The Effects of Kratom Withdrawal

Kratom, known by its scientific name, Mitragyna speciosa, is a plant that is native to countries in  Southeast Asia, such as Indonesia, Malaysia, and Thailand. Kratom leaves have been used as an herbal medicine as well as a ceremonial drink for many years. When ingested, usually as a tea or drinkable concoction, it produces a mixture of effects that resemble similar effects produced from stimulants and opioid drugs.1

In Europe and the US, kratom has especially become a popular drink, particularly for those who are recovering from heroin or opioid addiction. Other people may use it for its energizing stimulant effects as well as its pain relieving effects. While stimulant effects are usually felt at lower doses, pain relieving opioid-like effects are felt at higher doses.

Due to these physical and psychological effects, kratom may have some potential for abuse and dependence. Therefore, withdrawal from kratom is a concern if it is abruptly discontinued. The DEA and FDA have been known to criticize kratom for its opioid-like qualities. They have also issued bans and warnings in the past to restrict its use.2 Regardless of its legal parameters, it is important to be aware of the effects of kratom and how it can affect you even in the long term.

What Is Kratom Withdrawal?

According to a recent study, over half of those people who use kratom regularly (over 6 months of use) develop severe dependence on the herb. In that same study, a little less than half of the subjects developed a form of moderate dependence.

Physical withdrawal symptoms can include but are not limited to:

  • Trouble sleeping
  • Muscle aches
  • Decreased appetite
  • Diarrhea
  • Hot flashes
  • Watery eyes/nose
  • Fever

Other psychological symptoms include:

  • Irritability
  • Depression
  • Anxiousness
  • Increased stress

Of course, the severity of these withdrawal symptoms depends on the frequency and amount of kratom being consumed. These symptoms may be experienced at a greater degree especially if a user consumes 3 or more glasses of kratom per day.3

What is more concerning is that kratom is not regulated by FDA manufacturing processes to the same degree as other prescription drugs. Therefore, kratom products may have varying levels of its active ingredients, mitragynine and 7-hydroxymitragynine, which are potent alkaloids. Kratom leaves may contain anywhere from 0.5 to 1.5% of these alkaloids.4

How Is Kratom Withdrawal Treated?

Currently, there are no published studies describing the exact way in which kratom produces its effects. Therefore, there is not enough data to provide any specific guidance on how to actually treat withdrawal symptoms.5  

What we do know is that kratom does cause similar symptoms to that of opioid withdrawal. It is almost ironic that something being used to relieve opioid withdrawal can actually cause the same symptoms it was trying to prevent.

It would make sense, then, that protocols and medications used to treat opioid withdrawal could be used to treat kratom withdrawal. One case report describes how a 37-year-old woman suffering from kratom withdrawal symptoms was successfully treated with clonidine and hydroxyzine, two drugs used to treat opioid withdrawal.6 Despite this report, more studies need to be done to determine the differences in how kratom withdrawal works compared to opioid withdrawal.

How Can Kratom Withdrawal Be Prevented?

As with any drug that can cause dependence, the recommended way to prevent withdrawal is to taper, or wean off, the drug or substance in question. This would allow the body to acclimate to reduced doses over time.

It is possible that kratom may be abused or used alongside other medications that may interact or be dangerous in and of themselves. If kratom is taken with other opioids, for example, there may be increased risk of withdrawal symptoms from both substances. Other drugs should be tapered in the same manner.7

Another way is to use kratom in moderation or with the minimum quantity it takes to feel the purported benefits. However, some people report developing a tolerance to the effects of kratom. As a result, this could increase the risk of physical and psychological dependence if more kratom is needed to be effective. This could then increase the risk of withdrawal symptoms if large amounts of kratom are being consumed regularly.

Conclusion

Much of the reports describing the effects of Kratom have been anecdotal up until recent years. While it has been used for therapeutic purposes as well as for religious ceremonies in Southeast Asia, clinical evidence to support its use is lacking.

Despite this lack of evidence, Kratom has continued to garner a following across the US and Europe. Partly due to this popularity, recent clinical studies have begun to assess the effects of Kratom as well as withdrawal effects after prolonged use.8

From the perspective of safety, the DEA might have a valid point in scheduling and restricting the use of kratom. If you are new to kratom, you might encounter it if you ever go to a kava bar. You might proceed to ask yourself or the server, “What is this Kratom drink? Is it safe?”

Hopefully, this information can provide you with some insight. If you are a regular user of kratom, what is your experience with kratom and have you ever experienced any withdrawal symptoms?

 

 

 

 

 

 

 

References

 

  1. Fluyau D, Revadigar N. Biochemical Benefits, Diagnosis, and Clinical Risks Evaluation of Kratom. Front Psychiatry. 2017;8:62. Published 2017 Apr 24. doi:10.3389/fpsyt.2017.00062
  2. Henningfield JE, Fant RV, Wang DW. The abuse potential of kratom according the 8 factors of the controlled substances act: implications for regulation and research. Psychopharmacology (Berl). 2017;235(2):573-589.
  3. Singh D, Müller CP, Vicknasingam BK. Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug and Alcohol Dependence. 2014;139:132-137. doi:10.1016/j.drugalcdep.2014.03.017.
  4. Hassan Z, Muzaimi M, Navaratnam V, et al. From Kratom to mitragynine and its derivatives: Physiological and behavioural effects related to use, abuse, and addiction. Neuroscience & Biobehavioral Reviews. 2013;37(2):138-151. doi:10.1016/j.neubiorev.2012.11.012.
  5. White CM. Pharmacologic and clinical assessment of kratom. American Journal of Health-System Pharmacy. 2017;75(5):261-267. doi:10.2146/ajhp161035.
  6. Galbis-Reig D. A case report of kratom addiction and withdrawal. The Wisconsin Medical Journal. 2016;115(1):49-52. https://www.ncbi.nlm.nih.gov/pubmed/27057581.
  7. Murphy L, Babaei-Rad R, Buna D, et al. Guidance on opioid tapering in the context of chronic pain: Evidence, practical advice and frequently asked questions. Can Pharm J (Ott). 2018;151(2):114-120. Published 2018 Feb 8. doi:10.1177/1715163518754918.
  8. Singh D, Müller CP, Murugaiyah V, et al. Evaluating the hematological and clinical-chemistry parameters of kratom ( Mitragyna speciosa ) users in Malaysia. Journal of Ethnopharmacology. 2018;214:197-206. doi:10.1016/j.jep.2017.12.017.