Kratom is the common name for Mitragyna speciosa, which is a type of evergreen tree related to coffee. Kratom – the drug – is made by grinding the leaves of the tree, which contain psychoactive chemicals.
Kratom has recently become popular as a novel substance of abuse in the U.S. It is viewed by many as a legal way to get high and as an alternative to opioids. However, kratom is increasingly being regarded by the medical and public health community as an emerging contributor to the intensification of the opioid crisis.
The facts about kratom are skewed by a couple of factors:
- There has been very little research into the drug, mainly because of safety concerns with the drug, so a lot of “facts” are little more than “bro-science”
- Kratom users have a powerful lobby in the U.S. that has managed to derail the DEA’s 2016 attempt to make kratom illegal and also foiled attempts to ban the drug by the State of Florida; this lobby promotes “facts” that support the drug use and speaks out against facts that disparage the drug
In this article, we sort through the misconceptions and reveal the facts based on what we do know about this unusual drug.
How is Kratom Abused?
Can you smoke kratom? Kratom can be smoked but the amount of leaf that would be required is too large to be easily smoked. Some people dehydrate the tea to produce a resin that can be smoked.
Kratom is usually used orally. Locals in Southeast Asia sometimes chew the leaves off the trees or put them in their food. In the U.S. kratom is available in several formats, all based on M. speciosa leaves, either whole or ground up:
- Powder: made by grinding the dried leaves, and is usually sold in packets labelled “not for human consumption”
- Capsules or tablets: the powder and packaged into capsules, or pressed into tablets
- Tea: made by brewing the dried or powdered leaves
- Gum: sometimes the tree gum (resin) is chewed
Kratom has a bitter taste, so it is usually consumed with a sweetener. A popular drink in Southeast Asia – known as 4X100 – is a mixture of kratom tea, Coca-Cola, ice and codeine cough syrup.
Kratom Side Effects
There appear to be a variety of ways that kratom affects different individuals, and there is variation in the chemical content between different kratom products, depending on the type of kratom tree that it came from.
Generally, the side effects of kratom mimic those of opioids and, to a lesser extent, those of a mild stimulant. Available data suggest that most kratom users also use other substances of abuse concurrently with kratom, which may cause some of the side effects to be additive.
The stimulant kratom effects are uncomfortable for some people, and can produce:
- Aggressive behavior
One side effect of kratom is tainting of the uncontrolled substance. Already, the FDA has had to respond to batches of the drug that were poisoned with Salmonella, and some that were found to be laced with heavy metals.
How does kratom make you feel? Users report that kratom high effects give a feeling of being stimulated and relaxed at the same time. The short-term side effects of kratom use include:
- A very common immediate side effect of kratom is nausea. With repeated use this can cause anorexia and unhealthy weight loss.
- The digestive tract is lined with opioid receptors and activation of these by kratom’s opioid-like effects causes constipation.
- Being a brain-altering drug, kratom has known adverse effects on the brain, including seizure, coma and kratom headache.
- Kratom diarrhea occurs as a rebound effect when the drug wears off. The digestive system tries to compensate for the constipating effects of the drug, and the result is diarrhea once the constipating effects wear off.
- Kratom can cause blood pressure to rise to dangerous levels. Kratom’s effect on blood pressure is one of the leading reasons that kratom users call poison control centers in the U.S.
Because kratom has received very little study in human subjects and the drug is a relatively small player in the illicit drug market, we don’t know for sure all the long term effects of kratom use. However, long-term or high dose use of kratom has thus far been associated with:
- Dark discoloration of the skin on the cheeks (malar hyperpigmentation) is a known effect of long-term kratom use.
- Uncontrollable and persistent shaking of the extremities may occur with prolonged use of kratom.
- Kratom weight loss appears to be due to its nauseating and anorexic (appetite-reducing) effects, which can become chronic.
Tolerance to Drug
- Kratom tolerance develops with even short-term use; users need to use increasingly larger amounts of the drug to get the same effect. This is one of the characteristics of addiction.
Sexual Side Effects
- Kratom is known to cause abnormal elevations of the pituitary hormone prolactin, which results in sexual side effects in both men and women. In women, changes in menstrual cycles (ranging from ceasing to increased frequency), breast milk production, infertility and loss of libido can occur. In men, impotence, infertility, loss of libido and the development of breast tissue can occur with kratom use.
- Is kratom bad for your liver? Kratom is known to be hepatotoxic (poisonous to the liver) and has been documented in animal and human cases to cause liver injury and illness.
- Kratom has been documented as being cardiotoxic, which is one of the reasons that the FDA has warned consumers against using the drug. Kratom side effects on the heart are based on its effect at slowing electrical conduction in the heart, thereby provoking arrhythmias (irregular heart rhythms) that can be fatal.
Kratom Withdrawal Symptoms
Some former kratom users have described kratom withdrawal as being worse than when they withdrew from opioids. Kratom withdrawal typically produces symptoms very similar to those of withdrawal from opioids, including:
- “Goose flesh” (piloerection)
- Hot and cold chills, shivering
- Muscle aches
- Irritability, agitation, aggression
- Depression, anxiety
- Runny nose
- Jerky movements
- Intense cravings
Can you overdose on kratom? Yes. Taking the equivalent of more than 15g of raw leaf puts people at particularly high risk of overdose. At these doses, users usually show additional symptoms:
- Excessive sweating (diaphoresis)
- An uncomfortable feeling of unease (dysphoria)
According to the CDC, the most common symptoms causing people to call poison control centers after using kratom are:
- Rapid heart rate
- Agitation or irritability
- High blood pressure
Fatalities from kratom do not necessarily occur from an overdose; the toxicities from kratom can cause fatalities even when used within usual dosing ranges. The CDC has reported that between July 2016 and December 2017 152 deaths attributed to drug use tested positive for kratom and for most of them kratom was determined to be a cause of death. However, this data was collected from only 32 states.
Most kratom overdose deaths appear to be due to adulterated product or from taking kratom concurrently with other drugs of abuse.
How Addictive is Kratom?
Kratom produces the same characteristic effects that make substances addictive:
- Compulsive use
- Withdrawal symptoms
As such, kratom’s addiction potential is considered to be high. Case reports suggest that users find that their kratom use progresses over time and that attempts to cut back are met with cravings and withdrawal symptoms. Their attempt to find an opioid alternative has led to another addiction.
Kratom Abuse Facts & Statistics
Kratom use statistics are not available from the CDC, as the drug is difficult to track, and its use is still on a relatively small scale. However, independent researchers conducted a U.S. survey of 10,000 kratom users, of which 8,049 responded. This 2016 survey showed the following facts about kratom users:
- Kratom users are usually 31-50 years old and make $35K per year or more and have private health insurance
- 40% of users report their kratom use to their healthcare provider
- 0.65% required treatment from toxicity from the drug
- The main reasons for using the drug were pain, mental health or emotional symptoms and opioid withdrawal
Kratom Abuse & Treatment Trends in South Florida
Although kratom is banned in Sarasota County, kratom use appears to be thriving in South Florida. A quick Google search shows a number of shops that sell the drug, as well as bars that serve the drug, usually as a tea.
Florida lawmakers have made several unsuccessful attempts to add the drug to Florida’s list of banned substances.
Help Someone With A Kratom Addiction
It can be very difficult to help someone with a substance addiction who does not want help. The psychology of addiction includes a strong tendency to be secretive about drug use, to conceal it and lie about it and to attempt to rationalize it.
People who become addicted to substances of abuse such as kratom get caught in the cycle of addiction:
- Using the drug, getting high (for the effect, or to escape mental health symptoms, uncomfortable thoughts and feelings or life’s stresses)
- Withdrawing from the drug
- Obsessive thoughts about using the drug and a need to use to stop or prevent the withdrawal, and back to 1)
However, kratom can be easily rationalized by people who are addicted to it, by claiming that they need it for a medical reason, or by claiming that they are using it to help withdraw from other drug use, or by claiming that it is legal and natural and therefore safe.
As such, it is best to let a friend who may be addicted to kratom to know that you are approachable if he or she ever wishes to discuss the matter and that there is kratom addiction help available.
Kratom Addiction Treatment
Withdrawal from kratom can be a difficult ordeal, so many people who wish to stop their kratom use may wish to consider attending a kratom detox program. In a medical detox program, medical support and medication are used to reduce the symptoms of withdrawal and make the experience more comfortable.
There are suggestions in the medical literature that using the opioid replacement drug combination buprenorphine-naloxone (Suboxone) may be appropriate for treating kratom detox and early recovery.
Medical detox programs also allow for counseling support and treatment planning, so that individuals are able to transition seamlessly into a treatment program after detoxing from drug use.
There is no treatment that is specific to kratom addiction. Rather, the healing process is the same as for other substance addictions. The underlying cause of the addiction and the effects of the addiction are identified and addressed. Individuals learn to live life without using substances.
Key Points: Understanding Kratom Addiction and Abuse
Kratom is an unusual drug whose uses and effects are poorly understood. Nevertheless, there are some key facts to remember about kratom:
- Kratom is legally available in most parts of the U.S., at least for the time being
- The FDA has issued consumer warnings against kratom use and the DEA has declared it a chemical of concern
- Kratom has purported medical uses, but none have been substantiated by proper study
- Kratom has stimulant and opioid-like properties and is highly addictive
- Kratom abuse can lead to kratom addiction
- Kratom addiction is treatable
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