell in creative and it seemed to be what was a a bridge out of a relationship with drugs that they didn't like, and that it for many people was very effective and for other people

it was not as effective. And clearly we don't have controlled studies, but I do think it's important to listen to what people are saying, and so one of the things we did after I came tonight to is just look at Reddit data and what people are talking about

in these creatum subreddits. I have to say it was really refreshing to read it after having only looked at survey data that was being published, or only looking at case reports, which I have to say, the case reports are very valuable, and if you do a search for case reports related to creat Um, you need to really be cautious and how you read those case reports because they are often written by people who don't know anything

about creat Um. So I will save you that diet tribe other than to say that the case reports have been a great source of information, but they're also a very narrow, narrow viewpoint and incomplete pictures. So after digging around in case reports and the survey data, reading what people actually have to say reminded me of like, you know what, why do I even care about this, which is that people are really trying to have a relationship

with the substance that improves their life. I mean, that's that's kind of the tape take away in a very crude forum, and you know it informed quite frankly, the Reddit findings informed how I wrote some of the questions for this survey that we did shortly thereafter, which we're in the process of getting out into papers. Right now. You've said that you yourself have not been much of a creatim consumer, but you've been open about the fact, and this makes you a little bit unusual at NIDA

and in the research world. My understanding is that you yourself went through a period when you were younger of you know, being in trouble and maybe doing dependent upon heroin and and what have you. I wonder if you could just share your story there, I mean, how did that come about? And how long were you involved in a problematic relationship with heroin or other legal drugs, and how did you get out of it? You know, it's something I didn't talk about a lot when I was younger.

It's it's very inelegant how I refer to myself because I'm just like, well, I'm a person who used to inject heroin every day and was addicted to it. But I don't do the Twall stuff stuff, though I've I've tried that. I grew up in a fairly averagely dysfunctional, eccentric house. I'm from Knoxville, Tennessee, and so it was just a normal college town. And you know, I didn't have any trauma as a child beyond normal American trauma.

And just I was a very entitled, kind of lower middle class, suburban white kid, and I was very curious. And even when I was really young, I knew I wanted to inject heroin because I saw it in pulp fiction and it looked really, really, really fun, and I was like, I'm gonna do that one day. And in Knoxville, it's not like the heroine capital of the world. It never has been. So Knoxville, though it's technically in Central Appalachia, it's still very much a college, suburban I kind of town.

And so it's like cannabis, cocaine, pills, psychedelics, alcohol. So I did the cannabis, you know, tried cocaine, tried psychedelics, of course, alcohol, things like that, and then prescription of opoids right, So it was morphine. I was sixteen years old and someone injected me with morphine. And then when I was seventeen, that's when oxycotton made its real debut, and oxycotton became much more widely available, and so that came first, and then heroin came after. It started off

social and recreational and all of this stuff. I was a server full time, went to school at community college, but like just wasn't excelling, you know, I was just I wasn't on the street. I was, I guess by some standards, I was a highly functioning addicted person. By other standards, I was not meeting the expectations of someone with my upbringing and you know, socio economic status. And

I was forced into rehab when I was nineteen. I absolutely didn't want to go and that was a twenty day and patient and then after that I just continued about my business and just you know, hit it from my family better. So I guess aged twenty two twenty three is when my boyfriend at the time and I were We still had jobs, but we were absolutely ready to stop. And I told my family I want to go to treatment again, and of course my steffdad caused his insurance company, and oh no, you know this is

before the Patient Protection Affordable Care Act. Because you have already been jury have one time, you don't get to go again. So I detox at my parents house and they kind of like guarded me. And then after I left and I went back to my apartment, everything went back to how it was, and I couldn't get into a residential program, which is what I really needed and wanted, and so we kept using and then we I mean, this is not a secret, I'll just go ahead and

say it. We robbed two banks and went to federal prison, and that is how I got sober. I got prison instead of buprenorphine. And that's how it ended for me, or how it changed, I should say. I will say that. You know, even now and I've done work, associate programs are available to incarcerated people. The lack of treatment, humane treatment that is informed, you know, informed consent and treatment options is still utterly appalling and almost borders on a

human rights abuse issue. And I'm not saying we shouldn't have consequences for people who do illegal things that are a menace to society, right like I robbed it, but It's not like I was innocent, so I needed some sort of intervention or punishment, call it what you will. But the degree to which the facilities that people are aware housed in lack actual programs to help them is really amazing. It's just amazing. So I would say that, yeah, I am extremely fortunate. But I also did not go

to like summer camp either. It was really not a treatment oriented place to say the least. So I mean, would you say that your past experience with drugs and incarceration impacted who you are as a researcher and the work you're doing today. The answer to that is yes, to know. So, on the one hand, I am very much a um hard scientists, and you know, we need objective measures, we need validated instruments, we need validity of every kind, insert anything, and I'm pretty much on board.

That said, I think because of my past and also because of my training and social science and social work, I am oriented also too, and more open and receptive to the fact that we need these objective measures, we need basic science, we need all of this very hard science. However, if you don't talk to a person who uses drugs, whether it's you know, a psychoactive planet creative or cocaine

or heroine or anything. You really are missing the bigger picture, and you're missing a big part of what will help you inform all of those validated instruments and the types of research questions you ask, the types of trials you do. I wouldn't even be here had it not been for an acting with people in the real world. You use drugs, right, So it's it's you need both. And I think that pre clinical scientists and even clinical researchers would do well

to have conversations with people and qualitative work. The study that we're going to be doing is very rigorous. It has many objective measures. But if you don't have subjective measures as an outcome variable or as part of the data collection process, then you have an incomplete picture. And you know we're gonna be doing qualitative work as well, in addition to as saying creative products. So you need everything,

and if you think you don't, then you're misguided. I hate to say, well, you know, because I think I first heard about you. I had just been a guest a few months back on a podcast that's done hosted by Creative Science, an organization is very committed to trying to put out accurate information about this, and the podcast host had recommended you is a good guest for Psychoactive.

But when he then sent me a list of the survey they had done, and you know, just scrolling through the reports and seeing some of the other stuff of these sorties, you see people you know ofttimes writing back with these remarkable you know, how it helped them get off you put a heroin be habit behind them, or helped them when they relapse to sort of cut that relapse off and get better, or it helped with withdrawal, or it helped him dealing with a very serious pain

condition where other opioids or other sorts of things weren't working, or maybe sometimes anxiety or depression. Let's Betty over Well mean, when you hear people describe how transformative this has been and how helpful it's been, now you also find people saying this is boring and it did absolutely nothing for me,

and I'm utterly unimpressed. And that's fine. But for those that it has been helpful for during the time when we have very poor treatment options for people, and um a lot of people are very unsatisfied with the treatment options and there's a lot of stigma of course, and getting treatment for substance use disorder or chronic pain, even as highly undertreated and under diagnosed. So you have people who are sometimes desperate and they find Creatum and it

seems to be what they've been looking for. And it's so true to just many substances, which is that you know something can be beneficial but also have some side effects. And a lot of the people who you know, we read the accounts of they seem to say, Okay, I take this every day. It's part of my life, and I feel like I need to take it, and I know that if I don't stop taking it, I'm gonna not feel great. I'm probably gonna have some withdraw symptoms.

But by and large, the withdraw symptoms from Creatum seem to be well, no, they don't seem to be They're mild to moderate. So I would say that there are estimates of how many people are using Creatum or have used Creatum or daily regular users. I don't think we really know, but we do know that the sales in

the industry is growing rapidly. If that's an indication, We'll be talking more after we hear this ad So, Kirsten, you know, one thing among the people are sort of casually using um creative now buying in the shops, using it like CBD or coffee or whatever, and the people are using it to deal with chronic pain, um or or with addiction. Are there major differences are are there? Are the latter group taking it at much higher doses or with greater frequency? Or how much variability is is

there in that? So one key point to keep in mind is that many, I would say nearly all people that are using Creative are reporting, at least that we've looked at understable reporting more than one used motivation. Right, So there's a lot of overlap between having a drug addiction or having a prescription of dependence and then chronic

pain and then depression anxiety. So when people are given a list of you know, to check off all of the motivations for use, they're checking off many, many motivations. And so we can't cleanly separate people of like only for this, only for that, because usually it's they're using it for multiple reasons. So that said, what I can say is that on average, people who regularly use are using two to four times a day, So let's say

three times a day. They're dosing three times a day on average, and the amount um it varies, of course, because you can measure in cups of tea, com measure in grahams or spoonfuls or table spoons um. But the ranges aren't super wide, and we've looked at you know, higher doses and lower doses that can achieve effects, and doses that are too much, and dose doses that are ineffectual and things like that, and the range is not dramatic.

But typically people who use regularly are using to you to three times a day, sometimes four times a day daily, and how they're taking it, it depends on the person. But the route of administration is always oral. You cannot inject creatum, you can't stort it, so it's always gonna

be an oral route of administration. But we do have people who report using your thirteen times a day, and you have people reporting using like clockwork only three days a week, only before work because they have to stand on their feet at work all day. So it depends kind of on the person's situation. But I would say that the recreational users there's a lot more variability, and you know, you know, in frequency of use versus the people who are using as a self treatment, that's going

to be more like regimented. And as of right now, create and withdraw symptoms tend to be very similar to opod with draw symptoms. That said, many withdraw symptoms are going to be very similar across drugs, right, So if you're if you're withdrawing from benzos or alcohol or cocaine or I mean, you're going to feel irritable, right like, it doesn't matter what shruck it is, You're gonna be a little irritable. But other symptoms are more characteristics of

opioid withdraw. But again, it depends on the symptom, it depends on the dose. So we do have a very crude signal of dose dependent withdraw effects. Meaning if you're taking higher doses more often over a longer period of time, then chances are you're going to experience more intense withdrawal symptoms. And then if you're taking less creative intermittently for a shorter period of time, that's that's the signal we have. Oh, by the way, how are you feeling. How's that creative

treating you? You know, I just took another sip. You may have heard the ice cube there. I'm not enjoying the taste of it, I'll tell you that. And I don't know that I'm feeling any effect from it as yet. But then again, I'm very focused on our conversation, so we'll see what happens after. Yeah. Well, if I were to sum up what I'm what I'm hearing from you, and also I've been reading it, sounds like there's maybe what I'm crudely, one could break it into two camps.

And there's people dealing with really serious issues around paying addiction, depression, and those who are dealing with lower levels of you know, maybe anxiety or or you know, energy focus, what have you.

And that maybe the market for the latter group is big and growing big or very rapidly because of the rapid expansion of you know, Creatum's reputation and these stores, and that within all of that, right, I mean, that's if there's that spectrum of use, people are reporting a lot of positive stuff and at the same time people are talking about having sometimes negative consequences, right, having a hard time stopping using it. Oh, maybe not so hard

at stopping opioids. People feeling nauseous, people getting sick, people you know, having other sorts of weird physical reactions that may or may not be connected to the creatum they were using. It might be connected to other drugs they

were using, or some other health condition. Um. But that it's a very complicated sort of portrait of what's going on out there with only a small amount of information, where a lot of what's emerging is suggesting really interesting and promising potential and possibilities, um in terms of self treatment for depression, addiction, what have you. Uh, And that those appear to be greater than the negative side if you look at this more from a large a large

you know, large lens. Yes, no, Yeah, did I do it justice? You know? I believe we should listen to people take what they say mostly on faith unless we have some reason not to, and believe, you know. And I would say that a lot of drug research and ad dictionary research, the validity of self report is actually quite good, you know. And we should keep in mind

that these large online surveys are self selected. To so to sit down and take an hour, hour and a half long online survey that is unpaid, you have to either have a really favorable attitude or really unfavorable attitude to want to do that, and so um and and the fact that what we've seen from the large on line surveys tends towards the more positive beneficial effects from

Creative as opposed to you know, adverse effects. Then people might say, and I've said, you know, we need to be cautious with you know, how much you know, you know what we really think we knew about this given that we have we have a possible self selection biased So one thing that we did with our small recontact survey, and I'll say the sample size is small, but we identified people who had ever used Creative in their lifetime on a completely unrelated survey, and we recontacted a portion

of them. And you know, we had a small window of time to do this, and we asked a very comprehensive and they were compensated for their time. But they were not all current regular Creative users, meaning that we had people who would use Creative and quit. We had people who had may be used a few times. We had people who were regular users and still were regular users. And so we had a smaller but a much more

diverse sample. And with those data, what we've seen it kind of maps onto what you've said, and we saw what al Garcia Romeyo found in his larger online survey, which were really low rates of meeting diagnostic criteria threshold for a creative use disorder, and that we found a larger proportion than he did, but it was still not

a majority, and it was mostly mild and moderate. Now that's all fine and well, but the real meat of it is when you look at specific symptoms that clinicians used to diagnose a substance use disorder, and if anyone wants to go online and look these up, I think it is helpful because you see that there's many different

facets that are used in coming into this diagnosis. And I was not surprised to see that looking at individual symptoms, pollerance and withdraw symptoms were well represented and they were the most widely endorsed. However, impairments and psychosocial functioning were

not prevalent. When they're not the majority of people, right and for and who is a trained clinician, that is significant to me because when I think about helping people or what we need to do um to get, you know, to intervene if a person's relationship with drugs becomes problematic. It's that psychosocial impairment that is is kind of key, like are they are they putting their kids in the closet and neglecting to go to work and you know,

pawnying their grandmother's TV to go get creatium. And that's not what we're seeing here. So it's a different animal than some other drugs, especially given that a majority of the sample had at one point used creat um regularly, meaning it's not like the everyone had just tried it once. The other way we assessed this was by asking people, Okay, we've established that you get acute effects from your dose, you know most of the time. We asked all these

questions about effect and duration of effects. And because one thing David Epstein, my mentor, wanted to know is does create um for people who take it regularly enough? Does it act like an antidepressant over time where you can take it every day and not feel a psychoactive effect

or do you achieve a psychoactive effect every time? And I told him it was definitely the latter, and he was like, all right, let's find out, and and it was most people felt in acute effect of their use of their dose when they took it, even if they had been dosing for a long period of time. And we asked them, okay, so you feel an effect, you're you're taking this regularly. Are these effects helpful in meeting your daily obligations? And are they in keeping with your

meeting your daily obligations? Are they hindrance all? You know? We asked. They had many response options and the two most you know, highly endorsed options, where yes, creative is both helpful to meeting my daily effects and it's in keeping with my daily obligations. Right, it's not impairing my

daily obligations or my ability to meet them. And for those people who said that it was helpful in meeting their daily obligations, that's like a cup of coffee, right, Like when I drink my coffee in the morning, it is like me, I'm taking a psychoactive draw. It's not only you know, not impairing my daily obligations. It's helping me meet my my roles and responsibilities because I do

better work when I've had my coffee. The second, almost equally endorsed option was, you know, it doesn't help me meet my daily obligations, but it is in keeping with them, right, it's not impairing them in any way. And to me, that's more like a glass of wine. So like when I drink my glass of wine at night, you know, it's not hurting my ability to function and fulfill my daily roles and obligations. But I'm also not saying that it's you know, helping me fulfill them either. It's just

the thing I do that I am wind with. Creating is very complex pharmacologically, So I'm not trying to say we should consider create them to be like a cup of coffee or like a glass of wine. But as far as drugs, set and stuttying and how people use drugs and all of these you know or psychoactive substances, we are seeing at least a signal and again more work absolutely must be done, but we are seeing a signal based on self report that this is more of a substance or a product that is in keeping with

people's daily lives than a hindrance to it. Again, on the whole let me jump here into the politics of this thing, because I don't know if I told you this, but you know, I had barely been paying attention to create them while I was running Drug Policy Alliance. And then something happened in sixteen, which was the d e A announced that there were these problems with Creatum and that they wanted to zap it into Schedule one and

do it quite precipitously. The fact of the d e A just kind of abusing its legal administrative powers to basically prohibit something that was probably used was offensive to

our core principles. So we put out an alert to our two or fifty thousand email members the way we some do around marijuana legislation or opioid issues or you know your name, of the whole range of things that DPA was dealing with, and I and my colleagues were stunned, cursedon I mean, we got a response like we we thought, like people would barely notice this, who's paying attention on

our lists to creative. In fact, we got more responses to that email blast than almost any other email blast we had ever done, maybe one or two marijuana one one on the Rave Act and m d m A twenty years ago. I mean, huge numbers coming in and people outraged about the d e A and people reporting their personal stories about hey, you know, I'd still be I'd be I'd be dead from fenital now i'd be addicted.

But but you know, the creative saved my life where I was dealing with this or pain, or my doctor wanted me on you know, oxy content, but this stuff work better, I mean, one after another after another. And so with that result in it is, you know, all of a sudden, I'm in connection with the American Creative Association and interacting with them, and we're reaching out to

legislators and sending out other alerts. And you know, my understanding is that when the DA tried to do that, what happened was they failed, right that I think fifty thousand or more people wrote to uh D e A, and members of Congress stepped up and said cut this out, and leading researchers said this makes no sense, and so they backed off. And then the next thing I see is it looks like the FDA, the Food and Drug Administration, now seems to be on some campaign to try to

put it in Schedule one or ban it. And and so I'm trying to understand why. I mean, they're putting out these reports claiming that there were forty creatum related deaths. But when you sift through the data, it appears that not a single one or maybe one or two involved create them alone and almost no strong evidence about calls

of relationship and using creatum and dying. So you see this bullshit coming out of you know, the the organizations like d e A and f d A, And what I'm trying understand is that just same old drug war, redux drug war, you know, bullshit. What exactly is going on and what insight can you provide into this sort of stuff, especially now that you're working for the nationally sort of drug abuse and you're part of the bigger drug control establishment. Oh man, I never thought that someone

say I'm part of the big drug control establishment. I'm going to have to get a T shirt made. Um, that is hilarious. So, although I do try to stay on top of policy and what's going on with creative in different states, you know, I don't get involved with that because it's not really my job and there are better people equipped to do it anyway. So I am low low, low low on the totem pole of of the hierarchy, of the of NIDA, of of the federal government.

So d cannot make or should not at least historically, I should say, it has not been the case that d A does something hasty like schedule a substance that is a new substance without sufficient scientific evidence, right, And what don't say that again? You're saying d e A does not typically do that, has no real history of doing that, is not supposed to do that. No, No, we know what we know is not supposed to But if you look at their history, it seems to me

one that's oftentimes been fundamentally anti scientific. And I think they're they're getting their act together a little bit better these days now the cannabis is being legalized in psychelics, is getting so much positive press around the research. But I mean, I just saw them as essentially a Neanderthal agency when it came to some of these policy issues and a whole range of things they were dealing with.

But I'm very concerned about that. I looked at I think I think it was in the night A website, the fact page about create um. You know, it did not seem to reflect the kind of broad survey data and was more broadly known. It seemed to be, you know, as they did with marijuana, all about the negative negative, negative, negative negative without talking about any of the positive things

that people are reporting. So, you know, I've seen this kind of drug war mentality permeating not just the law enforcement agencies but also sometimes f d A, sometimes night to um, you know, and I you know, with cretum, where it's got this interesting potential to really be helping people struggling with addiction, struggling with pain, struggling with depression, it seems like there was a kind of knee jerk

impulse to do you know, the opposite. My takeaway from talking with you, Kirsten, and also with the reading I've been doing an anticipation of talking with you is that you know, this country and maybe the world more broadly, would be better off if creatum does not get banned, and if the FDA begins to effectively regulate it the way it does sort of food supplements or other sorts of things, so that way they can keep track of adulterated products, you know, they can recall things, they can

put out notices, they can ban certain things which aren't what they are being marketed to be. But that what we really need here is truth and labeling, truth and advertising. Going back to what the original food and Drug Act was all about back in the early part of the twentieth century, and now that although there are certain risks associated with that approach, the benefits of that given the potential of creative and helping people struggling with all sorts

of medical conditions. You know that that that the benefit is going to significantly exceed the cost if we can implement a sensible regulatory policy. Would you basically agree with that?

I think we are scientists have so much work ahead of us that in this uncanny value where we have enough information, we have enough data, enough self report data, enough case reports, we we have enough information to say, Okay, let's hold on here and let's just not make a large, sweeping policy decision that is not scientifically informed and that

has very wide ranging public health implications. If people who are using creative daily all of a sudden cannot take their creatum and they are left with what you described

earlier as a black market. So, given that we don't know the full breadth of the public health implications of what would happen if creatum was prohibited tomorrow, UM, I could say we can speculate like I have already done on the show earlier about what might happen for some people and to that, and you know, I can I can only say that if you know, if I were emperor of the world and could do whatever I would, I would probably have a whole lot of other systems

in place to try to get science to reform policy better than it does. But I can't speak to any specific policy prescription right now other than that we desperately, desperately need more data. We need more science, right Kurson, Well, I mean I'll say this to your response. Okay, Um, maybe I'm a little frustrated because it does feel like a hyper cautious way of essentially saying sort of yes, you agree. Because ultimately, policy does happen. People make decisions,

d e A f d A does things. Legislators do things people researchers like yourself actually do need to be active. The level of pessivity and the drug research world for decades, the extent to which drug research just kept doing their thing and doing their research and following politically driven research agendas while the drug war got launched that arrested tensive

millions of people and carcerated millions of people. I actually think there's a sort of moral and professional obligation for researchers to really be stepping out and to be a little clear about this. You know, I'll tell you before I stop runing Drug Policy Alliance, we launched a program that's under the leadership of Jewels Netherlands, you know, an

Office of Academic Engagement, and it had two objectives. One was to ensure that the Drug Policy Reform Agenda d p A and the broader reform world was firmly grounded

in research right. And the second was to basically empower researchers to get more involved in advocacy, because what happens is researchers is oftentimes adopt a position if we don't have enough research, we don't have enough evidence, a real position of kind of pessivity in the face of politicians and others, you know, making terrible decisions that harm people

all sorts of ways. And when you have agencies whose default is to put something in Schedule one and prohibit it, you know, rather than to say, let's try regulating this first and as responsible as we can, and then as the evidence comes in, we'll deal with that. I really think it's important to be pretty clear about this sort of thing, you know, It's not just about what the evidence is in front of you. It's also about values. It's about core values about what kind of society we're

going to live in. And so when somebody's out there saying prohibit hi hibit or FDA is doing this thing, you know, people including people working for the government as public servants doing drug abuse research, need to be able and willing to step up and say that's not right. Sorry to give you that rant there, but UM, I

just felt like I needed to do that. The creative is kicking in, you're getting getting no no. I know, I appreciate that there's there's this optimistic part of me that thinks, okay, we have advocates taking the science that we're producing, the a K is using it along with a KA being American credim Association, Yes, and working at the state level to you know, implement over either overturned bands or prohibsions on creatum, but also to introduce some

sort of regulatory um, you know, consumer Protection Act kind of um. You know, let's station And I'm I'm very thankful that that work is being done and that the work that we're doing UM at University is that NIDA can help inform that along with all of the stories of the people using Creative And I do think that you know Neida in particular, is you you alluded to

some improvements earlier. They are actively working to revitalize their Creative web page to make it up to date and to make it more informative and in keeping with the science, and to have an outward facing, you know, set of facts to the extent that we have them that is more fleshed out and is more detailed than it currently is. So that is actively underway. I know that much. And I know that Neida is invested in understanding creatim better.

So there is an appetite to understand this. And in the interim, I don't think anyone um would I would hope not shy away from this kind of common sense,

you know regulation. So just a few last questions. One is, you know, I've heard about Creatum being used with various addictions and with pain um, but especially respect to opioid dependence, and and I've seen it, you know, some of the academic articles saying that basically there are elements of creatum that make it like an opioid, and in some respects it's like an opioid agonist like methanon or boopernorphine, and some plate loose sexist like an antagonist like uh, I

guess nilox one in some respects is like a partial agonist, you know that, but that it operates on some of the opioid receptors and that's what makes it oftentimes helpful for people in trying to get off of opioids, to reduce withdrawal symptoms, to stay off of it, to use it as a substitute and something instead of maybe methodon

or booper orphine. But what can you basically tell me about the relationship or the opioid like nature of creative The short answer is that at least for alkaloids act as partial agonists at new receptors, right, And those are the receptors that are responsible for analgesia and you know,

like the pain culling effects, also some anxiolytic effects. But also what we're seeing is that they seem to be partial agonist, right, which means that there is a ceiling as to how much they're going to be able to activate um, you know, that receptor and produce an effect. And so there's what's called a biased opioid agonist and that term is highly hotly debated right now in terms

of the mechanisms of action for bias agonism. Some people think there's a second messenger pathway the data rest and that doesn't get activated, and and that's what is often associated with respiratory depression g I upset things like that. Um, However, there's new literature to suggest, and again this is highly debated, and it's never kind of another but related conversation, there's a bias within the selectivity of the proteins before these pathways.

Long story short. Some people and even I've put into papers, Um, you know these alkaloids metroggy and seems to act as a partial bias agnus. Well, I'm kind of walking that bias part back now until we know more. But we do know that, I mean, you know, it does act like I would say, it's closer to buprenorphine than methodone.

Just explained to our audience. Many of them won't know the difference between those two because they're both being used for people are struggling with addiction to heroin or other you know, illicit opioids. UM and methodon can only be attained for most people for addiction treatment and a clinic, many of which are very hard to access in parts around the United States, where's booper and orphine is something that can be prescribed by physicians, so it's much more

easily accessible. So when you say that maybe creatives a little more like boopern orphine than it is like methodon, what exactly do you mean without getting too technical. Methodon is what's called a full agonist, meaning that you can increase the dose really really really really high, and you

can keep increasing that dose until you've died. Basically, so there's um you know, there's going to be more effect with the more you take of it, and with puper noorphine there's a ceiling effect, meaning and it's a partial agnes. You know, people thought less of the potential for abuse or misuse, and you know that may or may not be true. That's a different conversation, but I think the main thing to keep in mind is that whatever Creative

is doing, there are non opioid mechanisms of action. Right, So even if we just wanted to call Creative an opioid, which I'm not ready to call it an opioid point blank, but the psychoactive substance this plant has action ovoid receptors, but it has action these other receptors as well. And again going back to that symphony analogy or metaphor that Chris has, you know, we don't know what they're all

doing in combination. It could be that one is attenuating the activity and of another or potentiating the activity of another. And you know, we don't know what people are using Creative in conjunction with. But more importantly, if someone is trying to get off the opioids and they think that you know, creative is helpful, well, Creative might be helpful because of its opioid like properties, but you hear people withdrawing, using benzos and using alcohols, so it isn't necessarily the case.

And often I would say even the bigger, bigger point is that many people who are using opioids or are Polly substance users, right, they're using many drugs. If they're trying to get off many drugs, well, it could be that the omnibus effects of creatum are I just feel better when I take creatum And we don't know if it's the action at at opioid like at new receptors

that is doing the heavy lifting. Likely that's part of the story, but it could be that it's a lot of different things pharmacologically that are making the person feel better. Even stimulants can make a person feel better, So it doesn't have to be a one to one opioid replacement or opioid substitution. But what we're seeing is that some people are using it for ovoid substitution. But we're also

seeing some of that with amphetamine and alcohol. And so the question I'm want to ask you about creatum, and this is my last question, is in your gut jump forward ten fifteen years, do you think that creatum has a potential to play a really important role in this country and elsewhere in dealing with problems like opioid addiction, other drug dependence, pain, and maybe some other conditions, or do you remain very skeptical it really can play a big role in the future. Well, I don't even have

to use my gut on this one. All of the work that I've done, all of what I've seen firsthand, you know, I'm staking my career on this. Or I

love to research traditional opioids obiodious disorder treatment. If I didn't think creatum was going to be relevant, And when I say I mean relevant on many different levels, both creating products proliferating in real world settings, but also more sophisticated understandings of the mechanisms of actions and how that can be leveraged into some therapeutics, and both can currently such that there's like a medicinal creatum similar to cannabis

situation going on. You know, if I didn't think creatum was going to be relevant, I wouldn't be sitting here talking to you. And again, you know, it's not even my gut. If I thought it was not helping people, I would be working on something else. But I will say, you know, it takes a really really long time to take any uh, you know, alkaloid or you know, molecule and get this particular set of molecules into a format that can be delivered to humans and certain trials and

then tested and brought to market. So you know, the just and future is the just in future. And I think that, you know, to the point about policy, if creatim is scheduled, it's going to make our job a lot harder and as researchers to do our work. Christen, I am really grateful for your taking the time to

be on psychoactive with me. I really wish you more a success as your career moves on, and I hope you're going to be coming outstanding researcher and scientists about creative and other substances and bring your life experience to bear on all of that. So thank you ever so much for joining me on this program. Absolutely, And I would only ask one last question, how are you feeling

with your creatum tee? Well, you know, I think that you know, maybe I've been very animated on this episode, so maybe it's the creatum that maybe maybe that way, I don't know, you don't I don't know. When I went to the shop, you know, they were distinguished between the red creatums and the green cretums, and the red was more sedating and the greens. And I don't know, maybe it's the same kind of bullshit like you to hear like his indicinsativa really different or not? Right? Um?

But I and this liquid one I drank, they don't even tell you whether it's red or green. All I know is I'm feeling pretty good. You should try and extract. I'm not prescribing that. I'm not endorsing creative us, but I'm just saying that that's not clinical advice. That does not I do not speak for anybody but myself. I appreciate the nonprofessional advice. Thank you, so thank you, so very very much. No, thank you for the opportunity. It

was lovely. We love to hear from our listeners. If you'd like to share your own stories, comments and ideas, then leave us a message at one eight three three seven seven nine sixty that's eight three three psycho zero, or you can email us at Psychoactive at protozoa dot com or find me on Twitter at Ethan natal Man. You can also find contact information in our show notes. Psychoactive is a production of I Heart Radio and Protozoa Pictures. It's hosted by me Ethan Naedelman is produced by Noam

Osband and Josh Stain. The executive producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren Aronotsky from Protozoa Pictures, Alex Williams and Matt Frederick from my Heart Radio and me Ethan Naedelman. Our music is by Ari Blucien and a special thanks to a Brio s f Bianca Grimshaw and Robert bb Next week I'll talk with Dr Gave, one of the world's leading psychotherapists working with the drug kennemine. I feel like kenemine is a beautiful medicine and I

think it has a lot of advantages. I really feel psychedelic psychotherapy allows one to almost find the door out of our prison, which are all patterns, are characters, are conditioning, and to have new possibilities and an emergence into the full aspects of who we are, not based on our survival based strategies from childhood in the environments we grew in. So I really feel it is a process of liberation and growth and new possibilities. Subscribe to Psychoactive now see it, don't miss it.