Leaves from the tropical South-Asian native tree Mitragyna speciosa, or kratom, have mind-altering effects and are marketed as herbal supplements, which often are sold online. Kratom is sought after for many uses, including to aid in the management of depression and to help minimize opioid or alcohol withdrawal symptoms. Kratom interacts with opioid receptors in the brain and can, therefore, have an opioid-like effect as well.
Marketed in pill, capsule, extract, gum, resin, or powder form, and as dried leaves, kratom is typically ingested orally.
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The leaves are brewed into a tea or smoked. Kratom goes by many names, such as Ketum, Thong, White Sumatra, Super Elephant, Biak, Kakuam, Ithang, and Black Diamond. It also can be marketed in products labeled “not intended for human consumption.
“Currently, kratom is not federally illegal within the United States; however, the U.S. Food and Drug Administration (FDA) commissioner issued a public health statement as a warning that kratom is unregulated, untested, and, therefore, potentially unsafe for human consumption. The FDA argues that without adequate scientific research as to how kratom interacts in the body and with other substances, the medical claims as to its health benefits are unfounded.
In 2016, the Drug Enforcement Administration (DEA) announced plans to temporarily classify kratom as a Schedule I controlled substance, making it illegal in the United States; however, it was met with intense backlash and reversed its decision, the National Center for Complementary and Integrative Health (NCCIH) publishes. To date, kratom remains federally unregulated, and, therefore, technically legal, but several states and cities have taken steps to ban the potentially hazardous substance.
Kratom is a psychoactive substance that is abused. It can, therefore, have many potential negative consequences of use.
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Details of Use and Abuse
Kratom is relatively new on the American recreational drug scene, so it can be difficult to know exactly who is abusing it and why. It seems apparent, however, that kratom is used for two main purposes: as a form of self-medication for a wide range of ailments, including pain, post-traumatic stress disorder (PTSD), obesity, diabetes, mood disorders, and opioid addiction, or as a recreational drug of abuse.
Kratom has two main psychoactive components, which are mitragynine and 7-hydroxymitragynine (7-HMG). Both are believed to be opioid agonists in some form, as they bind to receptors in the brain in a similar fashion to opiates. Kratom in its raw plant form is thought to be more potent than morphine.
Kratom has both stimulant and opioid-like effects. Its effects depend on the dosage. With lower doses of kratom, a person may be more alert, excited, sociable, and have high energy levels while larger doses can cause sedation, impaired reflexes, sluggishness, slurred speech, dizziness, altered moods, and decreased cognitive abilities.
Hazards of Use
Calls to poison control centers related to kratom exposure have spiked in recent years. U.S. Pharmacist reports that between January 2010 and December 2015, there were 660 calls related to adverse kratom exposure. The Kansas City Star further warns that there have been 36 deaths related to the use of kratom products in the United States.
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As a central nervous system (CNS) depressant, kratom seems to have less respiratory depressive functions than other opioid drugs do, but especially if it is mixed with other drugs or alcohol, it can still lead to overdose and death. Many of the deaths involving kratom also reported the presence of alcohol, benzodiazepines, acetaminophen, narcotics, or other botanical substances. Kratom’s opioid effects can be reversed with naloxone, just as opioid drugs can, so in the event of a possible overdose, the opioid antagonist can be useful.
Kratom can be a dangerous substance. Its effects are unpredictable and can bring numerous potential hazardous consequences. There are many possible risks associated with kratom use, including:
- Appetite loss
- Skin irritation and itching
- Dry mouth
- Increased urination
- Increased body temperature/sweating
- Fast heart rate
- Vivid dreams
Kratom is also considered to be an addictive substance, and with regular use, drug tolerance and dependence can build up. The National Institute on Drug Abuse (NIDA) publishes that insomnia, irritability, aggression, hostility, mood swings, a runny nose, muscle aches, and twitching are potential withdrawal symptoms associated with kratom dependence.
Just like with other drugs that interact with brain chemistry, and thus alter moods, regular kratom use can create a physical and psychological dependence level wherein drug cravings, low moods, and withdrawal symptoms can occur when the drug wears off.
Addiction is a brain disease that affected nearly 20 million Americans in 2016, according to the National Survey on Drug Use and Health (NSDUH). Kratom is often heralded as an herbal supplement that can treat opioid addiction; however, this is unsubstantiated, and its safety for use in this way is not proven.
Kratom has its own potential for addiction, which can make it difficult for a person to stop taking the drug even if they want to. Kratom addiction can lead to a host of social, emotional, physical, and occupational issues, and misuse of this drug is cause for concern.
Kratom and Opioid Addiction Treatment
Kratom is not illegal in most parts of the United States, and it can be easy to find and order off the internet in many different forms and products. It is not scientifically proven to be useful as the herbal supplement it is often marketed as, however. As a result, it should be taken with extreme caution.
It can be difficult, and even impossible at this point, to know exactly how kratom will interact with other substances or in the body, thus making it potentially hazardous. There are other safer supplements and medications for the ailments kratom is said to help with.
For example, opioid addiction is a chronic and potentially devastating disease that requires professional and specialized treatment; simply taking kratom will not effectively treat addiction.
Most treatment programs will include therapeutic, supportive, and often medical or pharmaceutical methods to manage opioid addiction. Using an untested and unregulated supplement such as kratom to manage opioid withdrawal and addiction can be highly dangerous.
Opioid withdrawal can be particularly intense and, therefore, relapse is a common occurrence. A relapse after stopping opioid use, which allows the brain to reset its tolerance levels, can be devastating.
The U.S. Department of Health and Human Services (HHS) publishes that 116 Americans die every day from an opioid overdose. Opioid addiction and overdose are at epidemic levels in the United States. While kratom may seem like a magic cure to the disease, it is not a safe or tested treatment. Unfortunately, there is no cure for addiction, though it can be effectively managed with medical detox and comprehensive addiction treatment.
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Spotting Abuse and What to Do
Kratom is illegal in six states: Alabama, Vermont, Tennessee, Wisconsin, Arkansas, and Indiana, The Seattle Times publishes, as well as in the District of Columbia and also in the cities of Sarasota, Florida; San Diego, California; and Denver, Colorado. These bans stemmed from concern over kratom being a drug of abuse and having the potential for drug dependence and addiction.
Use of kratom for any reason can be problematic, as the drug does have mind-altering properties, and is not medically cleared or regulated to treat any ailments or illnesses at this point.
In short, kratom use can be unpredictable and, therefore, risky. Kratom products may contain a variety of fillers as well since it is unregulated, and these substances may have toxic effects.
Generally speaking, kratom use is often an indicator of additional issues that need to be managed.
Some indicators that a person may be abusing kratom and it’s time to get professional help are:
- Strange packages coming in the mail
- A lot of time spent online ordering supplements
- A lot of time spent in drug chat rooms/forums
- Appetite changes and drastic weight loss
- Erratic and unpredictable behaviors
- Inconsistent ability to fulfill commitments
- Repeated absences at work and/or school
- Interpersonal relationship issues
- Changes in social circles
- Lack of interest in things once enjoyed
- A large number of supplements
- Mood swings
- Changes in sleep patterns
- A decline in personal appearance/health
- An inability to stop taking kratom
Treatment Options for Kratom Abuse
There is no specific treatment method or medication for kratom addiction, but a specialized and individualized addiction treatment program can be highly beneficial in helping to manage kratom abuse and addiction.
A program that includes both supportive and therapeutic methods can help individuals to recognize that kratom use is problematic and to come up with healthier methods for managing pain, stress, depression, and sleep issues. Coping skills and tools for managing relapse and drug cravings are learned through group and individual counseling and therapy sessions.
Since kratom can have some physical dependence issues, and, therefore, withdrawal symptoms, a detox program can be a useful first stage of treatment. A medical detox program can use medications as well as therapeutic and supportive methods to manage withdrawal. After the brain and body are physically stable from detox, the psychological components of drug abuse and addiction can be defined and addressed.
The Substance Abuse and Mental Health Services Administration (SAMHSA) operates a national helpline that people can use to find treatment information and get referrals to local help options.
There are more than 14,000 specialized addiction treatment programs in the United States, NIDA reports, so there are many options for people to choose from.
A drug abuse and addiction treatment program should focus on each individual and their specific circumstances. For instance, some people will benefit from an outpatient treatment program that allows flexibility in scheduling and the ability to continue working, going to school, or attending to family needs.
Inpatient, or residential, treatment programs are highly beneficial in providing a structured environment focused on healing, giving individuals a chance to reset and fully center on recovery. Addiction treatment programs provide lasting and ongoing support through alumni programs, transitional living arrangements, and peer-support programs.
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(September 2018). Statement from FDA Commissioner Scott Gottlieb, MD., on New Warning Letters FDA is Issuing to Companies Marketing Kratom with Unproven Medical Claims; and the Agency's Ongoing Concerns About Kratom. U.S. Food and Drug Association. Retrieved September 2018 from from https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm620106.htm
(June 2018). In the News: Kratom (Mitragyna speciosa). National Center for Complementary and Integrative Health. Retrieved from from https://nccih.nih.gov/news/kratom
(March 2017). The DEA Changes its Mind on Kratom. U.S. Pharmacist. Retrieved September 2018 from from https://www.uspharmacist.com/article/the-dea-changes-its-mind-on-kratom
(May 2018). What You Need to Know About Kratom as the Feds Crack Down on the Herbal Supplement. Kansas City Star. Retrieved September 2018 from from https://www.kansascity.com/news/nation-world/article212251809.html
(July 2018). What is Kratom? National Institute on Drug Abuse. Retrieved from from https://www.drugabuse.gov/publications/drugfacts/kratom
(September 2017). Key Substance Use and Mental Health Indicators in the United States: Results from the 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Retrieved September 2018 from from https://www.samhsa.gov/data/sites/default/files/NSDUH-FFR1-2016/NSDUH-FFR1-2016.htm
(March 2018). What is the U.S. Opioid Epidemic? U.S. Department of Human Health and Services. Retrieved September 2018 from from https://www.hhs.gov/opioids/about-the-epidemic/index.html
(May 2016). States Ban Kratom Supplement Over Abuse Worries. Seattle Times. Retrieved September 2018 from from https://www.seattletimes.com/nation-world/states-ban-kratom-supplement-over-abuse-worries/
(April 2018). National Helpline. Substance Abuse and Mental Health Services Administration. Retrieved September 2018 from from https://www.samhsa.gov/find-help/national-helpline