People in growing numbers are going to their hospital’s emergency room reporting negative effects from kratom use.
Commonly, individuals are unaware of the addictive nature and withdrawal syndrome of the drug, as it is promoted by kratom advocacy groups and dealers as being non-addictive. The internet is rife with websites that sell or advocate for kratom that exaggerate its beneficial effects and downplay or deny its potential for harm.
As such, kratom withdrawal and detox are subjects that are not well understood by many people and many healthcare professionals who are not specialized in treating substance abuse.
What Causes Kratom Withdrawal?
Kratom contains a number of psychoactive chemicals, meaning that they manage to penetrate the brain’s protective blood-brain barrier and change the chemical composition of the brain. The affected brain chemicals (neurotransmitters) control everything from how people think and feel to how they move and behave, so the drug-induced alterations disrupt the brain’s normal ability to function, affecting how its owner thinks and behaves.
The main chemical effects of kratom on the brain are stimulant and opioid-like. The brain tries to compensate for these effects by making major changes in its chemical processes. Over time, as the brain is subjected to repeated doses of kratom, the compensatory changes become the brain’s new normal.
Kratom withdrawal occurs because the sudden cessation of exposure to the drug once again disrupts the brain’s chemistry, and the brain is shocked into trying to normalize itself once again. Until this normalization occurs, brain and body functions become disrupted and withdrawal symptoms result.
The resulting withdrawal symptoms are generally the opposite of how the drug makes individuals feel. For example:
- Euphoria from the drug becomes dysphoria in withdrawal
- Constipation becomes diarrhea
- A feeling of calmness becomes anxiety and worry
- Stimulation and high energy becomes lethargy and fatigue
Kratom Withdrawal Symptoms
Although kratom has received little attention from the research community in the United States, Malaysian universities have conducted some research into kratom addiction and withdrawal in recent years.
About 65% of kratom users experienced mild withdrawal effects, while the other 35% reported moderate-to-severe symptoms. The severity was related to the amount of kratom used, with those consuming the equivalent of three glasses of tea or more daily being more likely to experience severe symptoms. The duration of kratom use has less of an effect on the severity of withdrawal symptoms.
Many — perhaps most — kratom users also use other substances of abuse. As such, kratom withdrawal symptoms may be accompanied by symptoms from those substances.
- Physical Withdrawal Symptoms
Physical symptoms tend to be more prevalent during the acute withdrawal phase (the first week or so after discontinuing the drug). The most commonly reported physical withdrawal symptoms are:
Fever, hot flashes,
Nausea and vomiting,
Muscle spasm and cramping,
Watery eyes and nose,
- Psychological Withdrawal Symptoms
Psychological symptoms occur during the acute withdrawal phase but often continue as protracted symptoms. Psychological symptoms are prevalent; about 73% of people withdrawing from kratom use report at least five different psychological symptoms within the first day of withdrawal. The most common psychological withdrawal symptoms are:
Nervousness, tension and anxiety,
Sadness and depression,
Anger and agitation.
Mild to moderate craving occurs in 77% of people withdrawing from kratom, while the other 23% report severe cravings.
Fortunately, suicidal ideation does not appear to be a common symptom of kratom withdrawal.
- Symptoms of Post Acute Withdrawal Syndrome (PAWS)
Post acute withdrawal syndrome (PAWS) refers to a lingering collection of symptoms that may persist following acute withdrawal, often lasting for a year or more. Many of the symptoms of PAWS are simply acute withdrawal symptoms that last longer than the usual duration, especially:
High blood pressure and heart rate,
Low energy, fatigue and apathy.
While PAWS is predominantly associated with alcohol use disorder (AUD), it can occur following withdrawal from other drug use as well. However, more commonly, drug withdrawal symptoms do not fit with the typical PAWS presentation and are instead simply known as protracted withdrawal symptoms.
- Protracted Withdrawal Symptoms
Although not specifically detailed in the scarce research literature that discusses kratom withdrawal, the opioid-like nature of kratom withdrawal syndrome strongly suggests the possibility of protracted symptoms. Following the acute withdrawal period, longer-term, protracted withdrawal symptoms may emerge and may last weeks or months from the last drug use. These tend to be primarily psychological and may include:
Fatigue, lethargy (often related to depression),
Anhedonia (inability to experience pleasure),
The “pink cloud” syndrome (excessively happy feelings, ignoring the reality of life),
Negative feelings typical of addiction: guilt, remorse, self-loathing, low self-esteem and anger,
The psychological symptoms are an especially potent cause of relapse. These symptoms and their underlying causes are directly addressed by addictions treatment programs.
- Kratom Withdrawal and Death
Kratom withdrawal is not known to be associated with fatalities. Rather, it is the use of kratom that carries a risk of death. As such, detoxing from kratom can be viewed as a potentially life-saving measure.
Kratom Withdrawal Timeline
How long does kratom withdrawal last? The kratom withdrawal timeline is consistent with the 24-hour half-life of its main active ingredient and its opioid-like properties.
Withdrawal symptoms are first noticed within 12 to 24 hours after the last dose and last up to seven days. The average duration of harsh symptoms is approximately three days.
Psychological symptoms usually last two to three weeks.
The withdrawal timeline is generally consistent for most people, but there are some individual factors that may cause differences in the severity and duration of symptoms. These factors include:
- General health
- Liver and kidney function
- Genetic and biological make-up
- Concurrent use of other drugs
- Co-occurring mental health disorder (if any)
- Use of medically assisted detox, or not
- Amount of kratom used (and to a lesser extent, the duration of use)
- Number of previous attempts at detox
Helping Kratom Withdrawal
Since kratom use remains relatively untouched by the United States research community, the search for what helps with kratom withdrawal is ongoing. However, theoretically, the use of opioid replacement therapy with buprenorphine or methadone would be very useful. This practice has been in use by some physicians and reported in the medical literature.
However, some physicians may be unwilling to prescribe a controlled substance such as Suboxone or methadone for kratom addiction, especially if they are not familiar with kratom, as this is not an FDA-approved therapy.
Medical detox from kratom involves the use of medical supervision with or without medications to withdraw safely and comfortably from kratom or other substances. An in-patient medically assisted kratom detox program may be critical to some people’s ability to stop their drug use, because without help the cravings and drive to end the sickness by using again can be overwhelming.
As well, some people fear the withdrawal process and will avoid it unless they have help. Medical detox provides the support and expertise to get people through this significant barrier to recovery. It also allows for interacting with other people who share the same situation and connecting with addiction counselors and other staff to put together a plan for recovery.
There are some evidence-based supportive medications that can be used during kratom detox to manage specific withdrawal symptoms and kratom side effects:
- Agitation, anxiety and insomnia: benzodiazepines and clonidine
- Abdominal pain, diarrhea: loperamide for kratom withdrawal and other antidiarrheals
- Muscle spasms: benzodiazepines
- Joint pain, muscle aches: non-opioid pain medications
- Sedation: naloxone
- Confusion, hallucinations: benzodiazepines and naloxone
- Nausea, vomiting: antiemetics
- High blood pressure, rapid heart rate: benzodiazepines, clonidine and heart blockers
- Seizures: benzodiazepines, naloxone and anticonvulsants
The Internet offers many purported home remedies for drug detox, and people should be careful when considering such treatments. Most are unproven, untested and unregulated. Discussing in advance any chemical use — natural or otherwise — for treating withdrawal with a healthcare professional knowledgeable about drug detox is a good idea.
A natural remedy for opiate detox that appears to have some merit is the naturally occurring hallucinogen ibogaine; by extension, it may be useful for kratom detox as well. However, this drug is illegal in the United States due to its considerable potential for harmful side effects.
An outpatient kratom detox program involves detoxing at home with advice and help from a physician or under the guidance of a kratom detox center. The major disadvantages to this approach is the lack of availability of professional help at all hours in case of difficulty or serious complications.
People considering detoxing at home should do so under the care of their doctor. The cravings and the desire to use to stop the withdrawal symptoms may be overwhelming for some people, so people who try to detox on their own might not succeed. They may be putting themselves through unnecessarily difficult symptoms.
People who plan to detox at home should have some elements in place:
- A stable and supportive home environment
- They should not live alone, and the people at home should be aware of the detox situation
- Highly motivated to recover
- Involvement of their doctor or an outpatient detox center for advice on how to detox from kratom at home
- Absence of co-occurring mental health disorders
- Absence of other substance use
It should be remembered that detox does not in any way constitute treatment for substance addiction. People should make arrangements in advance for some kind of treatment to address the reasons behind the substance use, and to help heal from the mental and physical damage caused by the drug use. Consider the following aspects of detox:
- Cold Turkey – Quitting kratom cold turkey results in a rapid onset of withdrawal symptoms. The risk of experiencing a setback during such a withdrawal is high.
- Ease of Withdrawal – The main tip for how to ease kratom withdrawal is not to do it alone. There is excellent professional help available to make detox and withdrawal safe and comfortable, and to put the supports in place for long-term recovery.
Finding a Detox Center
Undergoing medically assisted detox and treatment at an accredited facility offers the best opportunity for a return to good health and function in long-term successful recovery. Some factors to consider when selecting a detox program include:
- Staff-to-Patient Ratio
Key Points: Understanding Kratom Withdrawal and Detox
There are some key points about kratom withdrawal and detox to remember:
- There is a great deal of misinformation about kratom in the press and on the internet, particularly from kratom advocacy groups
- Kratom has a high addiction potential
- Kratom produces significant withdrawal symptoms upon lowering or discontinuing the dose
- Kratom withdrawal symptoms closely resemble those of opioids
- Kratom withdrawal may benefit from the use of opioid-replacement therapy or naloxone
- Medically assisted detox provides the safest and most comfortable approach to withdrawing from kratom use
- Detox from kratom does not constitute treatment for the addiction
If you or a loved one struggle with kratom use, contact The Recovery Village Palm Beach at Baptist Health today to speak with a representative about how professional treatment can help. Take the first step toward a healthier future today.
Anwar, Mehruba; Law, Royal; Schier, Josh. “Notes from the Field. Kratom (Mitragyna speciosa) exposures reported to poison centers — United States, 2010–2015.” CDC Morbidity and Mortality Weekly Reports, July 29, 2016. Accessed August 9, 2019.
Chalana, Harsh; Kundal, Tanu; Gupta, Varun; et al. “Predictors of Relapse after Inpatient Opioid Detoxification during 1-Year Follow-Up.” Journal of Addiction, April 7, 2016. Accessed August 9, 2019.
Galbis-Reig, David. “A case report of kratom addiction and withdrawal.” Wisconsin Medical Journal, February 2016. Accessed August 9, 2019.
Olsen, Emily; et al. “Notes from the field: Unintentional drug overdose deaths with kratom detected — 27 States, July 2016–December 2017.” CDC Morbidity and Mortality Weekly Reports, April 12, 2019. Accessed August 9, 2019.
Singh, Darshan; et al. “Severity of kratom (Mitragyna speciosa korth.) psychological withdrawal symptoms.” Journal of Psychoactive Drugs, August 28, 2018. Accessed August 9, 2019.
Stanciu, Cornel; et al. “Kratom withdrawal: A systematic review.” Journal of Psychoactive Drugs, January 5, 2019. Accessed August 9, 2019.
White, Michael. “Pharmacologic and clinical assessment of kratom.” American Journal of Health-System Pharmacy, March 1, 2018. Accessed August 9, 2019.
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