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Kratom: What you need to know

By Melissa Shulman PMHNP


Kratom is the name of a plant that is native to Southeast Asia. It is sold online, in head

shops, and health food stores as an “herbal supplement” and can be bought as capsules,

tablets, concentrated extracts, and chopped leaves to make tea. It is advertised as a “natural” way to treat pain, depression, and anxiety. But using this seemingly harmless substance can in fact cause addiction and painful withdrawal symptoms.


Kratom binds to opioid receptors in the brain, the same receptors that are activated by prescription painkillers and heroin. Many people learn about kratom from online forums. They may be seeking alternative methods to self-medicate chronic pain and anxiety. And

some people turn to kratom as a way to manage dependency on other opiates.


The issue is that chronic kratom use can cause tolerance, physical dependence, and opioid withdrawal symptoms. People report needing to use more and more kratom to find relief, and eventually are using large amounts just to stave off withdrawal. Kratom has a short

half life with effects that peak and then end quickly, causing people to need to take it multiple times throughout the day. Between doses people begin to feel withdrawal symptoms of intense irritability, anxiety, nausea, diarrhea, muscle aches, joint pain, runny nose, and insomnia. Many people don't realize that they’ve become trapped in a cycle, and that the kratom withdrawal is in fact making their pain and anxiety worse. Because of its addictive qualities, it can be very difficult to stop using kratom.


A 2014 study of 293 kratom users found that 89% of subjects who attempted to quit kratom eventually relapsed. In 2016 the DEA proposed making kratom an illegal schedule 1 drug because of its effects on the opioid system and potential for abuse. But political backlash forced the DEA to delay its ruling and kratom remains merely a “drug of concern.” This is problematic because many people falsely believe that because it is legal it must be safe. It remains accessible to anyone, including minors. The American Kratom Association estimates that 3-5 million Americans may be using kratom. And because it is classified as an “herbal supplement” there is no oversight or regulation of this product. There are documented instances of kratom product contamination or manipulation with deliberate addition of other drugs. One study found a kratom product contained incredibly high concentrations of opioid compounds, many-times higher than can be found naturally occurring in the plant leaf.


Fortunately, there are effective treatments for kratom and other opioid addictions. If you

are struggling to stop using kratom and are dealing with unmanageable anxiety, irritability,

insomnia, or other symptoms, we encourage you to speak with a provider. We are here to

support you!



Sources:

Eastlack, S. C., Cornett, E. M., & Kaye, A. D. (2020). Kratom-Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review. Pain and therapy, 9(1), 55–69.

https://doi.org/10.1007/s40122-020-00151-x

Groff, D., Stuckey, H., Philpott, C., Van Dyke, E., Silvis, M., Leong, S. L., & Bone, C. (2022). Kratom use disorder: a primer for primary care physicians. Journal of addictive diseases, 40(1), 131–141. https://doi.org/10.1080/10550887.2021.1950263

Singh, D., Müller, C. P., & Vicknasingam, B. K. (2014). Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug and alcohol

dependence, 139, 132–137. https://doi.org/10.1016/j.drugalcdep.2014.03.017

Vicknasingam, B., Narayanan, S., Beng, G. T., & Mansor, S. M. (2010). The informal use of ketum (Mitragyna speciosa) for opioid withdrawal in the northern states of peninsular Malaysia and implications for drug substitution therapy. The International journal on drug policy, 21(4), 283–288. https://doi.org/10.1016/j.drugpo.2009.12.003

White C. M. (2018). Pharmacologic and clinical assessment of kratom. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 75(5), 261–267. https://doi.org/10.2146/ajhp161035

Yusoff, N. H., Suhaimi, F. W., Vadivelu, R. K., Hassan, Z., Rümler, A., Rotter, A., Amato, D., Dringenberg, H. C., Mansor, S. M., Navaratnam, V., & Müller, C. P. (2016). Abuse potential and adverse cognitive effects of mitragynine (kratom). Addiction biology, 21(1), 98–110. https://doi.org/10.1111/adb.12185

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