Kratom addiction has become an alarming safety issue in the United States increasing in scale as the drug has gained more and more wide scale popularity. The dangers are twofold, with Kratom acting as a gateway drug that leads addicts back to their substances of choice (often opiates), as well as for it’s standalone addiction potential.
Kratom was originally labelled as a dietary supplement, then later as a soap or incense to sidestep FDA restrictions. As such it is currently not subject to regulation under the Federal Controlled Substances Act as a drug. There has recently been a movement in the US towards regulation and it is on the DEA Drugs of Concern watch list¹ as well as the National Institute on Drug Abuse identifying Kratom as an emerging drug of abuse¹. The US Department of Health and Human Services has even gone as far to recommend¹ that the DEA include Kratom as a Schedule 1 drug as it currently has no accepted medical use and poses a high potential for abuse. It is currently illegal in many countries around the world including Denmark, Australia, Malaysia, and Thailand (one of the countries from which it originates).
Other than strictly recreational use or for the reduction of anxiety or depression, Kratom is often used as an opioid withdrawal treatment. As far as a treatment for anxiety and depression, the lack of medical evidence means that any and all claims reporting this are anecdotal in nature and scientifically unsound. The Mayo Clinic has even gone so far as to say that Kratom is “unsafe and ineffective” regarding these beneficial claims¹.
Kratom Withdrawal Symptoms
As Kratom is still quite mysterious in terms of pharmacodynamics, there is no medication that is FDA approved for Kratom withdrawal or detox and there are currently no drugs in development or clinical trials for Kratom withdrawal. The experience of Kratom withdrawal has been described as very similar to Opioid withdrawal. The timeline for withdrawal is unknown, but some of the symptoms which can be expected include¹²³:
- Anxiety / Irritability
- Depression (with or without suicidal ideation)
- Dysphoria (a general sense of unease or unhappiness)
- Hypertension (very high blood pressure)
- Incessant Yawning or Stretching
- Rhinorrhea (extremely runny nose)
- Mood Swings
- Muscle, Bone, and Joint Pain
- Diarrhea and Nausea
While there have not yet been enough studies performed to get a clear picture of Kratom withdrawal in humans, we can look at some documented cases¹² to get a rough idea of the time involved in the acute (potentially dangerous) withdrawal phase. Having very similar symptoms to Opioid withdrawal, going through withdrawal from Kratom appears to take a similar amount of time to complete the acute phase. Depending on the amounts and length of time you used Kratom, the acute phase lasts roughly 4 to 7 days. It would be wise to seek medical attention for Kratom withdrawal, especially for the first few days to make sure you undergo this process in the safest way possible.
First 24 Hours
Withdrawal symptoms will begin around 12 hours from the last time you used Kratom. The first symptoms will be diaphoresis (excessive sweating) and weakness with an increase in anxiety. These will start off very mild and escalate dramatically over the first day. From roughly 12 to 24 hours after Kratom use, you can expect to also begin experiencing muscle, joint, or bone pain, abdominal pain and nausea, and visual distortions (not necessarily hallucinations). A fever is also expected to begin during the first day and possibly worsen. Anxiety will increase throughout the day and night and insomnia is extremely common during the first few days. Cravings for Kratom may also begin at this point. Also, mood swings (sometimes very intense) may be expected, but the appearance of mood swings and their intensity varies greatly between people.
Days 2 and 3
The above mentioned symptoms will still be very much present, and may even worsen during the second day. During this time, depression may set in as well as cravings for Kratom beginning or intensifying. The visual distortions that some people experience may disappear during this time. Uncoordinated movements and possibly tremors can begin during this time, and insomnia, lack of appetite, and dehydration can worsen these symptoms. Fever will usually stabilize during this time.
Days 4 – 7
While the physical symptoms begin to lessen over several days anxiety, depression, and cravings can become more pronounced. Typically the pain in the muscles, joints, or bones will decrease substantially during this time. The abdominal pain may go away completely but the nausea may persist for a few more days. Likewise, the tremors, fever, and coordination issues will probably resolve around the fourth day, although a mild tremor may persist for a short time.
Week 2 and Onwards (Post Acute)
The worst of the physical symptoms of acute withdrawal are behind you at this point, although you aren’t completely out of the woods yet. The depression and cravings mentioned earlier will probably persist or maybe even intensify over the next few weeks. Anxiety can also be expected to be present for some time, but generally lessens in the weeks after acute withdrawal.
The lack of regulation on Kratom makes it hard to determine the exact doses that a user is taking, however it is known that higher doses of Kratom will produce more intense withdrawal symptoms. Similar to Opioid withdrawal, the longer Kratom is used and the larger the amounts used, the greater the withdrawal symptoms will be. For example, the first study referenced above focused on a user who had been using Kratom for ~2 years, although the medical staff was unable to discern the purity of the Kratom extract she was using. Also, the second study referenced was a man who used Kratom for about 3 1/2 years, and he claimed his withdrawal was less intense than classic Opioid withdrawal, but lasted longer.
For a more exact look, a collaboration study performed by the Universiti Sains Malaysia and the University of Erlangen-Nuremberg in Germany seems to be definitive on this matter. They surveyed 293 regular Kratom users and found that of those who used Kratom for more than 6 months, more than half developed severe dependence on Kratom, while just under half had moderate Kratom dependence problems. The average amount of the active metabolite Mitragynine in the Kratom drinks these subjects were taking was 79mg per drink. Those that had 3 or more Kratom drinks per day had a much higher chance of developing Kratom addiction, withdrawal, and cravings. Finally, the withdrawal symptoms become more intense the longer the drug is used as well as the amounts that are used¹.
Using Kratom for Opiate Withdrawal
Many people have begun using Kratom as a means to stop taking Opioids. While Kratom can produce similar effects to Opioids and may reduce withdrawal symptoms, there is a very real possibility of becoming addicted to Kratom while using it in this way. While there is ongoing and future plans for research into this application of Kratom, the positive claims for this use are anecdotal and unfounded in scientific fact. It is not recommended to use Kratom in this way, and it may even do more harm than good.
Even with a complete lack of medical or scientific evidence, there have been many anecdotal claims¹ of Kratom used to successfully treat Opioid withdrawal. It should be pointed out that Kratom is a much weaker Opioid receptor agonist compared to many classic Opioids. This means that someone addicted to Opioids is going to have to do a large amount of Kratom to suppress the serious withdrawal symptoms. The lack of research on the many compounds in Kratom, as well as some early research about a few (in particular MPI) indicate that Kratom use in large doses is especially dangerous as a possibly neurotoxic agent and as the long term risks are not fully known.
How Effective is Kratom For Opiate Detox?
It is unclear just how effective Kratom can be with regards to heroin withdrawal. As mentioned, the active drugs in Kratom do exhibit cross-tolerance to Opioids. Since Kratom does work on some of the same Opioid receptors as classic Opioids, it does make sense that withdrawal symptoms would be lessened through Kratom substitution¹. Someone using Kratom in this manner would essentially just be switching one chemical addiction for another, as there is no documented studies even suggesting that Kratom can be used as an addiction recovery aid.
Some preliminary research published in September 2019 has indicated that Kratom used as an Opioid detox treatment may actually have the opposite effect. Administration of 7-HMG, a component of Kratom, has been shown to increase future Opioid intake and cravings for Opioids. Also, 7-HMG itself is considered to have a high potential for abuse which negates any claim that it may help with another addiction. Strangely, the compound which is most abundant in Kratom – Mitragynine – does seem to decrease future Opioid use. While Mitragynine is more abundant in Kratom, 7-HMG is a much more potent compound so the implications of these findings are not clear as of yet. While these findings still need to be discussed and reviewed at length, there seems to be no merit to the claims that Kratom can help with Opioid withdrawal¹.
With Kratom being promoted as an Opioid withdrawal suppressor, many people begin using it as a way to get off true Opioids like Heroin or Oxycodone. While there are some studies showing cross-tolerance (mentioned above), continued use of Kratom can produce addiction with withdrawal symptoms very similar to that of true Opioids.
An online Kratom use survey done in October 2016 had 8,049 people complete the forms. Of these, 56.59% of respondents admitted to using Kratom consistently for more than 1 year. Additionally, 2,352 people admitted to using Kratom for help getting off of a drug dependency (either illicit or prescription). Finally, only 0.65% of respondents admitted to seeking medical help for their Kratom use, suggesting that many people do not consider regular Kratom use a problem. This may be due to the prevalence of the anecdotal benefits of Kratom use as well as the lack of disseminated scientific documentation of the long term effects of Kratom use, either positive or negative.
Regardless of the lack of awareness, Kratom addiction is a very real concern. Beginning either as a hobby, social activity, or withdrawal regimen, chronic Kratom use can quickly lead to physical dependence. The timeline for Human withdrawal symptoms is not clearly defined but, in rodent studies, tolerance has been observed as early as 5 days of use which is an indicator of dependence¹. Daily use is certain to lead to physical dependence at some point, and dependence is just one stop on the way to full blown addiction.
Side Effects of Kratom Use
Some of the minor potential side effects one may experience while using any amount of Kratom for extended periods of time include:
- Diaphoresis (excessive sweating)
- Polyuria (excessive urination)
- Decreased Appetite / Subsequent Weight Loss
- Confusion or Dizziness
- Depressed Breathing
- Anxiety / Agitation
With chronic use, tolerance will build requiring more Kratom to achieve the same effects. When increasing the dose you use, the risks rise accordingly. Some of the more serious effects which present in Kratom addiction include:
- Skin Discoloration (particularly of the face)
- Nausea / Vomiting
- Increased Aggression
Kratom Treatment and Recovery
Currently there are no Kratom-specific detox and treatment programs, however any reputable detox center will gladly accept those going through Kratom withdrawal. Addiction is a disease that requires treatment. The specifics of someones drug or alcohol use may vary, but the underlying issue is the same. For this reason, it is recommended to attend a treatment program for Kratom addiction.
Once through withdrawals, you will need to be proactive in your recovery. This means seeking out a treatment program and support group to further your sobriety. There are several types of short to long term treatment available which can be beneficial. These include:
In addition to paid treatment programs, 12 Step programs have been adapted for a variety of addictions including drugs, alcohol, or behavioral. 12 Step programs appear to have an extremely solid track record when it comes to people getting and staying sober. There is no apparent reason that this approach would not work for Kratom as well, since addiction is addiction.