Author: Hannah Sumpter

Kratom is a newly popular substance in the United States originating from the leaves of the Mitragyna speciosa tree and commonly found in Southeast Asia¹ and Africa.² In those cultures, kratom is frequently used for a wide variety of medical purposes,³ religious events, and social engagements.⁴

Kratom can be consumed in tea, smoked in a pipe, or used in powder form, making it a versatile and enticing, but dangerous, opioid-like substance for Americans¹ within the last 2 decades.⁵

What is Kratom Used For

Although used for religious and social engagements in other cultures, the American use of kratom is largely that of medical purposes, especially as a natural remedy for opioid withdrawal and pain management. Kratom is also used to help with:¹

• Anxiety
• Depression
• Post-traumatic stress disorder (PTSD)
• Improving energy and focus

Although not formally approved for use by the U.S. Food and Drug Administration (FDA), kratom success stories may encourage you towards a trial run to see if its analgesic effects are well-suited to your needs.⁶

If you have considered or your medical provider has suggested kratom therapy, it might be helpful to know that although kratom is a newer medication for pain and opioid withdrawal management, studies show that kratom’s chemical constituents have useful pharmacological agents. Meaning, the positive kratom effects are genuine and not placebo.⁷

Self-reports from those taking kratom also show a high efficacy rate and a low rate of adverse reactions when kratom is used properly and managing most medical conditions.

Kratom Side Effects

Kratom studies and self-reports appear to be remarkably positive. Kratom proves to be useful for the treatment of pain, with few serious side effects. Studies on kratom show little to no impact on motor skills, memory, attention, executive function,⁸ or other areas of physical health.⁹

Additionally, few studies show a correlation between kratom use and a negative impact on psychological or social functioning, even after long-term use of kratom,¹⁰ unless a kratom addiction develops.

Other studies demonstrate some rare side effects,⁷ with 13% of users experiencing one side effect. Fortunately, most side effects were reported as overwhelmingly mild and easily manageable at home.

It’s important to be aware that kratom is still classified as a drug, so side effects may present differently in each individual. Some kratom users report moderate to severe side effects while taking the drug, making medical oversight advisable.⁶

Moderate to severe side effects of kratom use may include:¹¹

• Hallucinations
• Delusions
• Depression
• Muscular pain
• Chills
• Organ damage
• Nausea/vomiting
• Respiratory hepatotoxicity
• Overdose
• Seizures
• Coma
• Death

Kratom has been shown to cause herb-drug interactions, most notably with other central nervous system substances. If you are considering kratom for yourself and are taking a medication that may affect your central nervous system, please speak with a medical professional.

Drug-induced liver injury (DILI) is a rare but possibly serious side effect of kratom. DILI is most often seen with patients taking a higher kratom dosage for a longer time, with a month being the soonest that DILI may develop.⁶

Lastly, safety concerns should be considered with kratom purchases in the United States, especially over the internet. The market for kratom is unregulated, and products may be adulterated or contaminated, placing additional health risks on yourself or your loved ones. If kratom is a consideration for yourself for your family, speak with your doctor to ensure the purchase of kratom is safe.⁵

When starting a new medication, speak with a medical professional to gauge your risk factors and make a final determination of the best treatment options for yourself and your condition.⁷

This advice becomes more significant with kratom, as studies have shown that kratom dependence, withdrawal, and life-threatening toxicity are higher among people who began kratom therapy without a prescription and continued oversight and guidance from a medical professional. As such, the unregulated use of kratom is not advised.¹²

Kratom Overdose

Overdose is a well-known risk for any medication and/or drug used with and without medical oversight. Kratom, being used both medically and recreationally, holds the same overdose risk and should be used cautiously.

Since becoming popular in the United States, accidental overdose has been noted among kratom users, and most especially among those using kratom in combination with other medications and substances. This comes as no surprise, as kratom is known to have negative interactions with other medications.

Kratom overdose was most commonly observed in patients who had been taking kratom for longer periods, at higher levels than medically recommended^13, and without medical oversight. This is why it’s important that kratom is used only with medical guidance and support.

Risk of Kratom Addiction

Most often, kratom is appealing for those looking to avoid narcotic and opioid use, possibly due to a past, present, or fear of addiction to narcotics or opioids. If you are considering kratom use as a means to avoid addiction to narcotics and opioids, awareness should be made of the potential risk of addiction to kratom itself.¹

As mentioned, kratom’s side effects are rare, yet for others, side effects are more severe, and kratom dependence and addiction can develop.¹⁴

Dependence on kratom is known to develop mostly among those taking kratom for prolonged periods (6 months or longer),¹⁵ and/or for managing opioid withdrawal symptoms.¹⁶ This dependence is strongly linked to your history of addiction, with the same pattern of increasing tolerance and dependence with kratom instead of your past drug of choice.¹⁷

Kratom addiction has become a new yet confusing phenomenon among kratom users,¹⁵ as some, even with an addictive past, show no dependence on kratom. In contrast, others experience addiction and withdrawal symptoms even after a short time using the substance.¹⁰ For those who developed dependence, withdrawal symptoms were reported as highly uncomfortable and abstinence was difficult.¹⁸

Why is Kratom Addictive?

Kratom addiction seems likely due to its opioid-like effects for pain relief. It has been compared to other narcotics, such as morphine when assessing the risk of death.¹⁹

Although it is largely regarded as a safe alternative to opioids more studies are needed to understand its potential for addiction and impact on mental health, physical health, and social wellness.¹⁰

Kratom does contain addictive properties but it has been found to be less harmful than other opioid pain medications.¹⁰ However, one specific addictive property of kratom has been found to be 10 times more potent than morphine and as addictive as heroin.

Kratom’s potentially toxic and lethal properties have created an emerging public health concern.¹⁷ In 2008, the Drug Enforcement Administration (DEA) listed kratom as a drug of concern with intent to place it on the Controlled Substances Act. Yet, the DEA retracted their intentions, and kratom is still legally sold as a dietary and herbal supplement.

Due to the limited information around kratom safety and concern with potentially severe kratom effects, personal awareness and caution is recommended before using kratom. Medical oversight is highly recommended while using kratom therapy.

Kratom Withdrawal

Withdrawal is also a risk associated with kratom use, both for those with a kratom dependence and without, but most especially if kratom has been taken for longer than a month. Withdrawal symptoms may include:¹⁵

• Muscle spasms
• Pain
• Sleeping difficulty
• Watery eyes and nose
• Hot flashes
• Fever
• Decreased appetite
• Diarrhea
• Restlessness
• Tension
• Anger
• Sadness
• Nervousness
• Anxiety
• Depression

Self-reports from those kratom users who experienced withdrawal indicate that cessation from chronic kratom tea consumption was associated with unpleasant psychological symptoms, including the new onset of anxiety and depressive symptoms. The level of withdrawal symptoms depended on the amount of kratom consumed, with higher levels of use being associated with higher levels of anxiety and depression.³

Studies have also found that kratom tea shows little to no withdrawal symptoms if only one cup is consumed daily, and withdrawal symptoms begin to develop when two to three glasses were consumed a day.³

The average cup of kratom tea contains 79 mg of mitragynine, making an average daily intake of 276.5 mg. Knowing that cravings and withdrawal symptoms begin to appear after two to three average cups of kratom tea, medical professionals are able to safely prescribe an equivalent amount of mitragynine in other forms as well.¹⁵

If you or a loved one are considering kratom therapy for the treatment of pain or another medical condition, rest in the assurance that kratom is a safe substance and a positive alternative to opioid use. Yet, potential risks remain for side effects and the development of kratom addiction. Please speak with a medical professional or call 800-934-1582(Who Answers?) for further guidance or assistance with kratom use, kratom dosage, or any other support that you may need.

References

1. Cole, M.A., Pillitterri, J.L., Sembower, M.A., Gerlach, K.K., & Henningfield, J.E. (2019). Kratom as a substitute for opioids: Results from an online survey. Drug and Alcohol Dependence, 202, 24-32.
2. Warner, M., Kaufman, N., & Grundmann, O. (2016). The pharmacology and toxicology of kratom: from traditional herb to drug of abuse. International Journal of Legal Medications, 30(1): 127-38.
3. Singh, D., Muller, C.P., Murugaiyah, V., Hamid, S.B.S., Vicknasingam, B.K., Avery, B., Chear, N.J.Y., & Mansor, S.M. (2018). Evaluating the hematological and clinical- chemistry parameters of kratom (Mitragyna speciosa) users in Malaysia. Journal of Ethnopharmacology, 3(25): 197-206
4. Singh, D., Narayanan, S., Vicknasingam, B., Corazzo, O., Santacroce, R., & Roman- Urrestarazu, A. (2017). Changing trends in the use of kratom (Mitragyna speciosa) in Southeast Asia. Hum Psychopharmacology. 32(3). doi: 10.1002/hup.2582
5. Veltri, C., & Grundmann, O. (2019). Current perspectives on the impact of kratom use. Substance Abuse Rehabilitation, 7(10), 23-31.
6. Fernandes, C., Iqbal, U., Tighe, S., & Ahmed, A. (2019). Kratom-induced cholestatic liver injury and its conservative management. Journal of Investigative Medicine High Impact Case Reports, 12(7).
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8. Singh, D., Narayanan, S., Muller, C.P., Vicknasingam, B., Yucel, M., Ho, E.T.W., Hassan, Z., & Mansor, S.M. (2019). Long-term cognitive effects of kratom (Mitragyna speciosa korth) use. Journal of Psychoactive Drugs, 51(1)19-27.
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13. Palasamudrum, S., Rojas, E.E., D’Angelo, C.C., Gillenwater, S.R., & Martinez, G. (2019). Legally lethal kratom: A herbal supplement with overdose potential. Journal of Psychoactive Drugs, 51(1), 28-30.
14. Galbis-Reig, D. (2016). A case report of kratom addiction and withdrawal. WMJ, 115(1), 49-52.
15. Singh, D., Muller, C., & VIcknasingam, B. (2014). Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug and Alcohol Dependence, 1(139), 132-7.
16. Singh, D., Chear, Y., Narayanan, S., Leon, F., Sharma, A., McCurdy, CR, Avery, B.A., & Balasingam, V. (2020). Patterns and reasons for kratom (Mitragyna speciosa) use among current and former opioid poly-drug users. Journal of Ethnopharmacology, 1(249), 112462.
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18. Swogger, M., & Walsh, Z. (2018). Kratom use and mental health: A systematic review. Drug and Alcohol Dependence, 183, 134-140.
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