Kratom is the name of a tree in Southeast Asia, and also the name of the intoxicant derived from its leaves. In the US, it can often be found in capsule form, with a powdered form of the substance inside the pill or, less commonly, chopped up for smoking or brewing in a tea. It’s also known by the names ketum and kratumum.

Pharmacy theme, Heap of white round medicine tablet antibiotic pThis intoxicant acts like a natural opioid painkiller, and it is used locally to manage chronic pain. It can also alter moods and produce hallucinations. Its recreational use has become popular in the US and other Western countries as its use has not been entirely restricted. Some state or local governments may have laws against the use of kratom, but there are no federal restrictions in the US. It also doesn’t show up in many drug tests.

Due to this, experimentation with kratom is popular among young people who are not legally able to purchase alcohol and afraid of the consequences of trying illicit substances. They may also believe that kratom is safer than other drugs, but the problem with this substance is that it’s not well understood as researchers have not yet had time to study its effects. It’s also sometimes used by those addicted to other drugs to soften the effects of withdrawal, especially from other opioids. According to the American Society of Addiction Medicine, 1.9 million people in the US had a substance use disorder involving prescription painkillers in 2014, and 586,000 had a substance use disorder related to heroin.

However, there have been documented cases of the drug producing withdrawal symptoms in individuals who stopped taking it after a period of regular use. This could point to the kratom being an addictive substance. Anyone taking it on a regular basis should keep an eye out for signs of addiction as well as other potentially dangerous effects.

Effects of Kratom

 
The appealing effects of kratom depend on the dosage taken. Much like ecstasy, at low doses, it acts as a stimulant, increases sociability, and makes the user more talkative and energetic. At higher doses, it produces a euphoric high and lethargy, more like heroin. However, as a psychoactive drug, its effects can be unpredictable. Some people may have negative reactions to it, and it can produce some very unpleasant physical symptoms. These include:

  • Anxiety
  • Sweating
  • Tremors
  • Prolonged nausea and vomiting
  • Itching
  • Constipation
  • Respiratory depression
  • Aggression
  • Paranoia
  • Delusions
  • Hallucinations
  • Psychosis

These effects can be worsened by mixing kratom with other substances like alcohol or illicit drugs. All of the reported cases of deaths in the US associated with kratom use also involved the ingestion of other intoxicants.

As an opioid like heroin and morphine, kratom works by binding to opioid receptors in the brain. This causes the brain to release endorphins that produce pleasurable effects. If this happens frequently, the brain will attempt to balance the amount of endorphins released by decreasing the sensitivity of the opioid receptors, meaning that more of the drug will need to be taken to produce the same effects. This is referred to as “building a tolerance,” and it is a stepping stone to addiction. It also produces withdrawal symptoms once the intake of the drug stops, as the brain doesn’t work as it did before the individual started taking the intoxicant. It takes time for the brain to restore receptors to their original sensitivity.

There is some evidence to suggest that long-term, heavy opioid use can lead to neurotoxicity – permanent damage to the brain. Studies have found that among hospitalized cancer patients on opioids for pain, incidents of cognitive impairment are around 77 percent, while those not on an opioid have only a 14-29 percent incidence rate. Some people who come off drugs like heroin find that they can never feel joy and happiness the way they did before they began taking it, possibly due to the fact that their opioid receptors have been permanently diminished.

It’s impossible to yet know if kratom could produce the same effect as there is little to no research into its long-term effects on the brain, but it’s important to keep in mind that this is a possibility.

Opioids are also notorious for their effect on body systems like the gastrointestinal system. The slowing of this essential function can cause chronic constipation and, in the long-term, damage to the intestines. Kratom in particular has been linked to cases of bowel obstruction – a very painful and potentially deadly condition that occurs when a blockage develops in the bowel, preventing material from passing through normally. It’s also been associated with weight loss and even anorexia, which can cause a variety of serious physical problems.

The respiratory system is also slowed by opioid use as it depresses the entire central nervous system. This produces the biggest overdose problem – severely slowed breathing can cause hypoxia, a condition characterized by a lack of oxygen to essential tissues like the brain. This can cause coma, brain damage, and eventual death.

Luckily, kratom appears to have a very low overdose potential. However, even if the individual does not overdose, long-term abuse of opioids and similar drugs can cause an increase in respiratory infection and other lung problems.

Signs of Addiction

 
Not every intoxicant is considered to be addictive, at least in the physical sense, but many are. Kratom’s interaction with opioid receptors and creation of withdrawal symptoms suggest that it may be physically addictive, even if research has not yet confirmed this.

Addiction can look different from person to person, but it’s mainly defined as a brain disease characterized by a feeling that one needs the substance in order to get through the day and the emergence of psychological distress when the drug is not available. Physical addiction typically involves withdrawal symptoms and intense cravings, but addiction can exist even if it’s not a physical dependence. The emotional need for the drug is known as psychological addiction, and it can be just as difficult to recover from as physical addiction.

Addiction forms over time. Not everyone who takes an addictive substance will become dependent on it, but heavy and/or frequent abuse increases the chances. Some people may also be genetically predisposed to developing addiction, and there’s a link between life satisfaction and substance abuse. Poverty and mental illness also play their own roles. Overall, it was estimated in 2013 that 22.7 million Americans had a problem related to drug or alcohol use that, according to professionals, needed treatment.

Even without any of these factors, it’s a good idea to keep a lookout for signs of addiction. These include:

  • Change in social circles or preferred activities
  • Loss of interest in hobbies
  • Change in hygiene or grooming habits
  • Sudden change in personality
  • Unexplained mood swings
  • Drastic change in energy levels
  • Avoiding situations where the drug will not be available
  • Anxiety or irritability when without the drug
  • Negative physical symptoms when without the drug for an extended period of time
  • Refusal to attempt to quit or failed attempts at quitting

Not all of these point to an addiction on their own, but multiple symptoms, especially when substance abuse is already known, should be cause for concern.

Seeking Treatment

 
If addiction is suspected, it’s highly recommended to seek professional treatment. Many people avoid pursuing treatment options for addiction due to the stigma attached to the problem. However, addiction is an illness like any other. There’s no reason to be ashamed of an addiction disorder, and it’s very unlikely that it will go away on its own.

Male doctor at the hospital with his teamThere are many addiction treatment centers across the US. Though kratom is an unusual substance and there hasn’t been a lot of research into it, there are several treatment options that can be generalized across all types of addiction. The important thing is to ensure that the medical professionals understand that addiction treatment needs to be personalized – each individual’s situation is unique.

The addicted person’s immediate needs should be addressed first. Since kratom isn’t as well understood as common intoxicants, an evaluation will likely be needed to assess how severe the addiction is. If the addiction is serious and contributing to dangerous health effects, like bowel obstruction or anorexia, treatment should start immediately if possible. Immediate treatment is also needed for those recovering from heroin addiction, as some have claimed that kratom use in detox led them right back into heroin abuse.


Unfortunately, there can be barriers to addiction treatment. Though many insurance policies cover this kind of treatment, those without insurance or who cannot afford the copay may need to look for low-cost treatment centers or places that charge on a sliding scale for low-income clients. Plenty of these exist, but research is required to determine if these are options, and there may be a waiting list. Though the number of Americans without insurance has declined sharply in recent years, it’s estimated that 10.4 percent of people in the country are still uninsured.

There’s also the question of whether to accept residential treatment or a more flexible outpatient option. Inpatient rehab consists of several weeks spent in a facility where clients are unable to leave until treatment is complete. Though family visits are allowed, most of their time will be spent attending support group and 12-Step meetings, going to therapy, and learning how to cope with cravings and temptations. There are many different workshops available in each treatment center depending on the center’s philosophies on addiction, but in general, the more clients engage in these learning opportunities, the better off they’ll be once released back into the real world.

Inpatient addiction treatment can be very effective, but it’s not a practical option for everyone. In the US, workers can get leave for addiction treatment, but it’s typically unpaid. Some people are unable to afford missing several weeks of work. Others may have children and cannot find care for them for the duration of the program. For these individuals, outpatient treatment can be a better option.

Outpatient treatment offers many or all of the treatments associated with inpatient rehab, but the client can come in to the center for several hours a few days each week and then go home, or come in for treatment after work. The downside to outpatient treatment is, of course, that temptations are available and relapse or dropping out of treatment is possible. Transportation to and from the addiction treatment center can also be a problem, as this involves additional time and costs.

Luckily, there are over 14,500 addiction treatment centers in the US alone, so there’s a wide selection for most individuals. With enough research, almost anyone should be able to find something that meets their needs.

Withdrawal

 
The first part of treatment for any addiction is generally detox – letting the body naturally rid itself of the substance. This can be a very difficult hump to get over due to intense cravings for the drug and withdrawal symptoms.

Heavy use of kratom can produce withdrawal, though it tends to be less intense than that of similar drugs like heroin or prescription opioid painkillers. The symptoms can include:

  • Anxiety
  • Restlessness
  • Insomnia
  • Headache
  • Aches and pains
  • Muscle cramps
  • Stomach pain
  • Nausea
  • Diarrhea


If kratom was being used to self-medicate for chronic pain, the addicted person can expect that this pain will return. If this is the case, it’s important to consult with a medical professional for other pain reduction treatments. It’s not recommended for those with a history of addiction to try potentially addictive medications like prescription opioid painkillers, such as Vicodin. These individuals may need to try alternative treatments, like massage, yoga, or acupuncture.

The most intense symptoms of kratom withdrawal, like the headaches and diarrhea, tend to last for 3-5 days, sometimes lingering for up to a week for heavy, long-term users. Certain symptoms can last for a long time, especially if they are actually symptoms of other issues like chronic pain, anxiety disorders, and pre-existing sleep problems. However, these can all be treated with methods that don’t involve addictive intoxicants.