Kratom Misuse

Kratom is a naturally occurring herbal substance that produces effects similar to those of stimulants (cocaine, amphetamines) and opioids (morphine, heroin).¹ Although there is not enough convincing evidence to state that “Kratom is addictive and can result in a substance use disorder,” misusing Kratom may lead to physical dependence and potentially dangerous health effects.¹

Kratom can be a risky substance to use because the short- and long-term effects are largely unknown, it may contain unlisted additives, and may produce mild to severe adverse consequences.^{1, 4} As a result of the unknown long-term effects and potential negative health effects, the United States and international agencies have concerns about Kratom misuse.¹

If you use Kratom, or you know someone who does, this article will help you understand:

• What Kratom is.
• Kratom’s effects.
• Signs of Kratom misuse.
• How to seek treatment for Kratom misuse.

What Is Kratom?

Kratom is a substance made from the leaves of a tropical tree known as Mitragyna speciosa that is native to Southeast Asia.^{1, 2, 11}

Kratom is a popular substance because it can produce euphoric effects similar to stimulants and the pain-relieving effects of opioids. Kratom is believed to act on the mu-opioid receptors in the brain producing partial opioid-like effects at high doses. When taken at low doses Kratom can produce similar effects to stimulants which include increased alertness, increased energy, and a heightened sense of arousal and happiness.^{1, 11}

Kratom leaves can be chewed or dried to be swallowed or brewed into teas and are often labeled as “herbal supplements” and sold over the counter.¹

The medicinal use of Kratom in Southeast Asia has a long history, dating back hundreds of years.⁴ Widespread Kratom use in the United States is relatively new.^{1, 4} However, in recent years, medical professionals, the U.S. Drug Enforcement Agency (DEA), U.S. Department of Agriculture (USDA), and the U.S. Food and Drug Administration (FDA) have shown concerns about Kratom use.¹

Kratom use has increased in popularity in Western countries over the past decade; current estimates are that as many as 5 million individuals in the United States use Kratom regularly.^{4, 11}

Kratom is often used to help alleviate chronic pain and opioid withdrawal symptoms because many people think it is safer than opioids. However, more extensive research still needs to be done to prove this.¹

Kratom is misused by partygoers for its stimulating, euphoric, and relaxation effects. Kratom is often marketed as an appetite suppressant and a remedy for anxiety, depression, panic attacks.^{1, 4, 12}

The DEA proposed assigning Kratom as a Schedule 1 controlled substance (the same category as heroin), resulting in the possession of Kratom being illegal.⁴ However, this decision was placed on hold due to severe backlash from many consumers in the United States who stated that Kratom does have beneficial properties in treating opioid dependence and withdrawal symptoms.⁴

Kratom and associated Kratom products are still considered legal substances and available in many areas, though authorities like the FDA conduct ongoing reviews that help to inform policies regarding Kratom.¹ The FDA has advised consumers that they should not use Kratom or Kratom products due to the potential for adverse effects.¹

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Is Kratom Legal in the U.S.?

Kratom is still legal in the US, though some countries have banned Kratom and Kratom products.¹ The DEA has classified Kratom as a “drug and chemical of concern,” but it is not listed as a controlled substance under the Controlled Substances Act.^{2, 3} Regulations about Kratom possession and use may differ by each state.^{2, 3}

Kratom products are available for legal purchase online and in some stores throughout the U.S.¹

Why Do People Use Kratom?

A few reasons people use Kratom include:^{1, 4}

• Achieving a (perceived) safe and legal high that elicits feelings of relaxation and euphoria.
• An opioid alternative to managing chronic pain.
• Relief from cravings and withdrawal symptoms associated with opioid dependence.
• Self-medication for mental health symptoms, such as anxiety and depression.

People use Kratom in different ways, such as:^{1, 3}

• Swallowing Kratom as tablets, capsules, or liquids.
• Chewing dried Kratom leaves.
• Brewing Kratom leaves as tea.
• Mixing Kratom powder into food or drinks.

What Are Kratom’s Effects?

While Kratom is not yet fully understood, scientists know that it produces its effects because it contains many different chemical compounds.¹

As with any substance, Kratom’s effects can vary based on several factors, such as:¹

• Dosage used.
• How it’s used.
• Potency and strength.
• Using Kratom with other substances.
• Presence of co-occurring medical or psychological conditions.
• Previous Kratom use.

Research is still ongoing about the short- and long-term effects of Kratom, so it’s difficult to predict the effects a person might experience, especially since products and formulations can vary widely.¹ Additionally, some products contain contaminants like bacteria such as Salmonella, which can result in unwanted and unpredictable effects.¹

Kratom can produce opioid and stimulant effects.¹ Stimulant effects tend to occur at low doses, and Kratom opioid effects (sedative effects) can occur at high doses.³ Some of the stimulant effects of Kratom include:^{1, 3}

• Increased alertness and energy.
• Rapid heart rate.
• Talkativeness.

The opioid-like effects of Kratom include:^{1, 3}

• Relaxation.
• Sedation.
• Pain relief.
• Confusion.

Kratom use is not without potential health risks. Some of the reported adverse effects of Kratom include:^{1, 3}

• Nausea.
• Weight loss.
• Muscle pain.
• Constipation.
• Dizziness.
• Drowsiness.
• Confusion.
• Seizures.
• Slowed breathing.
• Liver problems.
• Psychotic symptoms include hallucinations and delusions.

There have been reported deaths associated with Kratom use, but most of these have occurred because people used Kratom with other substances or unknown contaminants were in the product.¹

Is Kratom Addictive?

It’s believed that Kratom misuse may cause dependence due to its stimulant and opioid-like painkilling effects.⁶ Dependence occurs over time when a drug is misused to the point that the body believes it needs it to function properly. As a result of physical dependence, when the dosage is reduced or drug use stops completely, the individual may experience withdrawal symptoms.⁵ Research is ongoing to investigate Kratom withdrawal and addictive potential.^{1, 3, 5}

In terms of addiction, medically known as a substance use disorder (SUD), there is not enough evidence-based research to determine whether Kratom is addictive.¹ Dependence is not always associated with addiction meaning that an individual can be dependent on a substance but not addicted. The main concerns are the potentially dangerous effects of Kratom misuse and the uncomfortable withdrawal symptoms.¹

Kratom Withdrawal Symptoms

Withdrawal occurs when an individual who is dependent on a substance experiences unwanted symptoms when they suddenly stop or cut down Kratom use.^{1, 9} There isn’t yet conclusive evidence on the extent of Kratom withdrawal symptoms, and research is ongoing; however, some studies show that people may experience mild to moderate withdrawal symptoms when quitting Kratom.¹

The intensity of Kratom withdrawal symptoms can be related to the dose you use and how often you use it.⁷ Quitting Kratom may result in symptoms, such as:¹⁰

• Muscle aches.
• Insomnia.
• Hostility.
• Aggression.
• Emotional changes.
• Runny nose.
• Jerky body movements.