Kratom is a tropical tree from Southeast Asia that contains many compounds including mitragynine and 7-a-hydroxymitragynine (7-HMG), which interact with opioid receptors to produce opioid-like effects, especially in large doses. These same compounds are thought to interact with other receptor systems in the brain to elicit the stimulant effects that are commonly experienced at lower doses.1 Southeast Asians, particularly Thai and Malaysian laborers, have been using kratom for decades for enhanced energy and relief from muscle strains.2
In the United States, kratom is currently sold in various forms, which include a green powder as well as a gum or concentrated extract. People may chew kratom leaves, brew the powdered leaves into a tea, smoke the leaves directly, or eat them in food. Common kratom nicknames include herbal speedball, ketum, kakuam, thom, and biak.1,2
Despite the lack of evidence supporting kratom’s safety and efficacy, some people use the herbal drug to treat chronic pain, to manage opioid withdrawal symptoms, and to reduce cravings for several addictive substances, such as opioids and alcohol.1 It is currently not an illegal substance and is easily purchased online. Its unregulated status and ease of access pose significant dilemmas, as kratom has also been associated with dependence and addiction.
The legal status of kratom remains controversial. In August 2016, the Drug Enforcement Agency (DEA) announced that it would temporarily categorize its primary psychoactive compounds (mitragynine and 7-HMG) as a Schedule I controlled substances, meaning they have no accepted medical use and exhibit high potential for abuse.3 The DEA is authorized to temporarily place drugs into this category while they gather more information regarding any potential public health hazards. Many factors fueled the decision to place kratom in the Schedule I classification.3
First, in the first half of 2016, the DEA noted a large increase in seizures of kratom (such as those made by U.S. Customs and Border Protection agents) planned for distribution on the recreational drug market. There was significant concern surrounding the ease of access to kratom through the Internet and smoke shops, since people were frequently misusing it to self-treat opioid withdrawal syndrome and long-term pain. But kratom use isn’t without its risks and side effects; the DEA became wary of kratom’s dangers and noted that addiction, dependence, and withdrawal have been reported with chronic use.3
Further, the chemical concentrations of kratom batches vary considerably, which can lead to volatile and potentially hazardous effects when similar doses are used. There have been some reports of certain kratom batches containing additional mind-altering substances, such as opioids and synthetic marijuana. The DEA also reported that there were more than 650 calls to United States poison centers related to kratom abuse between 2010 and 2015, as well as about 30 kratom-related deaths since 2009.3
However, the DEA’s decision to classify kratom as a Schedule I controlled substance resulted in very strong public reactions that included petitions, organized demonstrations, and congressional calls to overrule the decision. Advocacy groups, such as the American Kratom Association and Botanical Education Alliance, garnered over 100,000 signatures in favor of kratom’s benefits.3 They asserted that kratom was useful for pain-management and reducing opioid withdrawal symptoms. Advocates also claimed that kratom was far safer than prescription painkillers, such as Vicodin, Percocet, and OxyContin.3
Just two months later, in October 2016, the DEA withdrew its intent to schedule kratom as a Schedule I drug.3 To date, there has not been a final decision published by the DEA regarding the status of kratom. Currently, kratom is listed as a Drug and Chemical of Concern with the DEA.6
Kratom is a unique drug in that it can produce feelings that mimic those of both stimulants and opioids, depending on the dose.
When taken in small amounts, the user may feel stimulant-like reactions including:1,2
When taken in larger dose, the user may experience opioid-like effects, such as:1
Psychosis has also been reported in individuals with a severe kratom addiction. These people experienced delusions, confusion, and hallucinations.2
Like traditional opioids of abuse, users can develop a tolerance to kratom. When people become tolerant to a substance, they need to take larger or more frequent doses to achieve the desired effects. As tolerance builds and kratom use continues, a person can develop physiological dependence, which means that the person requires kratom in order to function optimally.7
When someone becomes dependent on kratom, suddenly stopping use of the substance will likely result in unpleasant or distressing withdrawal symptoms, which are similar to those seen during acute opioid withdrawal.
Kratom withdrawal symptoms may include:1,7
The presence of dependence and subsequent withdrawal symptoms does not necessarily mean someone is addicted; however, kratom dependence can certainly contribute to the development of an addiction as compulsive patterns of use take shape. Addiction is a complex condition characterized by maladaptive, drug-seeking behavior that causes significant impairment in the drug user’s life.4
While more research needs to be conducted on kratom, there have been reports of individuals developing an addiction to the drug.1,3 One study of addicted people in Thailand found that these individuals chewed kratom on the daily basis for an average of about 19 years.2
Some common signs of kratom addiction include:4
If you or someone you know exhibits signs of a kratom addiction, it’s important to seek help sooner rather than later. Detox and rehab can help you obtain and maintain sobriety in the long run.
If you are looking to quit kratom, your first step of recovery may be professional detox treatment. Detox refers to the group of interventions aimed to manage acute intoxication and kratom withdrawal symptoms.
The 3 main elements of a formal detox program include:5
Participation in a professional detox program may take place on either an inpatient or outpatient basis, depending on the person’s medical needs and addiction severity.
There are a variety of inpatient detox settings, including hospitals and free-standing detox facilities. Inpatient detox treatment provides 24/7 supervision, support, and monitoring for patients who are intoxicated or experiencing withdrawal. Patients live on-site and have access to physicians and clinicians at all times.5 If it is a medical detox facility, medications will likely be utilized. Typically, inpatient detox is for patients with severe addictions or an increased risk for medical or psychiatric complications.
Outpatient detox can take place in a physician’s office or a free-standing center. They provide structured services that last for a couple hours per week to several hours per day. The patient will commute to and from the center while continuing to live at home. Patients with mild-to-moderate addictions frequently benefit from outpatient detox.5
Detox is not a substitute for formal addiction treatment services. Once you complete detox, you should transition into a comprehensive, substance abuse treatment program that can address the underlying behaviors contributing to your substance abuse. Treatment can assist you in building a solid foundation for recovery.