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Kratom is a plant native to Southeast Asia that acts on opioid receptors in the brain to produce stimulant and sedative effects. In smaller doses, it has stimulating effects; in higher doses, it has sedating effects. It is available as a powder, liquid, tea and capsules. It has not been approved by the FDA for any medical purposes, but is widely used to ease pain and to treat opioid withdrawal symptoms.
It has been touted as a natural alternative to prescription pain medications and as a way to relieve symptoms of opioid use disorder (OUD), an addiction that claims 115 lives a day in the United States. But primary care providers should think twice before recommending it to their patients, said Dr. Marianne Chai, a physician at the Center for Living in New York City, who encountered one such patient: a teenage boy who began drinking kratom as tea to ease anxiety and ended up in her office for OUD treatment.
OUD is a chronic relapsing condition that can have devastating social, occupational and medical consequences. Many people with OUD have a history of substance or alcohol abuse and can struggle with depression, anxiety, attention deficit hyperactivity disorder, bipolar disorder, post-traumatic stress disorder and other mental health issues. It is difficult to diagnose and treat, and is the most common cause of death among people under 40.
In its unprocessed form, kratom pills contains mitragynine and alkaloids that have both stimulating and sedative effects. Its effects depend on the chemical structure of the alkaloids and the dosage. The most effective doses to induce analgesia and reduce opioid withdrawal symptoms are considered to be between 5 and 10 grams of dried kratom leaves. High doses can cause seizures, hallucinations and psychotic symptoms. Its stimulant effects may last for a few hours, but its sedative effects can last up to a full day. These can include a decrease in anxiety, depression and tension, increased energy and sociability and a increase in sexual desire. Those who take kratom for long periods of time may experience loss of appetite, diarrhea, fatigue and muscle cramps. They also may have watery eyes, twitching and difficulty sleeping or restlessness.
Unlike opiates, kratom does not appear to be addictive or lead to physical dependency. But it is reported to be habit-forming and can trigger dependence. It can also interfere with the brain’s production of dopamine, a neurotransmitter involved in reward and motivation. It can also interact with some antidepressants, such as SSRIs.
There is no specific regimen to treat kratom dependence, but doctors can prescribe drugs similar to those used to treat opiate withdrawal to help patients withdraw from kratom safely and without a relapse. Inpatient and outpatient drug treatment centers can help patients overcome a kratom addiction and learn to live life without illicit substances. Many private insurance companies are in-network with reputable rehab facilities.
