Thinking about Kratom? Read on

Kratom (Mitragyna speciosa) is a tropical tree native to Southeast Asia whose leaves have been used for centuries for their stimulant and opioid-like effects. In recent years, kratom has gained popularity in the United States as a legal, herbal supplement marketed for pain relief, anxiety, depression, and opioid withdrawal symptoms. However, its growing use has raised significant concerns among public health officials, addiction specialists, and policymakers due to its potential for abuse, dependence, and adverse health outcomes. This paper explores the pharmacology of kratom, its addictive potential, clinical effects, withdrawal symptoms, legal status, and implications for treatment.

Pharmacology of Kratom

Kratom contains over 40 active compounds, the most notable being mitragynine and 7-hydroxymitragynine, both of which interact with the brain’s opioid receptors. Mitragynine acts as a partial agonist at the μ-opioid receptor, producing pain relief and euphoria at higher doses, while low doses produce stimulant-like effects by acting on adrenergic and serotonergic pathways. 7-hydroxymitragynine is far more potent and responsible for much of the opioid-like effects of kratom.

Unlike classical opioids, kratom has a complex pharmacological profile that may contribute to both its perceived benefits and its risks. While some users report that kratom helps them reduce or quit opioids, others find themselves dependent on kratom itself, developing tolerance, withdrawal symptoms, and patterns of compulsive use.

Addiction and Dependence Potential

Though kratom is often marketed as a safer alternative to opioids, research and clinical observations suggest that kratom can be addictive. Long-term and high-dose use can lead to dependence, characterized by cravings, tolerance, and withdrawal upon cessation. According to data from the U.S. Centers for Disease Control and Prevention (CDC), poison control centers received over 1,800 calls involving kratom between 2011 and 2017. Withdrawal symptoms reported include anxiety, irritability, depression, nausea, muscle aches, insomnia, and intense cravings — similar to those associated with opioid withdrawal.

A 2019 study published in the journal Drug and Alcohol Dependence found that up to 30% of regular kratom users may meet the criteria for a substance use disorder. Despite this, many individuals continue to view kratom as “natural” and therefore harmless — a misconception that can delay or prevent treatment.

Kratom and Co-Occurring Disorders

Kratom use often co-occurs with mental health disorders such as anxiety, depression, and post-traumatic stress disorder (PTSD). Some users report self-medicating with kratom to manage psychological symptoms or chronic pain. However, this self-medication can lead to psychological and physical dependence, particularly when used as a substitute for other drugs without medical supervision. In individuals with a history of substance use disorders, kratom may serve as a trigger or replacement drug, undermining recovery.

Legal and Regulatory Landscape

As of 2025, kratom remains legal at the federal level in the United States, although the U.S. Food and Drug Administration (FDA) has issued warnings about its safety, and the Drug Enforcement Administration (DEA) has considered scheduling it as a controlled substance. Several states and municipalities have banned or restricted its sale and possession. The lack of standardized regulation means kratom products vary widely in potency, purity, and composition, increasing the risk of overdose and contamination with other substances.

Clinical Treatment and Recovery Implications

Treating kratom dependence involves a combination of behavioral therapy, medical monitoring, and supportive care. In some cases, medications like buprenorphine or clonidine have been used off-label to manage kratom withdrawal. However, due to the relative novelty of kratom addiction in the U.S., treatment protocols are still evolving.

Motivational interviewing, cognitive-behavioral therapy (CBT), and 12-step facilitation may be useful in supporting individuals recovering from kratom dependence. Clinicians should be educated about kratom and its effects, as patients may not disclose use unless specifically asked. Incorporating kratom into intake assessments and toxicology screenings is increasingly important in substance use treatment settings.

Conclusion

Kratom poses a unique challenge to addiction medicine and public health. While some view it as a harm-reduction tool for opioid users, it carries its own risks of addiction, withdrawal, and health complications. As kratom use continues to rise, especially among individuals seeking relief from pain or withdrawal, it is crucial for clinicians, counselors, and policy makers to understand its pharmacology, recognize the signs of dependence, and offer appropriate, evidence-based interventions. A balanced approach — acknowledging both the potential benefits and significant risks — is necessary to effectively address kratom use and protect public health.

What Is Kratom?
Kratom is a plant from Southeast Asia with leaves that can cause both stimulatingand opioid-like effects. It’s often sold as a powder, capsule, or tea in smoke shops, gas stations, or online.

People use kratom for:

• Pain relief
• Boosting energy or mood
• Reducing anxiety or depression
• Easing opioid withdrawal symptoms

Is Kratom Addictive?
Yes. Even though it's legal in many places and advertised as "natural," kratom can be addictive. People who use it regularly may:

• Build tolerance (need more for the same effect)
• Develop dependence (feel sick without it)
• Show signs of addiction (can’t stop even if they want to)

Common withdrawal symptoms:

• Anxiety, irritability, and depression
• Sweating, nausea, and shaking
• Muscle aches
• Insomnia and strong cravings

Is Kratom Safe?
Not always. Kratom is unregulated in most states, so doses and ingredients can vary. Some products are mixed with other drugs, increasing the risk of overdose or bad reactions.

It may also interact dangerously with other substances or medications, especially opioids, benzodiazepines, or alcohol.

Kratom and Recovery
Some people use kratom to quit harder drugs like heroin or fentanyl. While it might help short-term, many end up getting addicted to kratom instead. This can delay recovery and lead to new challenges.

If you're using kratom:

• Talk honestly with your counselor or doctor
• Don’t stop cold turkey without support
• You may need help managing withdrawal safely
• Recovery programs can help you learn healthy coping skills

How Is Kratom Dependence Treated?
Treatment can include:

• Counseling and therapy (CBT, relapse prevention,  12-Step support)
• Medical support for withdrawal
• Peer support and accountability

Key Takeaways:

• Kratom is not a harmless herbal supplement
• It can cause addiction and withdrawal
• Support and honesty are key in addressing kratom use
• Recovery is possible with help, one step at a time