The bitter leaves of the Mitragyna speciosa, or kratom, tree indigenous to Southeast Asia contains two psychoactive compounds: mitragynine and 7-hydroxymitragynine. According to the National Institute on Drug Abuse (NIDA), these compounds activate opioid receptors in the brain. In addition, kratom has stimulant effects in lower doses.
The drug is known to decrease inhibitions and increase sociability, improve moods, enhance energy and alertness, and decrease opioid withdrawal symptoms. It may be used as a painkiller or sedative as well.
This herbal drug’s leaves may be chewed; brewed into tea; or made into powder, capsules, liquids, gum or resin, tablets, or patches. The products are then typically ingested.
In Thailand, where kratom abuse has been around for many years and where the drug is considered an illegal substance, kratom is a popular drug among Muslim youths who boil the leaves of the tree, add the substance to cola or cough syrup, and then drink it for its mind-altering effects. This concoction is called 4×100, the Drug Enforcement Administration (DEA) reports. Kratom is also known as biak, thom, kakuam, thang, ketum, and herbal speedball.
Legality and Abuse of Kratom
In 2014, kratom was recognized by the US Food and Drug Administration (FDA) as a potentially dangerous substance, as it was being imported under the guise of botanical dietary supplements with potentially hazardous and toxic side effects. The FDA banned kratom imports then, warning users that using it can cause a number of health issues, such as hallucinations, tremors, loss of sex drive, agitation, itching, difficulties breathing, aggression, insomnia, nervousness, nausea, vomiting, constipation, skin pigmentation changes, depression, delusions, high blood pressure, drowsiness, psychosis, weight loss, irritability, irregular heart rate, and withdrawal symptoms.
Kratom is not considered safe, even though individuals may think of it as an herbal supplement, or even “natural.” Kratom has been available for purchase in the United States online as well as in gas stations or head shops labeled “not for human consumption.” In some states, there have even been bars selling drinks that contain kratom.
Since kratom is unregulated, formulations of the drug are unpredictable. Individuals may not be able to discern the purity, quality, or potency of the dosage, increasing the odds for an adverse reaction. The Centers for Disease Control and Prevention (CDC) publishes data from the National Poison Data System (NPDS) that indicates a spike in calls for kratom-related exposures in recent years. In 2015, there were 10 times as many calls for kratom exposure than in 2010. The average caller was 28 years old and male. CNN reports that there have been at least 15 deaths attributed to kratom use from 2014 to 2016.
Kratom has been listed as a “drug of concern” by the DEA for several years. Between February 2014 and July 2016, law enforcement officials seized enough kratom material to make 12 million doses of the drug, prompting the DEA to announce plans to place the active ingredients into the highest level of drug control in America: Schedule I. As of the end of September 2016, kratom is considered an illegal drug with no accepted medicinal uses within the United States.
Recognizing Kratom Abuse and Addiction
Kratom has been marketed for use as a substance to help with the side effects of opioid withdrawal. Individuals battling addiction to heroin or prescription narcotics may think of kratom as a “natural” plant-based supplement that can help to reduce withdrawal symptoms and opioid drug cravings. Since kratom works on opioid receptors along the central nervous system, it may be effective for this purpose; however, it can also lead to drug dependence and addiction in and of itself.
Physical dependence on kratom can be formed with regular use of the drug, which is signified by cravings between doses and difficult physical and emotional side effects when the drug wears off. Emotionally, individuals may experience depressed moods; have trouble feeling happy; be agitated, restless, irritable, or anxious; and have difficulties concentrating and thinking clearly. Physical withdrawal side effects often resemble flu-like symptoms.
Addiction is one step beyond dependence in that it also includes behavioral changes that are most recognizable by an inability to control drug use. Individuals may become fixated on getting, using, and recovering from kratom, leaving little time or interest for family, work, school obligations, and activities or social engagements that were important previously. Physical appearance may decline, and individuals may become moody, reckless, withdrawn, and secretive. Sleep patterns and eating habits may become irregular, and individuals suffering from addiction to kratom likely keep using the drug even in full awareness of the hazards its abuse presents.
There are some things loved ones can be on the lookout for if kratom abuse is suspected, such as:
- Excessive amount of time spent online, especially in drug chat rooms or forums
- Suspicious packages arriving in the mail containing “dietary supplements” or herbal materials labeled “not for human consumption”
- Significant mood swings as well as erratic and unpredictable behaviors
- The presence of unidentifiable pills, tablets, capsules, powders, teas, or plant-based materials
- Financial difficulties
- Increased risk-taking behaviors
- Run-ins with law enforcement
- Hostility, aggression, and violent actions that are out of character
- Changes in skin pigmentation and sensitivity to sunburn
- Periods of alertness and high productivity followed by a “crash”
Kratom typically produces stimulant effects at low doses, potentially similar to cocaine, and sedative-narcotic effects at higher doses, like those of opioid drugs. The European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) publishes that kratom generally takes effect within 10 minutes of ingestion and remains active in the bloodstream for about 1-1.5 hours. Individuals who use kratom on a regular basis may take it 3-10 times a day.
Kratom is a potentially dangerous substance with no approved uses in the United States. Use can cause drug dependence and difficult withdrawal symptoms as well as the range of issues associated with addiction.
Addiction Treatment Options
Currently, there are no specific treatments associated with kratom abuse and addiction; however, numerous options exist for both stimulant and opioid addiction. A specialized care plan and treatment program can be specifically tailored to each individual suffering from kratom addiction.
Many clients may benefit from medical detox as the first stage of a treatment plan in order to manage the difficulties that may arise during kratom withdrawal. Highly trained medical and mental health professionals can use both pharmacological and supportive measures during detox in a safe and secure facility to smooth out withdrawal while the drug processes out of the body. Kratom is often used with other drugs and/or alcohol, and a detailed drug screening is an important first step in the treatment protocol to prevent any adverse reactions. After detox, individuals should enter into a residential or outpatient program that can provide a wide range of treatment options and amenities.
Behavioral therapies, group and individual counseling sessions, and support group meetings can all help individuals to learn stress coping mechanisms, anger management techniques, communication skills, and relapse prevention tools for the future. Nutrition planning, fitness programs, art therapy and creative outlets, and complementary techniques are often part of a comprehensive care model.
Treatment programs are designed with the individual in mind, and no two plans will be exactly alike. For example, one person may benefit from a comprehensive and highly structured residential treatment program where they reside in a specialized facility receiving around-the-clock care, while someone else may require a more flexible outpatient treatment program where they can schedule sessions around family, work, or school obligations. The most effective treatment plan will be one that is catered to the individual in need.