Kratom: Abuse, Addiction, and Treatment


Kratom is a drug with both stimulant and sedative effects, derived from a tropical tree that grows in Southeast Asia. The plant is related to the coffee plant, and kratom leaves produce an unusual combination of stimulant- and opioid-like effects.1

The psychotropic substance is legal in the U.S., although several states and municipalities have banned the substance.2 I Kratom is not approved for medical use by the Food and Drug Administration (FDA) and the FDA has issued several alerts warning consumers against its use.3

The latest FDA alert says that using Kratom may “expose users to the risks of addiction, abuse, and dependence.”4 The Drug Enforcement Agency also lists it a drug of concern, but it is not a controlled substance.3

According to the 2019 National Survey of Drug Use and Health, about 825,000 Americans aged 12 or older (0.3%) used kratom in the last month.5 It’s sold as a supplement or tea and is often taken for pain management and also as an at-home detox for opioid abuse.1, 6 However, there is currently little research that proves it’s effective for this use. Kratom is, however, known to be abused and potentially may cause addiction and carry other health risks.7

How Does Kratom Work?

There are two basic compounds in kratom, mitragynine and 7-hydroxymitragynine, that interact with opioid receptors and other mechanisms in the brain to produce a pleasurable sedative-like effect and decrease pain. These compounds act on additional parts of the brain at low doses to create a stimulant-like effect.1, 8

Signs of Kratom Abuse

Medical or clinical professionals can diagnose a substance use disorder that involves kratom abuse using the criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. The user would demonstrate 2 or more criteria over a year period. These criteria include:10

  • Building up a tolerance to kratom, meaning more would need to be used to produce a similar high.
  • Craving the use of and effects produced by kratom.
  • Using kratom even when the person knows its use is a hazard to them physically.
  • Continuing to use the substance even though the person knows it’s causing problems for them at work, home, or with friends.
  • Experiencing withdrawal symptoms when going too long between uses.

People who use low-dose kratom from its stimulant effects report feeling more social and alert and having higher energy levels. At higher doses, Kratom produces effects similar to opioid drugs, including respiratory depression, sedation, and constipation.1, 8

The drug’s popularity in the West appears largely due recreational use, self-management of pain, and to help self-manage opioid withdrawal symptoms.6

Kratom for opiate withdrawal is not an appropriate or proven method of detox. There is no research to support this notion, and it should not be used as a substitute for a rehabilitation program and detox with an overseeing medical professional.1, 9

 

The Health Risks of Kratom Abuse

Physical side effects users of kratom could experience include:6

  • Nausea and vomiting.
  • Itching.
  • Constipation.
  • Dry mouth.
  • Loss of appetite.
  • Increased urination.
  • Sensitivity to sunburns.

There are some dangers associated with using kratom for a long time, including liver damage, although these effects appear to be rare. Extreme cases of kratom addiction may produce hallucinations, confusion, and delirium, but these cases are also rare.6

Stimulant vs Sedative Effects

The stimulant effects of kratom include:11

  • Giddiness.
  • Alertness.
  • Decreased inhibitions and increased sociability.
  • Loss of motor coordination.
  • Euphoria.

Sedative effects are very similar to the effects from opioids like oxycodone or heroin, with euphoric effects that generally tend to be less intense than an opioid medication. The effects of kratom begin around 10 minutes after consumption, and typically last for about 1 hour12 but they can last up to six hours.11

Kratom’s mild stimulant and opioid-like properties, may be less addictive than classical opioids, however, it there are numerous reports indicating that it may be highly addictive.11

Kratom overdose appears much like other opioid overdoses, and evidence suggests the reversal agent naloxone may temporarily reverse symptoms so the individual can get medical attention.13

Experiencing withdrawal symptoms is possible in those who stop using kratom. This can include opioid-like withdrawal symptoms such as:8

  • Restlessness.
  • Irritability.
  • Chills.
  • Runny nose.
  • Nausea, vomiting, and/or diarrhea.
  • Dilated pupils.
  • Hypothermia.
  • Tremors.

Anxiety and depression were also common psychiatric symptoms that were reported during kratom withdrawal.8

Treating Kratom Addiction

group therapy close upThose struggling with heroin abuse may turn to kratom to stave off withdrawal symptoms. Although it may be tempting to use kratom to self-manage or self-detox, further studies are need to clarify the efficacy and safety prior to use.6

Drug rehabilitation programs are the best course for people who struggle with addiction to any substance or behavior, including kratom.

Although kratom is technically legal in many areas of the United States, it is not safe, and it can lead to problems for people who use it. Individual therapy is the backbone of most treatment programs, addressing the underlying reasons that led to kratom abuse in the first place.

Rehabilitation programs also offer social support in the form of group therapy and activities. These programs, like Recovery First Treatment Center’s, are vitally important because they help clients to build a support system and firm foundation in recovery. Give us a call at 954-526-5776 to learn more, or click one of the buttons below.

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Sources

  1. National Institute on Drug Abuse. (2019). Kratom drugfacts.
  2. Veltri, C. & GRundmann, O. (2019). Current perspectives on the impact of kratom use.  Substance Abuse and Rehabilitation 10, 23-31.
  3. Drug Enforcement Administration. (2017). Drugs of abuse.
  4. U.S. Food and Drug Administration. (2019). FDA and kratom.
  5. Substance Abuse and Mental Health Services Administration. (2020). Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration.
  6. Prozialeck, W.C., Jian, J.K., Andurkar, S.V. (2012). Pharmacology of kratom: an emerging botanical agent with stimulant, analgesic and opioid-like effects. The Journal of American Osteopathic Association 112, 792-799.
  7. U.S. Food and Drug Administration. (2016). US Marshals seize dietary supplements containing kratom.
  8. Eastlack, S.C., Cornett, E.M., & Kaye, A.D. (2020). Kratom—Pharmacology, clinical implications and outlook: a comprehensive review. Pain and Therapy 9, 55-69.
  9. Boyer, E.W., Babu, K.M., Adkins, J.E., McCurdy, C.R., & Halpern, J.H. (2013). Self-treatment of opioid withdrawal using kratom (mitragynia speciosa korth).
  10. Addiction 103(6), 1048-1050. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA: American Psychiatric Association.
  11. Cinosi, E., Martinotti, G, Simonato, P., et al. (2015). Following “the roots” of kratom (mitragyna speciosa): the evolution of an enhancer from a traditional use to increase work and productivity in Southeast Asia to a recreational psychoactive drug in Western countries. BioMed Research International 2015, 968786.
  12. Mee-Lee, D., Shulman, G.D., Fishman, M.J., Gastfriend, D.R., Miller, eds. (2013). The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. 3rd ed. Carson City, NV: The Change Companies.
  13. Overbeek, D.L., Abraham, J., Munzer, B.W. (2019). Kratom (mitragynine) ingestion requiring naloxone reversal. CPC Emergency Medicine 3(1), 24-26.



About The Contributor

Ryan Kelley, NREMT
Ryan Kelley, NREMT

Medical Editor, American Addiction Centers

Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More


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