Understanding Kratom Abuse: Risks, Addiction, and Treatment Options

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What you will learn

• Kratom is an herbal extract from the leaves of a tropical tree in Southeast Asia.
• Mitragynine is the active compound that produces opioid-like effects.
• Kratom has been used in traditional Asian medicine for centuries and has gained recent popularity in the US as a remedy and recreational drug.
• Several reports have been linked to serious side effects, or even death, from consuming kratom products.
• Though not scheduled under the Controlled Substances Act on the federal level, regulatory bodies like the FDA have expressed concerns and are monitoring kratom closely.

Kratom has been showing up everywhere, from vitamin stores to farmers’ markets. It’s often sold as an energy booster, pain reliever, or other miracle supplement based on traditional Asian medicine, but the reality is more complicated.

While kratom has been used for medicinal purposes in its native Southeast Asia, its medicinal properties have not been well researched, nor have its potential risks. Learn more about kratom, its uses, and the possible dangers.

What Is Kratom?

Kratom is an herbal extract from the leaves of a tropical tree (Mitragyna speciosa) native to Southeast Asia. Its leaves contain a chemical called mitragynine, which produces effects similar to opioids like morphine or heroin.[1] People often use kratom as a “safe” alternative to opioid painkillers, despite serious side effects.

There are several phytochemicals present in kratom that have different pharmacological and toxicological properties. The primary components are mitragynine and 7-hydroxymitragynine, only found in Mitragyna speciosa.[2]

History of Kratom

Grown in Thailand, Malaysia, Myanmar, and other parts of Southeast Asia, Kratom has been used as an herbal remedy in the region for centuries. Traditionally, laborers used it as a stimulant to manage their hard work and relieve muscle pain. It was also used as an opium substitute if none was available or as a treatment option for morphine dependence.[3]

In Thailand, the Kratom Act 2486 made planting kratom trees illegal in 1943; the government enacted the Narcotics Act B.E. 2522 in 1979, placing kratom alongside marijuana in Category V of the narcotics classifications. It was since updated in 2021 and removed from the narcotics list.

Kratom has been growing in popularity in recent years on the recreational drug market. While there is no FDA-approved medical use for kratom in the US, it is commonly used as a natural remedy and is legal as a psychoactive product. Kratom products are currently legal and accessible and not listed in the Controlled Substances Act.

How Is Kratom Used?

Kratom can be used in many different forms. People may chew the leaves, brew them into tea, or swallow them dry. Kratom extract may be used to make the product in liquid form, which may be sold as a treatment for cramps, muscle pain, or food cravings. It also comes in tablet and capsule form.

In Asian traditional medicine, kratom is a substitute for opium. It’s believed to act on opioid receptors and, at low doses, may act as a stimulant. With higher doses, kratom may relieve pain and bring on a euphoric feeling. People commonly use kratom as a remedy for withdrawal from morphine, heroin, and other opioid drugs.

Recreationally, kratom may be used at parties or social settings. People may use it to relieve feelings of social anxiety or to get high, partly because it’s considered “natural and safe” as a plant-based substance.

What Are the Risks and Side Effects of Kratom?

People who take kratom swear by its benefits, but it comes with significant side effects and risks. The active ingredients in kratom plants can vary significantly, making it difficult to ensure an appropriate dose.

The effects begin about five to 10 minutes after ingestion and last about two to five hours. The more kratom ingested, the stronger the effects.

There are several possible side effects, including:[4]

• Dry mouth
• Weight loss
• Changes in urine output
• Chills, nausea, and vomiting
• Constipation
• Muscle pain
• Liver damage
• Dizziness
• Drowsiness
• Hallucinations
• Delusions
• Depressed breathing
• Seizures

In severe cases, kratom may lead to coma and death. But because kratom is a natural substance that can’t be dosed carefully, it’s difficult to determine the level of kratom that’s toxic in people.

Kratom use has been associated with several cases of overdoses and fatalities, but it’s often a result of contaminated products or an unsafe mixture of different drugs.

Potential for Addiction and Kratom Abuse

Because kratom acts on opioid receptors, it’s possible for those who use kratom regularly to become dependent as the body adapts to regular exposure. When they stop, they’ll have withdrawal symptoms as the body adjusts to no longer having kratom, which may include intense cravings to relieve the symptoms.

Though the risk of dependence hasn’t been well researched, it appears to be a higher likelihood for people who consume higher doses regularly.

More research is needed to understand how kratom affects the body, both in short-term symptoms and long-term use. The effects of kratom may vary according to the natural potency of the plant, the way the product is formulated, how it’s consumed, and the individual’s medical history and history of substance use.

Despite being marketed as a “safe” alternative to opioids, people may experience withdrawal symptoms when they stop taking kratom. This is especially true for users who develop a tolerance to kratom, requiring larger doses to achieve the same effects, which increases the risk of adverse reactions and withdrawal symptoms upon cessation. The potential for abuse is heightened by the lack of regulation and standardization in kratom products, leading to variability in potency and composition. Typical kratom withdrawal symptoms may include:

• Nausea
• Insomnia
• Restlessness
• Irritability
• Mood swings
• Diarrhea
• Muscle pain
• Joint stiffness
• Runny nose

How Is Kratom Addiction Diagnosed and Treated?

There’s still debate about the risk of kratom addiction, but it would fall under a substance use disorder. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the symptoms may include:[5]

• Inability to moderate or stop using the substance
• Continued use of the substance despite the problems it creates
• Increasingly reckless behaviors
• Tolerance to the substance
• Limited interest in activities that used to be enjoyed
• Withdrawal symptoms when the substance is no longer used
• Low productivity or problems at school, work, or home

Kratom Addiction Treatment

While kratom addiction is not specifically classified as a distinct substance use disorder, evidence suggests that treatments typically used for opioid addiction, such as buprenorphine and naloxone, may be effective for managing kratom dependence.

For individuals experiencing withdrawal symptoms from kratom, treatment options may include medically supervised detoxification. This process helps manage withdrawal symptoms more comfortably with the support of medications and medical professionals.

Once detox is complete, people can transition into inpatient or outpatient treatment programs that address the underlying emotional or behavioral issues that contribute to substance use. These programs offer an integrated approach with modalities like behavioral therapy, psychotherapy, and support groups.