Kratom Addiction: Signs, Symptoms, Risks, and Treatment Resources

What is Kratom?

Kratom is derived from the leaves of the Mitragyna speciosa tree, a tropical tree indigenous to Southeast Asia. Due to the presence of an alkaloid compound called mitragynine, kratom has psychotropic, or mind-altering, effects. In low doses, kratom acts as a stimulant, while in high doses, it acts as an opioid.

Kratom has the potential for dependence and addiction in some users. It is considered a ‘Drug of Concern’ by the U.S. Drug Enforcement Administration (DEA), reflecting potential health risks and abuse. The legal status of kratom varies by state in the U.S., with some states having regulations or bans in place. Other names for kratom include thang, kakuam, thom, ketum, and biak.

Kratom Quick Reference

How Do People Consume Kratom?

Kratom is sold in many different formats and strengths. It may be consumed orally as an extract, tablet, or capsule. It may also be dried or powdered and added to a tea. Occasionally, the leaves of the kratom plant are chewed, much like tobacco.

Is Kratom Legal in All US States?

Although kratom is considered a ‘drug of concern’ by the DEA, its legal status is determined by state laws, leading to a patchwork of regulations across the country.

In Tennessee, kratom is legal for possession and use by people ages 21 and older.
Kratom sales have been regulated more strictly in Tennessee than in other states.

In New Jersey, kratom is fully legal and can be accessed by people 21 and older. Kratom is widely available in the state due to its legal status and relative cost to other substances on the market.

The Effects of Kratom

The mitragynine alkaloids in kratom have both physical and mental effects. In low doses, kratom provides increased energy and alertness. In higher doses, kratom provides pain relief, relaxation, sedation, and other opiate-like effects. It has a half life of about 24 hours.

Due to the unregulated nature of kratom, predicting the effect of any dose is difficult. Other variables include the way kratom is taken, a person’s experience with this substance, mixing kratom with other drugs, and any known or unknown medication conditions. People using kratom should be aware of these risks and practice safe consumption habits with this herb.

How Does Kratom Affect the Body?

People who take kratom report stimulant-like effects, including increased energy, focus, alertness, and a rapid heart rate. In higher doses, people say that kratom provides pain relief, relaxation, and other sedative effects similar to opiates. Because of this overlap, kratom is sometimes used to manage symptoms of opiate withdrawal and support Opiate Use Disorder treatments.[1]

How Does Kratom Affect the Mind?

When a person uses kratom, the mitragynine alkaloid contained within its leaves converts to a compound called 7-hydroxymitragynine, which binds to mu-opioid receptors in the body and brain. This causes an experience comparable to a mild dose of opiates such as oxycodone or heroin.

The interactions between 7-hydroxymitragynine and the adrenergic, serotonin, and dopamine receptors in our bodies may also cause the stimulating effect of kratom.

Side Effects of Kratom

The side effects of kratom range from mild to severe and are dependent on the size of the dose taken, along with other factors such as the way this herb is consumed.[2]

Mild side effects of kratom may include:

• Dry mouth
• Euphoria
• Increased talkativeness and sociability
• Nausea
• Constipation
• Dizziness
• Drowsiness
• Increased urination
• Insomnia
• Itching
• Sensitivity to sun

Serious side effects of kratom may include:

• Tremors and seizures
• Confusions and delirium
• High blood pressure
• Rapid heart rate
• Slow breathing
• Vomiting
• Liver problems
• Hallucinations
• Delusion
• Paranoia
• Discoloration of cheeks

If you or someone you know experiences serious side effects of kratom, please consult a medical professional as soon as possible or dial 9-1-1.

Can Kratom Be Addictive?

Kratom use can result in dependence and addiction characterized by physical and psychological withdrawal symptoms that make it very difficult to stop using this herb, even when an individual wants to. Research indicates that therapeutic and pharmaceutical interventions[3] for substance use disorder hold promise for kratom addiction treatment.

Physical Symptoms of Kratom Withdrawal

Kratom works on the mu-opioid system of the body, similar to opiates such as fentanyl, heroin, and oxycontin. It also causes many of the same physical withdrawal symptoms, including:

• Myalgia, joint pain, and body aches
• Tremors and uncontrollable ‘jerkiness’
• Sensations of ‘crawling skin’ and extreme itchiness
• Diarrhea and other gastrointestinal issues
• Yawning, exhaustion, and loss of concentration
• Chills and a feverish feeling
• Runny nose
• Appetite loss

Psychological Symptoms of Kratom Withdrawal

The psychological effects of kratom withdrawal can be a double-edged sword. Not only are individuals confronted with psychological withdrawal symptoms, but they may also experience a resurgence of the addiction issues and mental health challenges they were using kratom to manage previously.

Some common psychological symptoms of kratom withdrawal include:

• Irritability, hostility, and aggression
• Depression, anxiety, and other emotional changes
• Restlessness and insomnia
• Feeling tense
• A return of symptoms of psychological disorders previously managed by kratom
• A resurgence of the psychological symptoms of other substance use disorders managed by kratom

Substance Use Disorder and Kratom

Kratom’s specific mention is not included under the criteria for substance use disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), not due to its legal status, but rather because the DSM-5 categorizes substance use disorders based on general criteria applicable to all substances, without listing each one individually. However, many behaviors common with kratom dependence and addiction are shared with other substances covered under this criteria.

Because kratom is not listed explicitly in the DSM-5, those with kratom-related substance use disorder may find it difficult to get a diagnosis or access to treatment. If you are struggling with any of the following substance use disorder criteria about kratom, please make sure to bring them to your medical professional’s attention:

• Taking the kratom in larger amounts or for longer than you’re meant to, or needing larger doses to get the same effect
• Wanting to cut down or stop using kratom but not managing to
• Spending a lot of time getting, using, or recovering from use of the kratom
• Cravings and urges to use kratom
• Not managing to do what you should at work, home, or school because of kratom use, and continuing to use despite these problems
• Kratom is damaging your social or familial relations, but you continue to use it
• Using kratom again and again, even when it puts you in danger
• Continuing to use kratom, even when you know you have a physical or psychological problem that could have been caused or made worse by it
• Development of kratom withdrawal symptoms which are relieved by taking more of it

Can You Overdose on Kratom?

While it is possible to experience an overdose on kratom, the management of an overdose should be guided by medical professionals. Self-management at home is not recommended due to the risk of severe complications, especially when kratom is mixed with other substances. But in some cases, especially when mixed with other drugs, a kratom overdose can be serious and may result in death.

According to a 2016 study, 7.4% of calls to U.S. poison control centers regarding kratom were about life-threatening exposure to health, including some residual disability.[4] This is of special concern for people who require larger and larger doses of kratom to achieve the required effect due to substance use disorder. Some signs of a kratom overdose include:

• Seizures
• Psychosis, hallucinations, and/or paranoia
• Dangerously slow breathing
• Severe vomiting
• Coma
• Death

Seek medical care immediately if you or someone you’re with experiences these overdose signs after consuming kratom.

Tennessee offers Regional Overdose Prevention Specialists throughout the state who offer overdose awareness training and naloxone distribution.

Mixing Kratom with Other Drugs Increases the Risk

Mixing kratom with other drugs increases the risk of serious side effects, overdose, and even death. This includes pharmaceuticals like benzodiazepines, acetaminophen, antidepressants, anticonvulsants, and mood stabilizers. Extreme caution should be exercised when drinking alcohol or using other drugs while taking kratom.

It is not advisable to mix kratom with drugs, especially ketamine, ethanol, narcotics, opiates, and other botanicals like cannabis. Another risk comes from the fact that when a substance is acquired in the black market, it’s impossible to know what it contains or how that might interact with kratom.

Kratom for the Management of Opiate Withdrawal

Anecdotal evidence suggests that using kratom may help decrease the withdrawal symptoms associated with recovering from opiate addiction. However, given that kratom also has the potential to become addictive, management of opiate withdrawal is better suited to proven medical interventions.

As of the last update, kratom has not been approved by the FDA for the treatment of opiate withdrawal or any other medical use, reflecting ongoing concerns regarding its safety and efficacy. In Southeast Asia, kratom has been employed as part of a traditional medicine approach to addiction treatment. Due to the escalating opiate overdose epidemic, many medical and research groups are currently advocating for further study into kratom’s viability and risk management in opiate substance use disorder.

Kratom Addiction Treatment

Treatment for kratom addiction follows a similar strategy as treatment for other substance use disorders — a detox from the substance, therapeutic treatments, and then long-term lifestyle management.

Detox from kratom may involve inpatient treatment under the supervision of a medical team or may be supervised by your family doctor at home. Withdrawal symptoms will be managed through tapering, medications, and other interventions. Withdrawal symptoms begin 12 – 14 hours after stopping the substance and may persist for 3-7 days.

Therapeutic treatments may take place during detox from kratom or after the withdrawal process has been completed. This will depend on both the individual seeking treatment and the treatment modalities used by their team of substance abuse specialists.

Inpatient programs are one option for kratom treatment and will feature a therapeutic environment complete with support groups, emotional management and addiction skills training, individual counseling, and recreational activities. Other options for the treatment of kratom include day programs, support groups, or individual appointments with a therapist. The best option is as unique as the individual being treated.

In the long term, abstinence from a substance following substance use disorder involves making lasting lifestyle changes [6]. This includes diet and nutrition improvements, individualized physical activity plans, sleep hygiene, healthy coping strategies, strong social relationships, and quitting smoking. It should also include support to manage the root cause of kratom use and address any psychological or physical challenges behind that use.

Recovery from kratom addiction is possible. Talk to your doctor or an addiction specialist to learn about your options.