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Should you consider the legal herbal supplement kratom to ease your opioid withdrawals or will you just end up with transferring your dependency to another addictive substance?

Read on to learn how kratom works, how it’s used and what risks you need to consider before getting started.

What Is Kratom?

Kratom is a plant that grows naturally in Malaysia,Thailand and other areas of Southeast Asia; it has been used medicinally in these areas for hundreds of years. Kratom leaves have psychoactive properties and the leaves are typically dried and smoked, steeped into tea or prepared for ingestion in capsules.

Kratom’s two primary psychoactive alkaloids are:1

  1. Mitragynine (a stimulant)
  2. 7-hydroxymitragyine, a sedative and analgesic which stimulates the mu opioid receptors.

Recreational Use

Though Kratom is used medicinally, it is also abused for recreational purposes. Kratom’s recreational effects are dose dependent. At sufficient doses, kratom users experience an initial stimulant-like high which is followed by a pleasurable and relaxed sedation. The high typically lasts from between 2 and 5 hours.2

  • At low doses, kratom may only induce mild stimulation. At higher doses, it stimulates the mu and delta opioid receptors in the brain and causes opioid-like effects, such as sedation, euphoria and analgesia.

Addiction Risks

As with other drugs that stimulate the brain’s opioid receptors, kratom is addictive and with prolonged regular use you will become dependent. In animal model studies, 5 days or longer of consecutive use induced a state of physical dependency that was characterized by opioid-like withdrawal symptoms.3

Medicinal Use

Beyond recreational use, kratom is also used traditionally/medicinally to treat opioid withdrawal symptoms, to reduce fatigue, to treat cough and diarrhea and to provide general analgesia.

  • In animal studies, researchers found that kratom and codeine provided similar cough suppression and pain relief.4

Using Kratom to Treat Opioid Withdrawal Symptoms

Depending on how you look at it, there is either overwhelming evidence to support kratom for opioid withdrawal – or little to none at all.

  1. People in South East Asia have a traditional history of using kratom as an opium/heroin withdrawal aid – and if you scour internet forums, you find a huge number of anecdotal reports on the effectiveness of kratom for opioid withdrawal.
  2. However, though we see a great deal of historical/anecdotal evidence, there is very little modern medical research on using the herb for opioid withdrawal.

So though there is evidence to support kratom for withdrawal, without sufficient medical research, and due to the potency variations, credible medical organizations won’t provide use-guidelines.

And this puts the potential user in a tough position!

Why Kratom Reduces Opioid Withdrawal Symptoms

  1. After becoming opioid dependent, you start experiencing opioid withdrawal symptoms as soon as opioid receptors in your brain fall into a state of under-stimulation.
  2. Since kratom stimulates the same opioid receptors in the brain as drugs like heroin or Oxycontin (mu and delta opioid receptors) an appropriate dose of this herbal medicine can greatly reduce the severity of your withdrawal symptoms.
  3. Kratom not only stimulates opioid receptors, it also exerts stimulant-like effects through activation of other receptors families. This complex-action may further help to reduce withdrawal discomfort. 5

Using Kratom for Opioid Withdrawal Symptoms

Note, the following information is a summation of internet user reports – generally how people are using kratom to combat withdrawals. This information does not originate from any credible medical source and is not a recommendation for any course of action. If you decide to use Kratom, you will have to figure out for yourself the best way forward.

Kratom is used for opioid withdrawal relief in the three following primary ways:

  1. Occasionally, to stave of sickness between opioid usage – Some users report that kratom can eliminate opioid withdrawal symptoms during periods without opioid access.
  2. Over a brief period, as a detox aid – Kratom can also be used, similarly to buprenorphine, as a short term detox aid. Basically, you switch off an opioid of abuse and onto a dose of kratom that’s high enough to mostly or completely eliminate your withdrawal symptoms. Then, after a short period of stabilization (a couple of days) you taper your kratom dose down to zero over the next week or two. Since kratom withdrawal symptoms are generally milder than full agonist opioid withdrawals, this can ease the discomfort of the detox.
  3. As a longer term substitution medication – You can also use kratom on a longer-term basis as a maintenance medication. This is less common, largely due to the higher costs of kratom when compared to methadone or Suboxone.

Using Kratom - Cautions and Concerns

Lack of Regulation/Oversight

As with other unregulated herbal substances, there is little product oversight and it is very difficult to know what you’re really going to get from your internet order. Consider the cautionary tale from Sweden where researchers in 2011 documented a series of 9 overdose fatalities that occurred after people took kratom capsules that had been adulterated with O-desmethyltramadol  (one of the active substances in the pain reliever, Tramadol).6

Potency Differences

A recent Japanese study illustrates how tough it is to gauge potency.7

Japanese researchers analyzed a sample of 13 internet-order kratom products. They found:

  • 11 of the 13 contained the psychoactive substances mitragynine (a stimulant) and 7-hydroxymitragyine (2 of the products had none at all).
  • Mitragynine levels varied by as much as 6 fold from a low of 1% to a high of 6% 
  • 7 –hydroxymitragyine levels varied by as much as 4 fold, from a low of 0.01% to a high of 0.04%.

Interaction Effects

Mixing kratom with other drugs and medications increases the odds of an adverse reaction. Adverse reactions have been reported with the use of kratom together with: carisoprodol (a muscle relaxant), Modafinil (a wakefulness drug) and propylhexedrine (a cold medication). Since at high doses kratom is sedating, you should probably avoid taking it wither sedating substances, such as alcohol or benzodiazepines.

Acute Side Effects

You may experience unpleasant acute side effects, such as: anxiety, irritability, aggression, itching, sedation, nausea and constipation. Although serious acute adverse effects are rare, kratom may have a tramadol-like seizure risk (due to peripheral stimulation of the noradrenaline and serotonin systems).8

Long Term Side Effects

Long term heavy use has been associated with incidents of: anorexia, twitching, tiredness, discoloration of cheeks, weight loss and psychosis. Long term kratrom use can lead to addiction and physical dependency. Quitting once dependent will lead to significant withdrawal symptoms.

Legal Status

As of April 2014, kratom remains legal in most states. The DEA does not consider kratom a controlled substance but has it on its ‘Drugs and Chemicals of Concern’ list. 

Interestingly, though kratom remains mostly legal in America, due to its abuse potential, it is illegal in many areas where it grows naturally, such as Thailand, Myanmar and Malaysia.

Kratom Withdrawal Symptoms

So if you transfer from a full-agonist opioid dependency to a kratom dependency, how will your withdrawal symptoms differ?

Kratom dependency causes an opioid-like state of withdrawal upon sudden stoppage. Typical kratom withdrawal symptoms are quite similar to opioid withdrawal symptoms, and include:

  • High blood pressure
  • Nausea and diarrhea
  • Insomnia and yawning
  • Tremor and jerky movements
  • Anxiety and irritability
  • Dysphoria
  • Runny nose
  • Muscle and joint pain
  • Cravings
  • General feelings of weakness

Kratom withdrawal symptoms are generally milder than full-agonist opioids, but persist for a similar duration(about a week). 

Interestingly, though kratom is generally touted as an effective opioid withdrawal aid, opioids (dihydrocodeine-lofexidine combination) are also suggested as a useful medication to help ease kratom withdrawal symotoms!4

References
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Page last updated Apr 28, 2014

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