Posts warn about kratom overdose deaths

Others spread false claims about SSPs and advocated for non-opioid pain medications.

After recent articles discussed overdose deaths from kratom, an unregulated herbal supplement, some social media users warned about its risks, while others said that they rely on kratom for pain management. Plus, posts discussed the impact of a July executive order on harm reduction efforts, with some falsely claiming that syringe services programs do not have benefits. Other conversations showed mixed opinions on whether health care providers adequately educate patients on pain management options, including non-opioid alternatives.

In light of these discussions, communicators may highlight kratom risks, outline the benefits of SSPs, and share information about pain management.

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What’s trending nationally in conversations about substance use

Several recent articles discussed the dangers of kratom, including reports of three kratom-related overdose deaths in Los Angeles. In response, many warned that kratom can be addictive and that taking and withdrawing from kratom can be life-threatening. A few said that they had never heard of kratom. On September 8, an Oklahoma news outlet published an interview with a mother who said her son died of a kratom overdose in 2021. In response, some social media commenters said that kratom was their only way to effectively manage pain. They expressed concern about potentially losing access to it after the FDA recommended classifying a concentrated byproduct (7-hydroxymitragynine, or7-OH) as a controlled substance in July. Others called for a ban on all kratom products or on products containing 7-OH.

Recent social media posts and articles highlighted how a July executive order is impacting harm reduction efforts across the country. The executive order calls for defunding programs that offer harm reduction services and makes it easier for states to force unhoused people with mental health conditions or substance use disorders into treatment programs. On September 13, a Facebook post from a Nevada news outlet noted that a local nonprofit had recently ended its syringe exchange program, citing concerns that the program could cause the organization to lose federal funding. On September 16, an article from KFF News discussed an HIV outbreak in Maine and warned that the executive order could prevent people from accessing HIV prevention tools like sterile syringes. In response to these posts and articles, some commenters advocated for SSPs, but the vast majority falsely suggested that these programs do not have benefits and cause “crime and chaos.”

On September 10, three popular X posts mentioned an event that they called the “Freedom from the Addiction Trap” roundtable. While information about an event by that name is not publicly available online, the X users said that the roundtable advocated for health care providers to prescribe more non-opioid pain medications to prevent opioid overdoses. One post received more than 151,000 views as of September 17. Some commenters expressed concern that opioids are prescribed too frequently and that patients are not made aware of non-opioid options. Others suggested that health care providers are too hesitant to prescribe opioids due to concerns about misuse and that opioids provide the best pain relief.

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Recommendations for public health professionals

Each week, the Infodemiology.com team will provide messaging recommendations in response to some of the trending narratives outlined above. These helpful tips can be used when creating content, updating web and FAQ pages, and developing strategy for messaging about substance use.

Conversations about kratom have persisted since the FDA’s July recommendation to classify certain products containing 7-OH as controlled substances. In response, communicators may continue to stress that the Drug Enforcement Agency lists kratom as a “drug and chemical of concern,” which means that consuming it can potentially lead to substance use disorder, and that it is not regulated by the FDA as an approved medication or supplement. Messaging may note that kratom can also cause serious side effects like liver damage, dizziness, trouble breathing, seizures, and delusions. Encouraging patients to talk to their health care providers about safe pain management options is recommended.

Ongoing messaging about naloxone may emphasize that it can quickly reverse an opioid overdose, that research has found it does not increase drug use, and that experts have consistently attributed declining overdose deaths to the availability of this lifesaving medication. Communicators may explain where to find free naloxone, such as community programs at libraries, parks, or vending machines. Messaging may also note that naloxone is available for purchase over the counter at pharmacies, at some grocery and convenience stores, and online. Sharing information about how to use nasal spray naloxone and highlighting any local naloxone trainings is recommended. Communicators may emphasize that bystanders witnessing a possible overdose should dial 911, administer naloxone (even if they aren’t sure whether the person took opioids), check for breathing, perform CPR if trained in it or if instructed by a 911 operator, and stay with the person until emergency services arrive. If overdose symptoms do not resolve, give additional doses of naloxone every two to three minutes until the person begins to breathe normally or until help arrives. Messaging may stress that it is safe to administer naloxone even if a person is not overdosing or is not overdosing on opioids.Given false claims about SSPs, messaging may explain that these programs have been shown to reduce the spread of infectious diseases like HIV and hepatitis C and reduce syringe litter, which benefits the whole community. Highlighting that SSPs offer a wide range of services beyond sterile syringes is recommended, including infectious disease testing and treatment, vaccinations, and referrals to care. Communicators may want to share information about local programs where people can get naloxone, drug test strips, and other supplies that prevent overdose and infectious diseases.

Pain management appeared in conversations about both opioids and kratom. These provide an opportunity to educate people about the risks of opioids, the signs of opioid use disorder, and safe non-opioid alternatives for pain management, as some individuals report using kratom for this purpose. Messaging may explain that anyone can develop substance use disorder, including those who are prescribed opioids. Communicators may note that patients should talk to their health care provider about the risks and benefits of pain management options.