Should I Use Kratom? Addiction Risk & Potential Benefits

The Facts and Questions Behind the Controversy

Is kratom addiction real? What are the benefits of kratom? What are the risks? Would it be a good idea to make kratom legal for everyone in America?

Those are just a few of the questions that continue to generate passionate debate among kratom users, government regulators, law enforcement officials, addiction treatment specialists, healthcare practitioners, politicians, and concerned citizens. The kratom controversy is sustained by the rapid spread of contradictory information, misleading statements, alarmist attitudes, and unsupported claims, as well as a severe shortage of independent, well-controlled clinical studies.

So if you're confused about what to believe, you're not the only one. When it comes to evaluating kratom, risks and benefits are primarily based on the personal accounts and experiences of users. (Scientific evidence related to the human consumption of kratom is fairly limited.) That leaves us with many more questions than answers.

Still, it's important to learn the facts. As kratom increases in popularity, we need to make informed decisions based on what we know to be true—not hasty or irrational decisions based on fear, hype, or blind acceptance. Even if you don't plan on using kratom, you may know somebody who does. Or maybe someone in your life is already consuming kratom for recreational or therapeutic reasons.

Some people have even reported success in kicking opiate or opioid addiction by using kratom to help ease their withdrawal symptoms. However, as with many other substances, caution is definitely warranted. That goes for kratom users as well as those who would ban it. (Legitimate safety concerns do exist. But the potential benefits for opioid addicts might outweigh the risks. In that sense, banning kratom may cause more harm than good, especially amid a national epidemic of opioid-related deaths.)

Check out the following information to learn what you should know about kratom. And if you suffer from a substance addiction or know someone who does, remember that help is available.

None of the following information constitutes an endorsement of kratom.

What Is Kratom?

Kratom (aka Mitragyna speciosa or M. speciosa) is a large tropical tree that's native to Thailand, Malaysia, Indonesia, Papua New Guinea, and Myanmar (Burma). It's part of the Rubiaceae family, which also includes coffee plants. Kratom leaves have been part of Southeast Asian culture for hundreds, if not thousands, of years. Traditionally, manual laborers would chew small amounts of the raw leaves in order to get boosts of energy. At moderate to high doses, the effects of kratom mimic those of opiates or opioids like morphine, heroin, oxycodone, and hydrocodone. That's why this herb is also used medicinally.

So, is kratom an opiate? The answer is no. Kratom is not an opiate. Many researchers believe that it shouldn't be classified as an opioid either. It's true that when a person consumes any form of the Mitragyna speciosa leaf, he or she can experience opioid-like effects. That's because the most important chemical compounds in kratom (known as alkaloids) partially activate the same receptors in the brain as opiates and opioids. However, those alkaloids are structurally different than opiates and opioids. So at the molecular level, they also act differently.¹ Kratom contains more than 25 different alkaloids. The most abundant ones include:³

• Mitragynine (which accounts for about 66 percent of the plant's alkaloids)
• 7-hydroxymitragynine
• Paynantheine
• Speciociliatine
• Speciogynine

Even though it isn't an opiate, the kratom plant is usually used for particular mind- or body-altering effects, which vary from user to user. People can also purchase different kinds of kratom. Types include red-vein kratom, white-vein kratom, and green-vein kratom. Those three main types are based on the color of the stems and veins of kratom leaves. Each type is known for producing slightly different effects on the mind and body. Within each of the three main types, people can purchase specific strains—often graded by their potency—with names like:

• Bali Kratom
• Borneo White
• Indo Kratom
• Maeng Da
• Malaysian Green
• Mitragyna Javanica
• Pontianak Green Horn
• Pontianak White Horn
• Red Sumatra
• Red Thai
• Red Vein Borneo
• Riau Kratom
• Sumatra Kratom
• Thai Kratom
• Vietnam Kratom
• White Vein Sumatra

In the Western world, kratom users have a wide variety of options for ingesting the herb. For example, kratom tea is often made by infusing the dried and crushed leaves in hot water. Kratom powder can also be used to make tea, or it can be put into capsules and consumed in pill form. In addition, kratom extract is often sold in the form of a highly concentrated liquid tincture or hardened resin. Manufacturers of the herbal extract use alcohol, acetone, or other stringent chemicals to draw the plant's alkaloids out of the leaves.

Although it can be done, smoking kratom is generally considered a waste of the herb. That's because, compared to other ingestion methods, a person needs to smoke a much higher amount of kratom in order to feel any effects. So smoking is an expensive and inefficient way to consume it.

What Does Kratom Do? What Is It Used For?

When consumed in small amounts (i.e., about one to five grams), kratom tends to act as a stimulant, similar to caffeine. At moderate to high amounts (i.e., about five to 15 grams), the herb can have medicinal effects such as pain relief. Kratom can also, paradoxically, act as a sedative when consumed at high doses (such as more than 15 grams at a time).² Of course, not all users have the same tolerance for kratom. Many heavy and long-term users have reported much higher tolerances than those who are new to the herb or consume it sparingly.

So, what is kratom used for exactly? When ingesting lower amounts of kratom, benefits can include:

• More energy
• Sharper mental focus
• A feeling of optimism
• Heightened sexual arousal
• Less social inhibition
• A suppressed appetite

When consuming higher amounts of kratom, effects can include:

• Pain relief
• Relaxation
• A sense of calm
• Better sleep
• Mild euphoria
• Relief from opioid withdrawal
• Sedation

Red-vein varieties of kratom tend to be more calming and sedating, whereas white-vein strains are usually more stimulating. Green-vein varieties are generally somewhere in between. Each user develops his or her own personal preferences.

Users have reported all kinds of different reasons for consuming kratom. Back pain and other types of acute or chronic pain are probably the most common reasons. In fact, in one online survey, about 68 percent of kratom users said they consume the herb for pain relief. Other major reasons included the desire to combat mood swings or the need to reduce the severity of withdrawal symptoms from opioids.⁴ Kratom has also been used in Southeast Asia to treat diarrhea. And some people have reported that kratom helps ease their symptoms of depression and post-traumatic stress disorder (PTSD).

You can get high from taking kratom, but a kratom "high" tends to be much milder than what people experience when abusing opiates or prescription opioids. That's why, with kratom, recreational users either go after the stimulating effects of lower doses or the gentle euphoric effects of higher doses.

Kratom vs. Kava: How Are They Different?

Like kratom, kava is often used for relaxing, relieving pain, reducing social inhibitions, or creating a feeling of euphoria. However, kava is an entirely different plant (part of the pepper family), so it comes with its own risks and benefits. As a native plant of Pacific islands such as Fiji, Micronesia, Vanuatu, Hawaii, and Papua New Guinea, kava has been a major part of religious customs for hundreds of years. Traditionally, kava root is ground up with water and then steeped and strained to produce tea. In addition to consuming kava during rituals and ceremonies, many Pacific islanders drink kava socially as an alternative to alcohol.

In some parts of Southeast Asia and the Western Pacific, many coffee shops, as well as kava and kratom bars, serve both kinds of tea side by side. As with those who consume kratom tea, effects for kava drinkers can vary. Many users feel that kratom tea tastes better than kava tea. However, kava tends to be less controversial, in part because it doesn't carry the same perceived risk of addiction. The effects of kava also tend to last for shorter periods of time.

Much more scientific research is needed into the safety and effectiveness of both the kratom herb and kava root. However, both substances carry potential medical risks, especially if consumed long-term, at very high doses, or in a non-traditional way, such as from concentrated extracts. Consuming either of these substances with alcohol, illicit drugs, or prescription medications can also be dangerous (even fatal).

Does Kratom Work for Opiate Withdrawal?

Reports of kratom being used as a treatment for opium addiction go back as far as 1836.³ Today, many opiate and opioid addicts report using the herb to manage their cravings and eliminate their most severe withdrawal symptoms. They are using kratom as an alternative to standard treatments like methadone and Suboxone, which can sometimes become new addictions. With kratom, opiate withdrawal is often reported to be more manageable, with less risk of new addiction. Kratom also tends to cost less and be easier to get than standard prescription therapies.

However, the U.S. Food and Drug Administration (FDA) has said that there isn't enough scientific evidence to support using kratom for the treatment of heroin addiction or other types of opiate or opioid addiction. The federal agency is concerned that addicts are using kratom without the guidance of licensed healthcare professionals. It's also concerned that addicts may be trading one addiction for another since mitragynine (the main alkaloid in kratom) partially activates the same receptors as morphine and other opiates and opioids.

Despite the FDA's concerns, many people remain proponents of kratom. Experiences throughout America are showing that the herb has real promise in helping addicts minimize opiate withdrawal and ultimately kick their addictions. And that could be good news when you consider that, each year, tens of thousands of opioid addicts are dying from fatal overdoses. If kratom can help people get off of dangerous opioids (especially fentanyl), then many of those deaths might be prevented.

That said, independent clinical research needs to be done in order to evaluate kratom's safety, effectiveness, and addiction potential, as well as to figure out what a proper kratom dosage for opiate withdrawal might look like. In the meantime, many doctors and addiction treatment specialists remain cautious or skeptical about kratom's benefits. At the same time, many addicts are determined to give kratom a try. As a result, a lot of addicts are experimenting with kratom dosages and sharing their experiences with each other to try and find the best path forward—often without medical supervision.

Is Kratom Safe? What Are the Risks and Side Effects?

This is where a lot of the controversy lies. Simply put, there isn't enough in the way of published scientific evidence or well-controlled clinical studies to say definitively that kratom is either generally safe or dangerous. However, many independent researchers say that, for most users, pure kratom seems to be relatively harmless when consumed at doses below 10 to 15 grams.¹ The most serious problems appear to crop up when users consume excessive amounts of the herb, use it over long periods of time, take it with other substances, or ingest kratom extracts or other forms of the herb that have been adulterated.

People who are concerned about kratom's safety point to the fact that between 2010 and 2015, poison centers in the U.S. received 660 calls related to kratom exposure—an amount that increased tenfold over that period. However, only about 7.4 percent of those calls were related to potentially life-threatening incidents. And in those more severe incidents, the people affected generally had other substances in their systems besides kratom.⁵

Most kratom users report relatively mild side effects that don't require medical treatment. In fact, a survey of more than 8,000 kratom users found that fewer than one percent (0.65 percent) of them had experienced any toxic effects that required medical treatment. Most of the herb's negative effects were associated with consuming higher doses and/or consuming it more than 21 times a week.⁴

People who are new to using kratom often go through a temporary period of adjustment that can involve mild to moderate symptoms until they find the particular strains and doses that work best for them. Commonly reported side effects of kratom include:

• Nausea
• General stomach discomfort
• Headaches
• Constipation
• Fatigue
• Irritability
• Drowsiness
• Loss of appetite
• Dry mouth

So, among most people who use kratom, side effects appear to be relatively mild and short-lived. However, in rare instances, severe effects—often requiring medical attention—have been reported, primarily in Western countries. (In most of the severe cases that have been reported, kratom is one of multiple substances in the persons' systems, so a direct causal link can't be definitively established.) These more severe effects have included:

• Confusion
• Hallucinations
• Seizures
• Psychosis
• Unintended weight loss
• High blood pressure
• Excessively rapid heart rate
• Problems with urination
• Severe vomiting
• Hyperpigmentation of the skin
• Kidney damage
• Liver damage

Some deaths have even been associated with the use of kratom. However, as with other severe effects, the victims have generally consumed kratom with other substances that are well known to carry a risk of dangerous side effects. In some cases, the victims may have unknowingly consumed kratom that was contaminated. In other cases, they may have intentionally consumed additional substances or ingested dangerous concoctions in which kratom was just one of multiple ingredients. In fact, other substances that have been involved in kratom-related fatalities include:

• Alcohol
• Caffeine
• Morphine
• Fentanyl
• Codeine
• Various anti-depressants
• O-Desmethyltramadol
• Modafinil
• Carisoprodol
• Temazepam
• Datura stramonium
• Propylhexedrine
• Diphenhydramine (Benadryl)

Many researchers believe that the chances of fatally overdosing on pure kratom are very low. That's because very high doses of kratom generally cause severe nausea. It's thought that when consuming such high amounts of the herb (in pure form), most users vomit it up well before experiencing any life-threatening symptoms. Plus, unlike what happens in fatal opiate and opioid overdoses, consuming too much kratom doesn't appear to cause users to stop breathing.¹

Still, the long-term risks and effects of consuming kratom remain uncertain. Independent, large-scale clinical studies will be needed to determine exactly how safe the herb is in its various forms. That's why, for now, the FDA hasn't approved kratom for any therapeutic uses. The agency has also issued a public health advisory to warn Americans of the herb's potential risks.

Is Kratom Addictive?

This is another subject of ongoing debate. Based on the stories of self-professed kratom addicts who are trying to quit, it certainly does appear that kratom can be addictive. Some users report that kratom dependence can sneak up on you after an initial "honeymoon" phase. They say that, eventually, your physical dependence on kratom can lead to addiction. And some studies show that mitragynine (the main active compound in kratom) acts as an addictive substance in animals.

However, many kratom users report using the herb for several months or years without developing an addiction. So it may depend on the individual. Some people may be more prone to addiction than others. For example, people who consume prescription or illicit opioids are probably at higher risk. And some people may be able to consume kratom indefinitely without developing symptoms of a drug addiction.

It's also true that physical dependence—taken by itself—is not necessarily the same thing as addiction. People who are addicted to a substance tend to have a psychological need for it and will continue using it despite the harm they may be causing to themselves or others. So it's possible that some people who report kratom abuse or addiction may in fact just be physically dependent on the herb. (Some proponents of kratom go as far as to say that being dependent on kratom is no different than being dependent on caffeine or sugar.)

That said, being physically dependent on the herb can make withdrawal from kratom unpleasant. And that experience can play a role in some people developing an emotional need for it, just like with an addictive drug. Signs and symptoms of kratom withdrawal are generally reported to be a lot milder and less intense than what people experience with opiate or opioid withdrawal. Rather than being debilitating, they are often more of an annoyance. Symptoms can include:

• Mood swings
• Irritability
• Runny nose
• Insomnia
• Anxiety
• Low motivation
• Diarrhea
• Joint pain
• Muscle pain

Many kratom users seem able to avoid reaching the point of substance abuse because of the uncomfortable side effects caused by consuming excessive doses. And being dependent on kratom (at least in its pure, traditional form) hasn't been shown to cause any major harm to users' abilities to function socially.⁶ Even so, people should always be cautious when consuming a substance with addictive potential.

Is Kratom Legal?

Currently, kratom is legal in the United States at the federal level. However, the herb has been banned in some states, including Alabama, Arkansas, Indiana, Rhode Island, Tennessee, Vermont, and Wisconsin. It has also been banned in some cities, including: Jerseyville, Illinois; San Diego, California; and Sarasota, Florida. Many other regions are also contemplating kratom bans, so it's a good idea to stay informed with an up-to-date legality map. In some cities (like Denver, Colorado), kratom isn't banned, but it must be sold with a warning label that includes a phrase such as "not for human consumption."

The U.S. Drug Enforcement Administration (DEA) currently lists kratom as one of its "drugs of concern." In August 2016, the DEA moved to regulate kratom as part of the Controlled Substances Act. Kratom was going to be reclassified as a Schedule I controlled substance (alongside drugs like heroin and LSD). However, due to public backlash, the DEA changed course in early 2017, preventing kratom from being banned at the national level.

Still, there are many regulators and law enforcement officials at the federal level who want to see kratom banned. Without proper clinical evidence of the herb's safety and medical benefits, they believe that kratom is bad for the country. They reason that kratom may worsen America's opioid crisis even though the herb offers the potential to help prevent fatalities through harm reduction. The FDA has even made plans to block shipments of kratom that are destined for U.S. consumers. So the federal government may still decide to schedule kratom as a controlled substance at some point.

In Canada, kratom is legal for personal use in small amounts. But it's against the law to package or sell it as a product for human consumption. In some other countries—such as Myanmar, Malaysia, and Australia—kratom has been banned outright. In 1943, they banned kratom in Thailand because people were using the herb to quit their opium addictions, which had the effect of reducing government tax revenues from the sale of opium (which was legal).

Back in America, the debate over the future of kratom's legality continues. The DEA gets to decide how substances are classified and, therefore, which substances get banned (based on statutory criteria). That leaves many people questioning why law enforcement officials have that power instead of scientists. Generally speaking, the DEA relies on the FDA to determine whether or not a substance is safe or has any currently accepted medical uses. But that system often creates a catch-22 when it comes to natural products like kratom.

In order for the FDA to grant approval to a drug or natural substance, many expensive scientific studies and clinical trials must be performed—mostly funded by the companies that want to bring the substance to market. But companies don't want to fund research into natural substances that can't be patented. (They want a big return on investment.) And non-profit research organizations often find it difficult or impossible to conduct adequate studies that meet the FDA's requirements since they often don't have enough money to do so. That means the FDA's regulatory process tends to favor synthetic drugs created by large pharmaceutical corporations.

So, many people see America's regulatory environment as an unfair playing field. They even point to the fact that a number of patents have been issued (or are pending) for pharmaceutical medications based on the active compounds in kratom. Drug companies and researchers are clearly interested in the therapeutic potential of kratom's various alkaloids. By synthesizing those alkaloids and getting exclusive patents and FDA approval for them, those companies may be able to profit handsomely while kratom, in its natural form, sits in regulatory limbo or gets banned altogether.

One other thing to know is that, currently, most employer drug tests do not screen for kratom. However, that could eventually change since at least one commercial drug screening company now offers a kratom drug test as part of its services. Estimates of how long kratom's alkaloids remain in your system range from 24 hours to more than five days.

Should I Use Kratom?

Most physicians would probably discourage you from using kratom since the potential risks and benefits are still poorly understood. And because kratom products aren't currently regulated in the U.S., it can be impossible to know exactly what you're purchasing. Many people end up consuming kratom products that have been tainted, sometimes with dangerous substances. So you should definitely exercise caution.

If you do decide to use kratom, be sure to let your doctor know. Many users and researchers also recommended seeking out the purest forms of the herb possible and avoiding extracts that could be adulterated with harsh chemicals. They also recommend starting with very small doses and avoiding other substances when you consume it, including alcohol, caffeine, and illicit, over-the-counter, or prescription drugs.

Kratom might be natural, but that doesn't mean it can't harm you. Stay cautious, and stay informed.