Kratom Addiction Treatment
What Is Kratom?
Kratom (Herbal Speedball, Biak-biak, Ketum, Kahuam, Ithang, Thom) is a tropical evergreen tree in the coffee family, native to Southeast Asia and small areas of Africa. Its bitter leaves contain psychoactive (mind-altering) opioid compounds and are consumed for their pain-relieving qualities, mood-uplifting effects and as an aphrodisiac. In the U.S., kratom is relatively new to the illicit market and used in a manner different from its traditional applications.1,2 Kratom leaves are used in the following ways:
- Chewed alone or as a gum
- Mixed into food
- Dried or powdered and brewed as a tea
- Added to other drinks as a liquid extract
- Smoked like marijuana
- Ingested in gel capsules1
Much controversy has surrounded kratom both in Southeast Asia and more recently in the U.S. Thailand is seeking to reverse a 74-year-old ban on kratom enacted under a rather dubious pretense. Options include making kratom available only by prescription, decriminalizing small amounts and total legalization. Many years ago, kratom was used in Thailand to effectively help opium users beat addiction, thereby cutting into lucrative opium taxes raked in by the government. Even after the 1943 ban, the kratom prohibition was loosely observed. In Thailand, people have been chewing the leaves for thousands of years with no cases of overdose, psychosis, murder or violent crime. Thai officials and drug experts believe its therapeutic use could be a potential solution for the horrific meth epidemic plaguing the country.3
In 2012, the U.S. Drug Enforcement Administration (DEA) placed kratom on its Drugs of Concern list (substances not currently regulated by the Controlled Substances Act, but believed to pose risks to persons who abuse them). The National Institute on Drug Abuse identified kratom as an emerging drug of abuse. While many states have already banned kratom, it is still legal in the U.S. and is often classified as a food product or supplement. Many more states are in the process of attempting to enact legislation to ban it.2,4,5
Several anecdotal reports by kratom users suggest it has benefits for the management of pain and opioid withdrawal, as well as depression and anxiety. In August 2016, the DEA suggested plans to add the psychoactive compounds found in the herbal agent kratom to the list of Schedule I drugs banned under the Controlled Substances Act. The DEA asked for public response and received comments touting kratom as a safe and legal psychoactive product that improves mood, relieves pain and may even be beneficial in treating opioid addiction. In light of the positive feedback, the DEA decided to delay imposing the ban on a temporary basis while further analysis is conducted by the U.S. Food and Drug Administration (FDA).2,4,5,6
Kratom is an emerging substance of abuse in the U.S. so scientific evidence about its inherent addictive properties is limited compared to other psychoactive plants like cannabis. There have been no controlled human studies regarding the use of kratom, and formal safety and efficacy studies are lacking. However, the number of reported adverse events associated with its use has increased in the U.S.6
Concern from U.S. government agencies is associated with the opioid-like effects of kratom noted in animal studies, and the suggested evidence that kratom and related substances (mitragynines) may interact with opioid receptors. Indeed, a variety of studies have shown dose-dependent kratom causes mitragynine to bind to the same mu-opioid receptor as morphine. Another recent concern has been increasing reports of adulterated kratom, with reported side effects of tachycardia, seizures, liver damage and in some cases, fatalities.4,6
Stats and Facts
- Kratom-related calls to U.S. poison control centers increased tenfold from 26 in 2010 to 263 in 2015.2
- Of 660 poison center calls associated with the use of kratom, an estimated 74% of exposures were intentional, and 90% resulted from ingestion.2
- The most commonly reported substances used with kratom were ethanol, other botanicals, benzodiazepines, narcotics and acetaminophen.2
- In some regions of southern Thailand, as many as 70% of males use kratom on a daily basis.7
- In 2014, the FDA abolished the inclusion of kratom in its dietary supplement category.8
Very little is known about kratom compared to more serious opioids. Although it is theorized kratom can have addictive properties, relapse may be less likely than with more powerful opioids. Nevertheless, the same types of behavioral interventions should be able to help individuals who abuse kratom address the underlying reasons for addiction and find healthier coping mechanisms including inpatient rehab and outpatient programs.
- What is kratom? National Institute on Drug Abuse website. https://www.drugabuse.gov/publications/drugfacts/kratom Updated February 2016. Accessed February 13, 2017.
- Anwar M, Law R, Schier J. Notes from the Field. Kratom (Mitragyna speciosa) Exposures Reported to Poison Centers – United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65:748–749. DOI: http://dx.doi.org/10.15585/mmwr.mm6529a4.
- Thailand looks to legalize kratom… Speciosa website. http://speciosa.org/thailand-looks-to-legalize-kratom-justice-minister-chaikasem-nitsiri-is-pushing-senior-officials-to-end-a-70-year-old-ban-on-kratom-enacted-under-a-dubious-pretense-kratom-once-helped-opium-users-kic/ Published May 4, 2016. Accessed February 13, 2017.
- Larry Greenemeier. Should Kratom Use Be Legal? Scientific American. September 30, 2013. https://www.scientificamerican.com/article/should-kratom-be-legal/ Accessed February 13, 2017.
- Robert Glatter. Kratom: New ‘Emerging Public Health Threat’, Says CDC. Forbes. July 30, 2016. http://www.forbes.com/sites/robertglatter/2016/07/30/kratom-new-emerging-public-health-threat-says-cdc/#5192414b5ae0 Accessed February 13, 2017.
- Kratom: What We Know. Medscape website. http://www.medscape.com/viewarticle/874301 Published January 23, 2017. Accessed February 13, 2017.
- Why the CDC is Wrong about Kratom. Botanical Education Alliance website. https://www.botanical-education.org/cdc-wrong-kratom/ Accessed February 13, 2017.
- Chang-Chien GC, Odonkor CA, Amorapanth P. Is Kratom the New ‘Legal High’ on the Block?: The Case of an Emerging Opioid Receptor Agonist with Substance Abuse Potential. Pain Physician. 2017 Jan-Feb;20(1):E195-E198.