Kratom is an herb derived from a tropical evergreen tree (Mitragyna speciosa) that grows mainly in Thailand and Southeast Asia. The leaves have been used for centuries to increase energy, reduce pain, elevate mood, and relieve intestinal distress. While early users of kratom chewed the leaves to achieve desired effects, the herb is now available in pill, capsule, powder, or tea form.
Because kratom is currently classified as an herb, not a controlled substance, the Food and Drug Administration (FDA) can only regulate it as a dietary supplement and not as a food or drug. As long as manufacturers adhere to certain FDA production standards, businesses can sell their product without FDA approval. However, companies are not allowed to claim their product will treat or heal specific medical conditions. Companies that make such claims are in violation of federal law.
In 2018, FDA Commissioner Scott Gottlieb stated the agency was issuing warning letters to companies promoting kratom as an effective treatment for opioid use disorder or for treatment of other medical conditions. According to Gottlieb, “to date, there have been no adequate and well-controlled scientific studies involving the use of kratom as a treatment for opioid use withdrawal or other diseases in humans.” He also cautioned that kratom can contain opioid-like substances and may carry the same abuse potential as opioids.
The FDA and the Drug Enforcement Agency (DEA) include kratom on their list of drugs of concern, while the National Institute of Drug Abuse (NIDA) warns kratom is an “emerging drug of abuse.” Even though these agencies, along with many health professionals, fear kratom poses serious health consequences, including addiction, there has been no definitive determination as to whether kratom is in fact addictive.
Is kratom legal in the United States?
Currently, kratom can be legally sold in many states and municipalities in the U.S. In some states, kratom is legal in the majority of cities and counties but not all. The herb has been banned in many countries, including Australia, Denmark, Germany, and, ironically, Malaysia and Thailand, its region of origin.
What are the effects of kratom?
According to NIDA, compounds in kratom interact with opioid receptors in the brain, causing effects similar to both opioids and stimulants. Kratom effects can vary greatly depending on the dose taken. When taken in low doses, it acts like a central nervous system stimulant, increasing energy, alertness, and the desire to socialize. Higher doses tend to produce effects similar to morphine, causing a sense of euphoria, pain relief, and numbness. Users feel the effects of kratom quickly, although they may last up to five hours.
Side effects most commonly experienced by kratom users include nausea, vomiting, and constipation. Many other uncomfortable, potentially dangerous, side effects that have been reported include:
- Frequent urination
- Sun sensitivity
- Loss of appetite
- Dry mouth
- Psychotic symptoms
- Tachycardia (irregular or rapid heart rate)
WebMD also warns kratom has been linked to hallucinations, delusions, and thyroid problems, and, in large doses, “may cause trouble breathing, brain swelling, seizure, liver damage, and death.”
Also reported by WebMD is an increased risk of suicide when kratom is used by those with alcohol dependency or a mental health disorder.
Is dependence the same as addiction?
There is a difference between dependence and addiction, although dependence can accompany addiction. Dependence on a drug can happen even when taking a prescribed drug as directed. The body comes to rely on the drug to manage certain symptoms, but when increasingly higher doses are needed to achieve the desired effect, users may be reaching an addictive state.
Addiction can be an overwhelming craving for a specific substance, thing, or activity. The NIDA describes addiction as “compulsive drug use despite harmful consequences — characterized by an inability to stop using a drug; failure to meet work, social, or family obligations; and…tolerance and withdrawal.” Both dependence and addiction are characterized by physical withdrawal symptoms when a user discontinues the substance.
Kratom has been shown to have opioid-like compounds, causing concern among health professionals that users may develop dependence and addiction. As with drug use, those who use kratom regularly, then stop taking it, may experience withdrawal symptoms.
WebMD identifies potential withdrawal symptoms as decreased appetite, diarrhea, muscle pain and spasms, twitches, watery eyes, anxiety, trouble sleeping, anger, hot flashes, and fever. Additional withdrawal symptoms may include mood swings, runny nose, and aggression.
Can kratom use cause an overdose?
A study published in the medical journal Clinical Toxicology reported a huge increase in recent years of kratom exposures reported to poison control centers during 2016-2017. Of the 1,807 exposures documented since 2011, 65% were reported between 2016-2017. Two of the reported exposures resulting in death were linked to kratom use only, while another 9 deaths were linked to multiple-substance use, including kratom. The study concluded that “kratom is associated with a variety of serious medical outcomes, especially when used with other substances.”
A report issued by the CDC in April 2019 evaluating Unintentional Drug Overdose Deaths With Kratom Detected found that in 152 of the 27,388 overdose deaths from July 2016 to December 2017, the deceased had kratom in their system. Although in 91 of those 152 deaths kratom was listed as the cause of death, most decedents tested positive for multiple substances. Fentanyl and heroin were the most frequently identified substances alongside kratom.
Can kratom ease opioid withdrawal symptoms?
Although many kratom advocates promote the effectiveness of kratom to ease symptoms caused by opioid withdrawal, current research does not support this claim. In fact, the Mayo Clinic states, “The evidence suggests that rather than treating addiction and withdrawal, the use of kratom may lead to them.”
One study cited by the Mayo Clinic found those who used kratom for six months, then stopped taking it, experienced withdrawal symptoms similar to those occurring when opioid use is discontinued. Both substances appear to affect brain chemistry associated with pleasure and reward, causing withdrawal as the brain seeks to regain a natural balance without the substance.
According to the Mayo Clinic, not only does kratom’s effectiveness for opioid withdrawal relief remain unproven, “as with pain medications and recreational drugs, it is possible to overdose on kratom.”
FDA continues to advise against kratom use
Unless research determines kratom is safe and effective for specific uses, the FDA urges people to avoid the use of kratom or any product that includes its ingredients.
There have been several warnings issued by the FDA about contaminants or dangerous organisms found in certain kratom products. According to the FDA, some kratom has been found to contain highly addictive opioids, salmonella contamination, and dangerously high levels of heavy metal contaminants. Depending on the contaminant, effects could range from health problems to risk of overdose.
For many years, both the FDA and the DEA have expressed concern over the use of kratom, stating the risk for abuse, addiction, and overdose. In fact, in 2016 the FDA moved to reclassify kratom as a controlled substance, which would have made it illegal in the U.S. Because of negative feedback and political pressure at the time, they decided not to push for the reclassification, but they continue to warn of the risks associated with kratom.
Seeking Professional Help
If you or a loved one is struggling with addiction or wants to stop using kratom or another substance, we can help. BlueCrest Recovery Center takes a whole-person approach to treatment, considering not only a person’s physical needs but also their emotional, psychological, and spiritual needs. Learn more about our approach to treatment, and contact us today for help.
Medically Reviewed By Dr. Thomaso Skorupski, D.O.