Alcarelle is a synthetic version of alcohol, providing all the “feel-good” effects of alcohol with none of the associated risks; this alcohol-alternative may be available in a bar near you within the next five years!
By Cassie Jewell, M.Ed., LPC, LSATP
Alcarelle, providing liquid courage without the consequences of alcohol: no hangover, no calories, and no harmful impact on your health. Sound too good to be true? Maybe… but maybe not.
Alcarelle is a substance that mimics the effects of alcohol; the Alcarelle website proclaims, “Like alcohol, but better.” Essentially, it’s a synthetic, non-toxic version of alcohol that activates the same neurotransmitters as booze, inducing the “warm fuzzy” feelings of tipsiness. Created by English neuropsychopharmacologist, David Nutt, the active molecule in Alcarelle provides the relaxing and social lubricating qualities of alcohol with none of the associated dangers.
According to a 2019 interview in Men’s Health, the Alcarelle effect “plateaus” after three drinks. The implications are that you won’t get hammered or black out with Alcarelle.
Currently, Alcarelle is in the development stage. Nutt’s plan is for Alcarelle to be available within the next five years; it will likely be offered in the form of a concentrated extract to mix into drinks.
What role will Alcarelle play in the treatment of substance use disorders? It’s unknown if someone could build a tolerance for or become dependent on Alcarelle. Could Alcarelle be the next harm-reduction or treatment method for alcohol use disorders? Could its use help with other addictions or mental health disorders? Could it potentially reduce the rates of alcohol-related accidents and diseases?
On the other hand, Alcarelle could lead to abuse and/or dependence (similar to how methadone, a treatment for opioid use disorders, produces powerful addictive effects). Also, it could end up being the equivalent of a “gateway” drug, increasing the user’s chances of later developing a substance use disorder.
Bottom line: too much is unknown at this point. Alcarelle may not make it past the testing phase. (Currently, only a prototype of the synthetic molecule exists and funding for the project is limited.) While I’m hopeful that an alcohol-alternative could advance the treatment of substance use disorders (especially since I believe the ultimate treatment, while yet undiscovered, will be pharmacological), I don’t anticipate Alcarelle being a magical “cure-all.”
Kratom is a tropical tree native to Southeast Asia. It’s becoming increasingly popular in the United States. It’s used for pain relief, mood enhancement, and to manage opioid withdrawal symptoms or reduce/stop opioid use. This post explores the use of kratom as a potential treatment for opioid use disorder.
By Cassie Jewell, M.Ed., LPC, LSATP
Kratom (mitragyna speciosa)
is a tropical tree native to Southeast Asia and, like coffee, is part of the
Rubiaceae plant family. Ingesting kratom leaves produces a high. Taken in small
amounts, kratom leads to stimulant-like effects (i.e. increased energy and
focus – stronger than caffeine, less intense than cocaine). When taken in
larger doses, the high is similar to that of an opioid (euphoria, drowsiness,
“pinned” pupils, dry mouth, sweating, nausea, constipation, etc.) Kratom is
unique in that it produces both stimulant and opioid-like effects.
Note: “Opioid” is the term used for any drug that binds to the opioid receptors in the brain. An “opiate,” on the other hand, is a naturally occurring chemical found in the poppy plant, such as morphine or codeine. All opiates are opioids.
In the United States, kratom users cite pain relief as a primary motive
for use. Kratom, an opioid agonist, works by binding to opioid receptors in the
brain. It can be effective for both acute and chronic pain. Others report using
kratom for energy, increased focus, lower levels of anxiety, to reduce/stop the
use of opioids, to reduce symptoms of PTSD or depression, and to elevate mood.
Kratom is legal in Virginia; it’s sold at vape or “head” shops as
a loose powder or in capsules. (Alternatively, kratom can be purchased online.)
Packaging is typically labeled “botanical sample only; not for human
consumption.” The extremely bitter powder can be sprinkled over food or brewed
into a tea. It’s easily swallowed in capsule form.
What does kratom mean for the opioid epidemic in America? Will
kratom one day play a key role in the treatment of opioid use disorders? Or will
it fall into the “harm reduction” category? Is it a natural pain medication, a
safe alternative to highly addictive opioid pain killers?
Or, will we find that kratom, like heroin, is habit-forming and
deadly? Currently, the research is mixed.
to Opioid Drugs
The results of a 2019 survey published in Drug and Alcohol Dependence revealed that 90% of respondents found kratom
effective for relieving pain, reducing opioid use, and easing withdrawal
In 2011, researchers discovered that kratom alleviated morphine
withdrawal symptoms. A more recent study indicated that kratom may reduce
Earlier this year, researchers found that kratom use was
associated with significant decreases in the occurrence and severity of opioid
adverse effects; kratom lessened the discomfort of opioid withdrawal. Multiple
studies have substantiated these findings, suggesting that kratom is a useful
medication for opioid addiction and withdrawal.
Interestingly, in 2007, it was found that kratom reduced alcohol
withdrawal behaviors. More recently, researchers discovered that kratom
decreased alcohol use; this suggests that kratom may help those with alcohol
use disorders (AUD) in addition to opioid addiction.
Compared to heroin, kratom is less addictive and has milder withdrawal
symptoms. Furthermore, the risk of deadly overdose is reduced with kratom use. A
2018 literature review indicated that kratom may have harm-reduction potential
for individuals who want to stop using opioids.
According to the CDC, there were 152 kratom-involved deaths
between July 2016 and December 2018 (“kratom-involved,” meaning kratom was a
factor). In seven of those deaths, kratom was the only substance found in
toxicology tests (although it should be noted that the presence of other
substances was not fully ruled out). It’s possible to overdose on kratom, and
when combined with other drugs or medications, kratom can be fatal.
In rare cases, kratom has been linked to liver toxicity, kidney
damage, and seizures. In the case of a 32-year-old woman who was using kratom
for opioid withdrawal, kratom was likely the cause of acute lung injury. Kratom
use may also cause cardiac or respiratory arrest.
Kratom’s harmful effects are not limited to the body; a 2010 study
linked chronic kratom use to alterations in working memory. In 2016,
researchers found that kratom use was associated with cognitive impairment. An
additional 2016 study supported previous findings that kratom may affect
learning. In 2019, researchers found that high doses of kratom were linked to memory
deficits. In contrast, a 2018 study indicated that high kratom consumption was not related to long-term cognitive
impairment. That same year, researchers found that long-term kratom use did not
appear to cause altered brain structures. More research is needed in this area.
Regarding whether or not kratom is addictive, multiple studies have found that regular kratom use leads to dependence, withdrawal symptoms, and cravings. Kratom cessation may also cause psychological withdrawal symptoms, such as anxiety and depression.
Will kratom step up as the hero of today’s opioid epidemic?
Doubtful. And for kratom to be a viable treatment option, more conclusive research
is needed. Additionally, researchers must study the safety of long-term kratom
While it’s unlikely, kratom use could lead to adverse health
effects or cognitive impairment; it could also fatally interact with other
substances or medications. Furthermore, long-term use may lead to addiction. In
sum, the majority of the literature suggests that kratom is, by no means, safe.
That being said, when compared to shooting heroin, kratom is safe (a safer alternative, at least). And if someone chooses to use kratom to reduce/stop their opioid use, I won’t lecture about the “dangers” of kratom. Until we have more answers, I will hold to the view that kratom is a harm-reduction measure… and it has the potential to save lives.
Apryani, E., Hidayat, M. T., Moklas, M. A. A.,
Fakurazi, S., & Idayu, N. F. (2010). Effects of mitragynine from mitragyna
speciosa korth leaves on working memory. Journal of Ethnopharmacology, 129(3),
Burke, D., Shearer, A.,
& Van Cott, A. (2019). Two cases of
provoked seizure associated with kratom ingestion. Neurology, 92(15), 4.5-030.
Coe, M.A., Pillitteri,J.L, Sembower, M.A., Gerlach, K.K., & Henningfield, J.E. (2019). Kratom as a substitute for opioids: Results from an online survey. Drug and Alcohol Dependence, 202, 24-32. ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2019.05.005
Eggleston, W., Stoppacher, R., Suen, K., Marraffa, J. M., & Nelson, L. S. (2019). Kratom use and toxicities in the United States. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy.
Gutridge, A.M., Robins, M.T., Cassell, R.J., Uprety, R., Mores, K.L., Ko, M.J., Pasternak, G.W., Majumdar, S., & van Rijn, R.M. (2019), Therapeutic potential of g-protein-biased kratom-derived and synthetic carfentanil-amide opioids for alcohol use disorder. The FASEB Journal, 33:1, 498.3-498.3.
Halpenny, G.M. (2017). Mitragyna speciosa: Balancing potential medical
benefits and abuse. ACS Medicinal
Chemistry Letters, 8(9),
897-899. DOI: 10.1021/acsmedchemlett.7b00298
Hassan, Z., Muzaimi,
M., Navaratnam, V., Yusoff, N.H.M., Suhaimi, F.W., Vadivelu, R., Vicknasingam,
B.K., Amato, D., von Hörsten, S., Ismail, N.I.W., Jayabalan, N., Hazim, A.I.,
Mansor, S.M., & Müller, C.P. (2013). From kratom to mitragynine and its
derivatives: Physiological and behavioural effects related to use, abuse, and
addiction. Neuroscience &
Biobehavioral Reviews, 37:2,138-151, ISSN 0149-7634. https://doi.org/10.1016/j.neubiorev.2012.11.012
Hassan, Z., Suhaimi, F., Dringenberg, H. C., & Muller, C. P. (2016). Impaired water maze learning and hippocampal long-term potentiation after mitragynine (kratom) treatment in rats. Front. Cell. Neurosci. Conference Abstract: 14th Meeting of the Asian-Pacific Society for Neurochemistry. doi: 10.3389/conf. fncel (Vol. 58).
Hassan, Z., Suhaimi, F. W., Ramanathan, S., Ling, K. H., Effendy, M. A., Müller, C. P., & Dringenberg, H. C. (2019). Mitragynine (kratom) impairs spatial learning and hippocampal synaptic transmission in rats. Journal of Psychopharmacology, 0269881119844186.
Hemby, S. E., McIntosh, S., Leon,
F., Cutler, S. J., & McCurdy, C. R. (2018). Abuse liability and therapeutic potential of the mitragyna
speciosa (kratom) alkaloids mitragynine and 7‐hydroxymitragynine.
Addiction Biology, https://doi.org/10.1111/adb.12639
Hughes, R. L. (2019). Fatal combination of
mitragynine and quetiapine–a case report with discussion of a potential
herb-drug interaction. Forensic Science, Medicine and Pathology, 15(1),
Jaliawala, H. A., Abdo, T., & Carlile, P. V. (2018). Kratom: A potential cause of acute respiratory distress syndrome. DRUG INDUCED LUNG DISEASE: CASE REPORTS, A6604-A6604, American Thoracic Society.
Olsen, E.O., O’Donnell, J., Mattson, C.L., Schier, J.G., &
Wilson, N. (2019). Notes from the field: Unintentional drug overdose deaths
with kratom detected – 27 states. MMWR
Morb Mortal Wkl Rep, 68:326-327.
Palasamudram Shekar, S., Rojas, E.E., D’Angelo,
C.C., Gillenwater, S.R., & Martinez Galvis, N.P. (2019). Legally lethal
kratom: A herbal supplement with overdose potential. Journal of Psychoactive
Drugs, 51(1), 28-30.
Raffa, R.B., Pergolizzi, J.V., Taylor, R., & Ossipov, M.H
(2018). Nature’s first “atypical opioids”:
Kratom and mitragynines. J Clin Pharm Ther, 43: 437– 441. https://doi.org/10.1111/jcpt.12676
Sakaran, R., Othman, F., Jantan, I., Thent, Z.
C., & Das, S. (2014). An insight into the effect of mitragyna speciosa korth
extract on various systems of the body. Global J Pharmacol, 8,
Saref, A., Suraya, S., Singh, D., Grundmann, O., Narayanan, S., Swogger, M.T., Prozialeck, W.C., Boyer, E., Chear, N.J.Y., & Balasingam, V. (2019). Self-reported prevalence and severity of opioid and kratom (mitragyna speciosa korth) side effects. Journal of Ethnopharmacology, 238, 111876. ISSN 0378-8741, https://doi.org/10.1016/j.jep.2019.111876
Singh, D., Chye, Y., Suo, C., Yücel, M., Grundmann, O., Ahmad, M. Z., … & Mϋller, C. Brain magnetic resonance imaging of regular kratom (mitragyna speciosa korth) users: A preliminary study.
Singh, D., Müller, C.P., & Vicknasingam, B.K. (2014). Kratom (mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug and Alcohol Dependence, 139, 132-137. ISSN 0376-8716, https://doi.org/10.1016/j.drugalcdep.2014.03.017
Singh, D., Narayanan, S., Müller, C. P.,
Vicknasingam, B., Yücel, M., Ho, E. T. W., … & Mansor, S. M. (2019).
Long-term cognitive effects of kratom (mitragyna speciosa korth) use. Journal
of Psychoactive Drugs, 51(1), 19-27.
Tayabali, K., Bolzon, C., Foster, P., Patel, J., & Kalim, M.O.
(2018). Kratom: A dangerous player in the opioid crisis. Journal of Community Hospital Internal Medicine Perspectives, 8:3,
107-110. DOI: 10.1080/20009666.2018.1468693
Veltri, C., & Grundmann, O. (2019). Current
perspectives on the impact of kratom use. Substance Abuse and Rehabilitation, 10,
Yusoff, N. H. M., Suhaimi, F. W., Vadivelu, R. K., Hassan, Z., Rümler, A., Rotter, A., Amato, D., Dringenberg, H. C., Mansor, S. M., Navaratnam, V.,
& Müller, C. P. ( 2016). Abuse potential and
adverse cognitive effects of mitragynine (kratom). Addiction
Biology, 21:98– 110. doi: 10.1111/adb.12185