UPDATE: As of February 6, 2018, the FDA is classifying Kratom as a controlled-substance, and as an opioid. Learn more about this change to Kratom regulation.
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In the tropical forests of Thailand, Malaysia, Myanmar, and other regions of Southeast Asia grows a tree that scientists call Mitragyna speciosa korth. It is known by other, more common names, and one of them is kratom (transcribed from the Thai language). The leaves of the kratom tree are psychoactive, meaning they affect users’ mood, thoughts, and behavior.
Background on Kratom
Kratom enjoys a long history in Thailand (where it is indigenous), but a complicated relationship with modern-day laws. For example, it has been historically used for medicinal purposes, such as for the treatment of diarrhea, opioid withdrawal, depression, hypertension, and, in rare cases, as an aphrodisiac, according to the Songklanakarin Journal of Science and Technology. It is also used recreationally in cultural settings, such as in local ceremonies and traditional performances.
For this reason, kratom is not generally considered a “drug” by the people of Thailand, in a comparable way that many Westerners might not think of coffee as a drug – even though, as NBC News reports, kratom and coffee are in the same family tree. Kratom is known for stimulating the user’s mood when the leaves are chewed, which introduces the dimension of addiction to any conversation about kratom. It is used by laborers and farmers to help them overcome the stresses of hard physical labor. Current Topics in Medicinal Chemistry published a report about kratom that talked about its opioid activity, which not only helps in alleviating the effects of muscle strain, but also serves as a substitute for opioids when none are available. Alternatively, kratom can be used to manage the effects of opioid withdrawal among chronic users.
When kratom leaves are consumed at low doses, users feel more alert, physically active, talkative, and sociable, which explains the popularity of kratom when used in traditional settings. When Kratom is consumed at higher dosages, the leaves’ opioid effects take over, and the user feels very happily calm and relaxed. These effects can last for up to five hours, but with potential uncomfortable side effects:
- Dry mouth
- Loss of appetite
The United States Drug Enforcement Administration warns that “kratom consumption can lead to addiction.” A DEA bulletin carried the information of a study of kratom addiction, where people addicted to the leaves chewed them every day for up to 30 years. Chronic consumption of kratom can lead to severe changes to the body, such as weight loss and insomnia. When users were deprived of kratom, they displayed withdrawal symptoms comparable to those seen in other examples of addicts not receiving their drug anymore. In the case of kratom, such symptoms were:
- Mood swings
- Muscle cramping and pain
- Uncontrolled movement in the limbs
- In extreme cases, users even experienced psychotic symptoms, such as hallucinations and delusions.
Is Kratom a Problem?
Notwithstanding kratom’s historical use among the people of Thailand and Southeast Asia, there does exist a danger of addiction from using kratom at excessive levels. This explains the drug’s complicated relationship with regulation: only four countries have outright banned kratom (including Thailand and Malaysia, where it grows naturally, although Thailand is considering legislation to repeal the ban); a number of other countries consider kratom a controlled substance; and yet other countries allow the drug to be bought and sold legally, but do not allow it to be marketed for human consumption.
In Thailand, the Transnational Institute quoted figures from the 2008 National Household Survey on the Status of Drug and Substance Abuse: 1.07 million users, an increase from survey results the following year. Up to 70 percent of Thai men use kratom on a daily basis, which might explain why there is a drive for the drug to be decriminalized in Thailand. Its original banning in 1943 was as much for political reasons as it was for reasons of health, as the government wanted to promote Thailand’s opium production. However, with kratom growing naturally in Thailand, the ban was never entirely successful. In 2013, Thailand’s Justice Minister recommended removing kratom from the government’s list of banned substances – in part because it can be used as a “safer alternative for meth addicts,” reports Scientific American – but regulating kratom because of the possibility of addiction. The Transnational Institute feels the same way, calling kratom usage in Thailand “unproblematic,” and calling the ban unnecessary and counterproductive while agreeing that “pharmaceutical control systems” should be strengthened.
Kratom in America
The United States does not consider kratom to be a controlled substance, and there is thus no federal regulation on the drug on American soil. However, the Drug Enforcement Administration has placed kratom on its list of “Drugs and Chemicals of Concern,” saying that the drug has “no legitimate medical use.”
As the DEA reported in its bulletin, kratom abuse is not monitored in the country, and information about user demographics is limited. Part of the reason for that may be because kratom does not show up on normal drug screening tests. FOX News, in an article entitled “The Latest Legal Plant-Based High,” pointed out that there has been only one known fatality related to kratom; however, as reported in the Journal of Forensic Sciences, the victim had a “documented history of heroin abuse,” leading the medical examiner to conclude that the role of kratom in the cause of death was merely “possible,” and that the death itself was an “accident.”
While the federal government does not have enough information to outright ban kratom, the states of Ohio and Indiana have outlawed the drug “because it includes synthetic cannabinoids.” However, as Ohio’s Fox19 shows, getting kratom remains “not too tough” – ironically similar to the way the ban in Thailand proved ineffective. Kratom’s popularity comes from people who are frustrated with prescription narcotics, such as a veteran who refused more medication when he started developing a tolerance to the pain management drugs he was given. Kratom, said the veteran, made an “amazing difference” without the addictive properties of prescription narcotics or opiates. On the other hand, kratom is legal for sale in South Dakota, with a detective in the Spearfish police department telling the Black Hills Pioneer that kratom is a “legal opiate.”
Getting Treatment for Abuse and Addiction
While the jury is still out on the long-term future and effectiveness of kratom, the truth of the matter is that it can still be dangerous. If used excessively, it causes harmful health effects on both the body and the mind. If terminated after chronic consumption, it causes withdrawal effects. Notwithstanding its long history and potential for beneficial use, kratom should still be approached with care. In the event a kratom user wants to kick his habit, a drug addiction treatment program offers the best avenue for success.
The first step in checking into a center involves an intake interview. Since information about kratom is scarce in the United States, the more information the patient can provide, the more effective the treatment plan can be. This can mean clarifying whether the kratom was chewed raw, or whether it was mixed with tea, and whether the kratom was taken recreationally, or whether it was used to offset the withdrawal symptoms of other opioids (and then became a source of addiction itself). Once enough information has been collated, and clinical staff members feel that the patient is ready, he will begin the process of detoxification, where the patient is systematically deprived of kratom, and carefully observed for negative effects. This is where the importance of detoxing in a controlled environment comes in to play; a patient who detoxes alone is always at risk for relapsing if the stress of withdrawal becomes too great. Additionally, severe withdrawal symptoms can include periods of psychosis and suicidal thoughts; if the patient is alone (or surrounded by people untrained in mental health and medicine), there is a risk that the patient might cause harm to himself, or to those around him.
In a rehab setting, however, doctors and staff members can step in to provide medication to lessen the stress of withdrawal – a medication that simply would not be available to someone attempting to get clean on her own. The choice and dosage of medication is influenced by the information provided during the initial intake process, as well as observations made by clinic staff before treatment actually begins. The length of detox depends on the severity of the kratom abuse, as well as other co-occurring factors (such as the presence of other drugs in the user’s system, and any mental health disorders that affect how the user responds to detoxification). Detoxification can take anywhere from a couple days to an entire week, as the body struggles to adapt to functioning without the kratom upon which it had become dependent. Once the patient has completed detox, she is ready to begin psychotherapy. During this stage, a therapist helps the patient understand the psychological reasons behind her unhealthy use of kratom.
No treatment program is complete without psychotherapy sessions, since in this stage the patient learns how to cope with the temptation to use drugs. There are a number of different therapeutic approaches that a therapist can employ: therapy that focuses on changing thought patterns and destructive behavior is one such option, and therapy that focuses on goals and rewards for improved behavior is another. After the end of formalized treatment, a patient should always follow up with various forms of aftercare programs, such as support groups and 12-step programs. Even though the patient may be “clean,” kratom is still out there, and the temptation to use is too.
The more solid a foundation a person has upon leaving treatment, the better he will be able to enjoy day-to-day life again without the shadow of kratom abuse hanging over him. The issue of kratom abuse can be complicated, and you probably have a number of questions about it. That’s why we here at Futures of Palm Beach are here: to answer your questions, to give you as much information you need on kratom abuse, and to guide you through the first steps of getting help. We have trained staff members standing by to take your call. Please get in touch with us today, and let us help you make your kratom problem a thing of the past.