Kratom Myths, Effects, Risks, and How to Get Help

Kratom Myths, Effects, Risks, and How to Get Help Addiction Drug Use Opioids Print What to Know About Kratom Use By Cathy Wong Medically reviewed by Medically reviewed by Steven Gans, MD on August 12, 2019 Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital. Learn about our Medical Review Board Steven Gans, MD Updated on February 03, 2020 Joe Raedle / Getty Images More in Addiction Drug Use Opioids Cocaine Heroin Marijuana Meth Ecstasy/MDMA Hallucinogens Prescription Medications Alcohol Use Addictive Behaviors Nicotine Use Coping and Recovery In This Article Table of Contents Expand What Does Kratom Do? Common Side Effects Signs of Use Myths & Common Questions Addiction & Withdrawal How to Get Help View All Back To Top You may have heard about kratom (Mitragyna speciosa), an herbal supplement used traditionally in Southeast Asia for energy and to help ease aches and pains. Derived from a type of evergreen tree, kratom contains alkaloid compounds  called mitragynine and 7-hydroxymitragynine. While kratom acts like a mild stimulant when taken in low doses, it can cause an opiate-like high when taken in high doses. Kratom is currently listed by the Drug Enforcement Agency (DEA) as a “drug of concern,” and has not been approved for any medical use by the Federal Drug Administration (FDA).   Also Known As: Kratom products are also known as Biak, Ketum, Kakuam, Ithang, Thom, Herbal, and Ketum. Drug Class: Kratom is classified as a stimulant. Common Side Effects: Side effects of kratom use include pain relief, relaxation, improved mood, increased energy, sensitivity to sunburn, nausea, itching, sweating, dry mouth, constipation, increased urination, and loss of appetite. How to Recognize Kratom Kratom looks like fresh or dried leaves and can be made into a green powder, liquid extract, gum, or pill. Packets are often labeled “not for human consumption.” People chew kratom leaves, brew the dried or powdered leaves as a tea, eat them in food, or smoke them. What Does Kratom Do? According to FDA research, kratom is an agonist that binds to the mu-opioid receptors. This is the same part of the brain that is activated when you take opioids, like prescription painkillers or heroin. Kratom is, essentially, a natural opioid. Like all opioids, it comes with a risk of tolerance, dependence, and withdrawal. It’s thought that mitragynine and 7-hydroxymitragynine  may help control pain by attaching to proteins called opioid receptors and, in turn, reducing pain perception. The results of a recent  online survey  found that kratom users in the United States tend to be middle-aged, middle-income people living with pain. Most of the over 8,000 survey respondents said that they were using kratom to treat pain or improve their mood. A smaller but significant number said they were using it to help them quit opioid drugs (a class of medication used for pain relief) or to treat opioid withdrawal. What the Experts Say Many proponents of kratom suggest that the herb could serve as a solution to the opioid crisis, both by offering another option for pain relief and by aiding those struggling to overcome opioid addiction. Other experts say that its not the magic solution some people claim it is. Published research on kratom’s possible benefits as a pain reliever and opioid alternative is very scarce. The available research includes a report published in the International Journal on Drug Policy in 2010, for which scientists surveyed 136 active users of kratom and found that the herb was “described as affordable, easily available, and having no serious side effects despite prolonged use.” This report included no testing of kratom’s health effects or potential hazards. In a more recent report published in Drug and Alcohol Dependence in 2014, researchers surveyed 293 regular kratom users and determined that more than half had developed severe dependence problems, including kratom withdrawal symptoms like muscle spasms, sleep disruption, anger, and tension. A mouse-based study published in the Journal of Medicinal Chemistry in 2016 indicated that kratom may not slow breathing to the same extent as other pain-relieving drugs like morphine. Given that deaths due to opioid overdose are usually the result of respiratory depression, the studys finding suggests that further research on the compounds in kratom is warranted. On August 30, 2016, the  DEA announced their intent to place two of the herb’s active constituents  on its Schedule I drug list  as early as September 30, 2016. The DEA  withdrew its notice of intent  in October 2016 and opened an official public comment period lasting until December 1, 2016. Schedule I drugs (which include heroin and MDMA) are considered to have “no currently accepted medical use and a high potential for abuse.” Mitragynine and 7-hydroxymitragynine are the kratom constituents set to be classified as Schedule I drugs, making possession or sale of the herb illegal. Kratom would remain on the Schedule I list for at least two years. The DEA’s intent to place mitragynine and 7-hydroxymitragynine on its Schedule I drug list was met with a great deal of backlash. In mid-September 2016, for instance, protesters held a march and rally at Lafayette Park in Washington, D.C., and presented a  petition  signed by over  120,000 people opposing the ban. At the rally, Botanical Education Alliance director Travis Lowin stated that the DEA “has failed Americans in its efforts to combat the opioid epidemic, and targeting kratom will make the situation worse.” According to those opposing the ban, placing kratoms alkaloids on the Schedule I drug list would also stifle further research on the compounds. On November 14, 2017, the FDA Commissioner Scott Gottlieb, MD,  issued a public health advisory about risks associated with kratom. Since then, the FDA has intensified warnings, citing strong evidence that the unregulated botanical substance has “opioid properties.” In an 18-month period, kratom was a contributing factor in more than 90 fatal overdoses; people had also taken fentanyl and heroin. Off-Label or Recently Approved Uses While kratom is traditionally used to boost energy and  soothe stress, in recent years, kratom has gained popularity as an alternative to  opioid pain medications  like Vicodin (hydrocodone) and OxyContin (oxycodone). In many cases, kratom is used to manage chronic pain associated with conditions such as arthritis  and fibromyalgia. Kratom is also increasingly used as an herbal approach to alleviating symptoms associated with opioid withdrawal, such as muscle aches and mood disturbance. Common Side Effects Although case reports have reported  drowsiness, irritability, palpitations, high blood pressure,  poor concentration, insomnia, hypothyroidism, seizures, psychosis,  hepatitis, and coma in people using kratom, its unclear how much is directly attributable to kratom. Risks  appear to be higher when its taken in concentrated extracts (which have a higher potency), mixed with other psychoactive substances, drugs,  or adulterants, or when its  taken by people with alcohol use disorders, a history of heroin use, or certain health  conditions. Short-term side effects: CalmnessEuphoriaTalkativenessIncreased social behaviorSensitivity to sunburnNauseaItchingSweatingDry mouthConstipationIncreased urinationLoss of appetite Long-term side effects: AnorexiaConstipationFrequent urinationInsomniaDiscoloration of the cheeksPsychotic symptoms (hallucinations, delusion, confusion) According to reports by U.S. poison control hotlines, calls involving kratom overdoses rose 50-fold from 2011 to 2016. In most cases, the kratom was laced with other drugs. If you or someone you love are experiencing any signs of overdose, call 911 or Poison Control helpline (800-222-1222) immediately.   Signs of Use If someone you love is using kratom, its important to be on the lookout for the common side effects (such as talkativeness, increased social behavior, itching, changes in appetite, sweating) as well as any unusual or extreme shifts in mood, behavior, appearance, and overall health. Myths Common Questions Many people believe that since kratom is an herbal remedy, its safe. But its important to keep in mind that herbal products aren’t reviewed by the FDA before they hit the market. As a result, there’s no guarantee that a  supplement will contain the ingredients listed on the label (or that those ingredients will appear in the indicated amounts). Adulteration and contamination with other drugs,  herbs, and substances are possible. Tolerance, Dependence, and Withdrawal Kratom comes with a risk of tolerance, dependence, and withdrawal. Kratom users can build tolerance, or needing more to achieve the desired effect, and experience symptoms of withdrawal when they stop taking the drug. How Long Does Kratom Stay in Your System? More research is needed to determine the exact half-life of kratom. Like other substances, how long kratom stays in your system will depend on the following factors: Type of kratomFrequency of useAgeGeneticsBody fatWater and food intakeMetabolic rate Its main active alkaloid, mitragynine, can be detected in a urine test. Addiction The DEA states that kratom abuse can lead to addiction and can result in psychotic symptoms, including hallucinations, delusion, and confusion. Not everyone will experience addiction in the same way, but there are several hallmark signs and symptoms, including: Tolerance, dependence, withdrawalSecretiveness, stealing, and/or lyingFinancially unpredictableChanges in friendsStashes of drugs or paraphernaliaTrouble scaling back or stopping drugLoss of interests in hobbies, social activities, or job or schoolVast amounts of time spent getting, using, and recovering from the drugChanges in mood, sleeping patterns, weight, and activity levels Signs and Symptoms of Addiction Withdrawal People who take large doses of kratom several times per day have an increased risk of moderate to severe withdrawal symptoms. In general, however, withdrawal symptoms are milder in comparison to opioid withdrawal and may include: Increased muscle spasms and  painDifficulty sleepingHot flashesFeverWatery eyesRunny noseDecreased appetiteMood disturbancesDiarrhea How Long Does Withdrawal From Kratom Last? How to Get Help Living with pain isnt easy. If you live with pain, you may already be all too familiar with the profound effect it can have on your quality of life. If you are considering trying kratom, you should speak with your care provider first. Some pain clinics are exploring complementary approaches, in conjunction with pain treatment, to manage or cope with pain. For example, mindfulness (and other  mind-body practices) may help some  people  remain pain-controlled despite the challenges of everyday life. If youve been using kratom to self-medicate and have noticed that it has begun to take over your life, dont wait to get help. A trusted healthcare professional can help guide you toward the path of recovery and pain-free living.