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Turning to Kratom For Opioid Withdrawal

Editor’s note: On Nov. 14, the FDA issued an advisory about “deadly risks” associated with kratom, saying there is no evidence to support using it for opioid withdrawal. Calls to U.S. poison control centers about kratom have incrased 10-fold from 2010 to 2015 and the agency reports 36 deaths associated with the herb.

Oct. 26, 2017 — Eric Mayhew Jr. wanted to break his more than decade-long addiction to opioids — one that started when his doctor prescribed them for knee pain.

But he didn’t want to do an in-house treatment and tried to detox on his own.

Nothing worked, until 2 years ago when he tried kratom.

“What kratom does is kills your brain’s desire when you are addicted to opiates and you want opiates,” says Mayhew, 37. “It dulls your pain and you start to get your wits back again.”

Now he takes the recommended dose of two to four capsules a day. He says he has had no side effects but admits he still needs his willpower.

“You have to want things to work. Nothing works unless you understand that,” says Mayhew.

He says he hasn’t relapsed since.

When it comes to withdrawing from opioids, medical experts and addiction counselors agree that you will be far more successful with support than trying it alone. But traditional treatment can be expensive and time-consuming, if it’s even available. Many treatment centers have long waitlists.

One study from 2015 found that only 21.5% of people with opioid abuse disorders are getting treatment. At the same time, about 91 Americans die every day from reasons related to opioid dependence.

That’s why some people dependent on opioids are rejecting traditional, medical-based withdrawal and seeking a do-it-yourself path.

Experts say — and conversations online show — that one of the most talked about methods is using kratom, a little-known herb made from the leaves of a tree that grows on the other side of the world. A recent survey found that nearly 70% of people using kratom were doing so to cut back on or get off of opioids or heroin.

But there’s little research on the herb’s effects on people, and some experts say it also can be addictive.

The herb is illegal in six states and the District of Columbia, and the Drug Enforcement Administration is considering labeling it as a Schedule I drug — a category that includes heroin, ecstasy, marijuana, and LSD. For now, the agency calls it a “drug of concern.”

Christopher R. McCurdy, PhD, a professor of medicinal chemistry at University of Florida’s College of Pharmacy in Gainesville, studies kratom and says while he believes the raw substance holds great promise for opioid withdrawal, he has deep concerns about how it is bought and sold.

“I definitely believe there is legitimacy to using kratom to self-treat an opiate addiction. I believe it from the standpoint of the material we know is pure and unadulterated and good. I just don’t know if all products available are consistently pure and good,” McCurdy explains.

Kratom for DIY Withdrawal

Kratom is made from the leaves of a tropical tree in Southeast Asia (Mitragyna speciosa) that have been used for hundreds of years to relieve pain. The leaves can be eaten raw, but more often are crushed or ground and brewed as tea or turned into capsules or liquids. It is sold online, where prices vary depending on the strains, amount, and form you buy.

DEA spokeswoman Katherine Pfaff says the agency considers it “harmful and dangerous.”

The FDA has warned people not to use any products labeled as containing kratom out of concern for its toxicity and potential health impacts.В

“As our nation struggles with epidemic levels of opioid abuse, we should be doing everything possible to ensure that those suffering with addiction have access to FDA-approved medicines and appropriate treatment options; not unregulated substances bought and sold over the internet,” Pfaff says.

In August 2016, the DEA announced its plans to temporarily classify the main psychoactive elements of kratom as Schedule I drugs, calling them an “imminent hazard to public safety.”

The DEA says it is aware of 15 kratom deaths, although other drugs were also reportedly found in those victims.

But after a public outcry, the agency agreed to allow time for public comments and an FDA investigation. The DEA says as of Oct. 12, 2016, it had received more than 23,000 comments from the public about kratom and is reviewing them as part of its decision on the fate of the herb, which for now is up in the air.

The FDA is preparing an analysis of kratom. A spokesperson says the agency has no time frame to complete this review.

Kratom Research

A study published in July 2017 found kratom is used for self-treatment of pain, mood disorders, and withdrawal symptoms that come with prescription opioid use. It was found to have few negative effects, including nausea and constipation, but generally only at high doses or when taken frequently.

But there aren’t a lot of human studies of kratom. In 2008, Edward W. Boyer, MD, director of academic development in the Department of Emergency Medicine at Brigham and Women’s Hospital in Boston, published a study about a 43-year-old man who abruptly stopped abusing opioid pain medicine by taking kratom.

The man spent $15,000 a year on kratom he bought online, drinking it in tea four times a day to ease his opioid withdrawal. The man said the herb cut his pain a lot and didn’t make him drowsy or cause any real side effects.

“I think the cool thing about it is this guy went from injection drug use to nothing, and all he had was a runny nose,” Boyer says. “It’s similar to something like methadone or any other opioid, but what is different is withdrawal from those substances is far more involved.”

People who use kratom typically don’t have withdrawals, says McCurdy, the University of Florida professor.

“That it helps them stop their cravings for going back to opioids and helps them with their mood. They feel good. They mention that they aren’t lazy like when using opioid prescriptions or addicted to opioids. They feel more productive and are doing things they love again, returning to a normal lifestyle.”

McCurdy’s research on mice shows kratom has a clear potential to treat opioid withdrawal with few side effects.

“It is probably addictive, but its addictive equivalent is something like coffee, which isn’t surprising because the leaf is in the coffee family,” McCurdy says. “We firmly believe that it will be very good for treating opioid withdrawal and may be a possible solution to the opioid epidemic we are facing as a country.”

But he says that would require testing kratom in clinical trials and controlled studies. He’s hopeful that will happen in the next 5 to 10 years. For now, he warns buyers to beware.

“You don’t know what you are getting, and I think that is the scary thing about going into self-treatment. On the flip side, I can tell you I get at least one email a week from someone on prescription opioids or heroin that states they have gotten off those drugs by using kratom,” McCurdy says.

Boyer agrees, urging caution because he says it’s still not well understood. Kratom isn’t regulated, and there are no standards for what is sold in the U.S. McCurdy and Boyer were involved with a study published in 2016 that analyzed several commercial kratom products and found many had opioid levels that were “substantially higher” than those in kratom’s raw leaves.

“We know that people buy what they think is kratom. We don’t know that it actually is,” Boyer says. “Some people have found it useful, but nobody can vouch for its safety or efficacy. So to say that it is miraculous is clearly an overstatement.”

Treatment Options

While kratom seems to be the most commonly used substance for self-detox from opioids, experts say other people try marijuana, Imodium, and over-the-counter pain relievers for body aches.

“It’s not surprising to me that people would try anything to alleviate the symptoms,” says Darren Ripley, a counselor with the Alliance for Addiction and Mental Health Services in Augusta, ME. “What I am hearing more of is marijuana.” He says people claim it helps with pain and anxiety.

Research out of Johns Hopkins Bloomberg School of Public Health finds the most common treatment option is self-help groups.

But the National Institute on Drug Abuse says successful treatment for drug addiction includes medical and mental health services.

FDA Commissioner Scott Gottlieb, MD, says people who use medication-assisted treatment (MAT) for opioid addiction cut their risk of death from all causes in half. Medication-assisted treatment is the use of medications like methadone and buprenorphine along with counseling and behavioral therapies.

What Can You Do?

Ripley is not just a counselor but also a recovering addict. More than 25 years ago, he says, he got clean with the help of a 28-day medication-based detox program. He thinks that to successfully detox, people also need a support system and peer-to-peer help like a recovery coach.

“There was nothing that was easy about it, and I have all the empathy in the world for someone just starting out and trying it,” he says.

When patients overdose on opioids, they often end up in emergency rooms, where they may have a chance to get professional help.

Bayshore Medical Center in Holmdel, NJ, started an intervention program in July to help addicts find treatment. Since then, 64% of those involved in 34 bedside interventions with recovery coaches have entered into treatment and recovery programs.

“When you have a coordinated support team, your success rates will be higher than going home and doing treatment out-patient or on your own,” says Rajiv Prasad, MD, medical director of the hospital’s Department of Emergency Medicine.

If you want to try to detox yourself, Boyer says it’s helpful to at least understand and expect that withdrawal is not going to be pleasant. “Opioid withdrawal is certainly uncomfortable but is not life-threatening. So the safest but most unpleasant approach is just to go cold turkey.”

But Mayhew says kratom was the answer for him. He works, is a proud uncle, takes things one day at a time, and says kratom has been a real lifesaver.

“I am just a guy from Kentucky, but I can tell you it gave me my self-respect, my word, my accountability back, and it gave me back what I felt like before I took opiates. It’s a long road. But you get your life given back. It is a really powerful thing.”

Sources

Edward W. Boyer, MD, PhD, Harvard Medical School, Boston.

Eric Mayhew Jr., Louisville, KY.

Christopher R. McCurdy, PhD, University of Florida, Gainesville.

Katherine Pfaff, DEA spokeswoman, Washington, D.C.

Rajiv Prasad, MD., medical director, Department of Emergency Medicine, Bayshore Medical Center, Holmdel, NJ.

Darren Ripley, Alliance for Addiction and Mental Health Services, Augusta, ME.

Drug Enforcement Administration: “Drug Facts Sheets,” “Drug Schedules,” “DEA Announces

Intent to Schedule Kratom.”

FDA spokesperson, Washington, D.C.

FDA: “Statement from FDA Commissioner Scott Gottlieb, MD,” Sept. 20, 2017.

Journal of Medical Toxicology. Dec. 2016.

Journal of the American Medical Association. October 13, 2015.

Current Drug Targets. April 25, 2017.

Drug and Alcohol Dependence. July 2017.

Journal of Psychoactive Drugs. April-June, 2015.

Trends in Neuroscience. Feb. 2017.

Drug and Alcohol Dependence. Nov. 1, 2017.

The Washington Post: “Long waiting lists for drug treatment add to addicts’ desperation.”

Some people dependent on opioids are trying the herb kratom to help them get off the drugs.

What to Know About Kratom Use

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Joe Raedle / Getty Images

You may have heard about kratom (Mitragyna speciosa), an herbal supplement used traditionally in Southeast Asia for energy and to help ease aches and pains. Derived from a type of evergreen tree, kratom contains alkaloid compounds called mitragynine and 7-hydroxymitragynine.

While kratom acts like a mild stimulant when taken in low doses, it can cause an opiate-like high when taken in high doses. Kratom is currently listed by the Drug Enforcement Administration (DEA) as a “drug of concern,” and has not been approved for any medical use by the Food and Drug Administration (FDA).

Also Known As: Kratom products are also known as Biak, Ketum, Kakuam, Ithang, Thom, Herbal, and Ketum.

Common Effects: Effects of kratom use include pain relief, relaxation, improved mood, increased energy, sensitivity to sunburn, nausea, itching, sweating, dry mouth, constipation, increased urination, and loss of appetite.

How to Recognize Kratom

Kratom looks like fresh or dried leaves and can be made into a green powder, liquid extract, gum, or pill. Packets are often labeled “not for human consumption.” People chew kratom leaves, brew the dried or powdered leaves as a tea, eat them in food, or smoke them.

What Does Kratom Do?

According to FDA research, kratom is an agonist that binds to mu-opioid receptors n the brain.   These are the same receptors that are activated when you take opioids, like prescription painkillers or heroin.

Kratom is, essentially, a natural opioid. Like all opioids, it comes with a risk of tolerance, dependence, and withdrawal.

It’s thought that mitragynine and 7-hydroxymitragynine may help control pain by attaching to these opioid receptors, which, in turn, reduce pain perception.

Kratom has gained popularity as an alternative to opioid pain medications like Vicodin (hydrocodone) and OxyContin (oxycodone). In many cases, kratom is used to manage chronic pain associated with conditions such as arthritis and fibromyalgia.

The results of an online survey in 2014 found that kratom users in the United States tend to be middle-aged, middle-income people living with pain.   Most of the over 8,000 survey respondents said that they were using kratom to treat pain or improve their mood.

A smaller but significant number said they were using it to help them quit opioid drugs (a class of medication used for pain relief) or to treat opioid withdrawal.

What the Experts Say

Proponents of kratom suggest that the herb could serve as a solution to the opioid crisis, both by offering another option for pain relief and by aiding those struggling to overcome opioid addiction.

Other experts say that it’s not the magic solution some people claim it is.

Published research on kratom’s possible benefits as a pain reliever and opioid alternative is very scarce.

The available research includes a report published in the International Journal on Drug Policy in 2010, for which scientists surveyed 136 active Malaysian users of kratom and found that the herb was “described as affordable, easily available, and having no serious side effects despite prolonged use.” This report included no testing of kratom’s health effects or potential hazards.  

However, in a 2014 report published in Drug and Alcohol Dependence, researchers surveyed 293 regular kratom users and determined that more than half had developed severe dependence problems, including kratom withdrawal symptoms like muscle spasms, sleep disruption, anger, and tension.  

A mouse-based study published in the Journal of Medicinal Chemistry in 2016 suggested that kratom may not slow breathing to the same extent as other pain-relieving drugs like morphine.   Given that deaths due to opioid overdose are usually the result of respiratory depression, the study’s finding suggests that further research on the compounds in kratom is warranted.

A 2019 review concluded that kratom offers some potential benefits but has a high potential for abuse, interactions, and adverse side effects.   The review also suggested that placing it behind the pharmacy counter could be a potential middle ground between banning the drug and allowing its sale unrestricted.

DEA Interventions

The future legal status of the drug remains unclear, although the DEA’s past statements on the subject give some indications of what might be expected. In 2016, the DEA announced their intent to place two of the herb’s active constituents on its Schedule I drug list.   Two months later, the DEA withdrew its notice of intent and instead opened an official public comment period.  

Schedule I drugs (which include heroin and MDMA) are considered to have “no currently accepted medical use and a high potential for abuse.”

Mitragynine and 7-hydroxymitragynine are the kratom constituents that would be classified as Schedule I drugs, making possession or sale of the herb illegal. Kratom would remain on the Schedule I list for at least two years.

The DEA’s intent to place mitragynine and 7-hydroxymitragynine on its Schedule I drug list was met with a great deal of backlash. In mid-September 2016, for instance, protesters held a march and rally at Lafayette Park in Washington, D.C., and presented a petition signed by over 120,000 people opposing the ban.

At the rally, Botanical Education Alliance director Travis Lowin stated that the DEA “has failed Americans in its efforts to combat the opioid epidemic, and targeting kratom will make the situation worse.”

According to those opposing the ban, placing kratom’s alkaloids on the Schedule I drug list would also stifle further research on the compounds.

In addition to the DEA’s position, the FDA has also issued warnings about the potential dangers of the drug. In late 2017, FDA Commissioner Scott Gottlieb, MD, issued a public health advisory about risks associated with kratom.   Since then, the FDA has intensified warnings, citing strong evidence that the unregulated botanical substance has “opioid properties.” In an 18-month period, kratom was a contributing factor in more than 90 fatal overdoses. In these cases, people had also taken fentanyl and heroin.

In 2018, the website STAT reported that the Department of Health and Human Services had recommended a ban on the chemicals found in kratom.  

As of 2020, federal regulation remains on hold as the debate over the substance continues. The FDA has issued warnings to companies that sell kratom in the U.S. and illegally market the drug as an herbal supplement to treat addiction, anxiety, pain, and other health issues. Only FDA-approved drugs can make such claims.   The future legal status of the drug remains to be seen.

Common Side Effects

Although case reports have reported drowsiness, irritability, palpitations, high blood pressure, poor concentration, insomnia, hypothyroidism, seizures, psychosis, hepatitis, and coma in people using kratom, it’s unclear how much is directly attributable to kratom.

Risks appear to be higher when it’s taken in concentrated extracts (which have a higher potency), mixed with other psychoactive substances, drugs, or adulterants, or when it’s taken by people with alcohol use disorders, a history of heroin use, or certain health conditions.

Potential health effects:

  • Anorexia
  • Calmness
  • Constipation
  • Discoloration of the cheeks
  • Dry mouth
  • Euphoria
  • Increased social behavior
  • Increased urination
  • Insomnia
  • Itching  
  • Loss of appetite
  • Nausea
  • Psychotic symptoms (hallucinations, delusion, confusion)
  • Sensitivity to sunburn
  • Sweating
  • Talkativeness

According to reports by U.S. poison control hotlines, calls involving kratom overdoses rose 50-fold from 2011 to 2016. In most cases, the kratom was laced with other drugs. If you or someone you love are experiencing any signs of overdose, call 911 or the Poison Control helpline (800-222-1222) immediately.

Signs of Use

If someone you love is using kratom, it’s important to be on the lookout for the common side effects (such as talkativeness, increased social behavior, itching, changes in appetite, sweating) as well as any unusual or extreme shifts in mood, behavior, appearance, and overall health.

Myths & Common Questions

Many people believe that since kratom is an herbal remedy, it’s safe. But it’s important to keep in mind that herbal products aren’t reviewed by the FDA before they hit the market.

As a result, there’s no guarantee that a supplement will contain the ingredients listed on the label (or that those ingredients will appear in the indicated amounts). Adulteration and contamination with other drugs, herbs, and substances are possible.

Tolerance, Dependence, and Withdrawal

Kratom comes with a risk of tolerance, dependence, and withdrawal. Kratom users can build tolerance, or needing more to achieve the desired effect, and experience symptoms of withdrawal when they stop taking the drug.

How Long Does Kratom Stay in Your System?

More research is needed to determine the exact half-life of kratom. Like other substances, how long kratom stays in your system will depend on the following factors:

  • Age
  • Body fat
  • Frequency of use
  • Genetics
  • Metabolic rate
  • Type of kratom
  • Water and food intake

Kratom’s main active alkaloid, mitragynine, can be detected in a urine test.

Addiction

The DEA states that kratom abuse can lead to addiction and can result in psychotic symptoms, including hallucinations, delusion, and confusion.  

Not everyone will experience addiction in the same way, but there are several hallmark signs and symptoms, including tolerance, dependence, and withdrawal. Other common signs of addiction include:

  • Changes in friends
  • Changes in mood, sleeping patterns, weight, and activity levels
  • Financial trouble
  • Loss of interest in hobbies, social activities, or job or school
  • Secretiveness, stealing, and/or lying
  • Keeping stashes of drugs or paraphernalia
  • Trouble scaling back or stopping drug
  • Spending vast amounts of time spent getting, using, and recovering from the drug

Withdrawal

People who take large doses of kratom several times per day have an increased risk of moderate to severe withdrawal symptoms. In general, however, withdrawal symptoms are milder in comparison to opioid withdrawal and may include:

  • Decreased appetite
  • Diarrhea
  • Difficulty sleeping
  • Fever
  • Hot flashes
  • Increased muscle spasms and pain
  • Mood disturbances
  • Runny nose
  • Watery eyes

How to Get Help

Living with pain isn’t easy. If you live with pain, you may already be all too familiar with the profound effect it can have on your quality of life.

If you or a loved one are struggling with substance use or addiction, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 1-800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

If you are considering trying kratom, you should speak with your healthcare provider first. Some pain clinics utilize complementary and alternative therapies in conjunction with traditional medical approaches for pain treatment and management. For example, mindfulness (and other mind-body practices) may help some people remain pain-controlled despite the challenges of everyday life.

If you’ve been using kratom to self-medicate and have noticed that it has begun to take over your life, don’t wait to get help. A trusted healthcare professional can help guide you toward the path of recovery.

The DEA plans to ban ingredients in an herb called kratom, but critics argue that the herb may benefit people living with pain or opioid addiction.