What are the signs someone has a problem with kratom?
Before you can recognize the signs someone has a problem with kratom, it’s probably best to understand what it is.
If your knowledge of drug culture is minimal, don’t take it personally if you’ve never heard of it, or if you’ve never endeavored to learn more about it. It’s been marketed for several years as a herbal supplement, but because the laws governing it are scattershot, it’s only recently gained headline traction as a potential substance of abuse.
Simply put, according to the National Institute on Drug Abuse (NIDA) , “Kratom is a tropical tree (Mitragyna speciosa) native to Southeast Asia, with leaves that contain compounds that can have psychotropic (mind-altering) effects.” It’s been touted as a natural remedy for addiction to a number of harsher drugs, and last October, NBC News interviewed several individuals  who claim kratom has been a lifesaver: ““I could have died any day from a heroin overdose and kratom gave me a new lease,” 41-year-old Bobby DiBernardo of Rochester, New York, said, crediting kratom with helping him escape the clutches of heroin, oxycodone and alcohol. “It helped take away the pain of withdrawal.”
While kratom’s history dates back more than a century in Southeast Asia, Westerners — and particularly Western medicine and science — are still examining both the potential benefits and hazards of kratom. The signs someone has a problem with kratom may not be readily apparent, but it’s important to understand that problems can and do develop, according to Charles Veltri and Oliver Grundmann, who wrote a paper titled “Current Perspectives on the Impact of Kratom Use” for a July 2019 edition of the journal Substance Abuse and Rehabilitation : “Reports and studies of the dependence potential to Kratom are of serious concern given the current opioid crisis in the United States and rising abuse of opioids in other countries.”
What Is Kratom, Exactly?
A 2015 paper in the journal Biomed Research International  examines the origins of kratom, describing it as a tropical tree averaging anywhere from 13 to 52 feet, “indigenous to Southeast Asia, the Philippines, and New Guinea. Traditionally, in certain regions of Southeast Asia, the chopped fresh or dried leaves of the tree are chewed or made into tea by local manual labourers to combat fatigue and improve work productivity. In addition, kratom preparations have also been used for centuries during socioreligious ceremonies and to treat various medical conditions, such as morphine dependence in Thailand, and as opium substitute in Malaya.”
It’s referred to by a number of names, including  biak, ketum, kakuam, ithang and thom, all of which can be used interchangeably for both the tree and its psychoactive extract, an alkaloid called mitragynine and its analogs: “Although mitragynine can act on the mu (μ), kappa (κ), and delta (δ) opioid receptors, it is structurally different from morphine and other components from the opioid family; the reason why it has been suggested is that it might also present with a more broad receptor binding activity.” 
Those opioid receptors are located in the brain and are responsible, in laymen’s terms, for the release of dopamine, a “feel good” chemical that, in natural amounts, helps us experience bliss after a satisfying meal or sex. Opiates, on the other hand, activate the same systems, but in much greater amounts, thereby flooding the body with dopamine, which triggers reinforcement mechanisms that drive some users to repeatedly seek that reward, which can lead to addiction.
According to a 2012 article in the Journal of the American Osteopathic Association (JAOA) , “In Thailand, kratom use typically involves ingestion of the plant's raw leaves or consumption of teas that are brewed or steeped from the leaves. Kratom leaves are used for their complex, dose-dependent pharmacologic effects. Low to moderate doses (1-5 g) of the leaves reportedly produce mild stimulant effects that enable workers to stave off fatigue. Moderate to high doses (5-15 g) are reported to have opioid-like effects. At these doses, kratom has been used for the management of pain, diarrhea, and opioid withdrawal symptoms, as well as for its properties as a euphoriant. Very high doses of kratom tend to be quite sedating and can induce stupor, mimicking opioid effects.”
How does that work? As the JAOA paper points out, “no well-controlled clinical studies on the effects of kratom on humans have been published, there is evidence that kratom, kratom extracts, and molecules isolated from kratom can alleviate various forms of pain in animal models.” Sounds promising, right? But there’s a caveat: Although kratom compounds “have been shown to have analgesic and antinociceptive effects in animals,” they’ve been shown to “also produce opioid-like effects on organs,” “moreover, when they are given to animals for 5 days or longer, both compounds produce a state of physical dependence, with withdrawal symptoms that resemble those of opioid withdrawal.”
Signs Someone Has a Problem with Kratom: From Eastern medicine to Western dilemma?
According to Veltri and Grundmann , “the first reported use of Kratom in the scientific literature dates back to 1836 when it was noted that the leaves of the tree were used by Malays as a substitute for opium.” Observers of the time found that native populations of Southeast Asia also used it to dress wounds, reduce fever and to offset withdrawal symptoms from opium and heroin. Although the recorded usage of kratom is relatively new, in historical terms, the pair point out that it “has likely been part of the social fabric for hundreds of years given that the tree grows indigenously throughout Malaysia, Thailand, and Indonesia.”
As a stimulant, it was used to increase “work efficiency, endurance, and tolerance to hot and humid climate conditions for manual laborers and as a medical remedy for a range of symptoms. The latter practice as a traditional medicine and home remedy primarily uses fresh or dried leaf material to prepare a decoction by brewing the leaves and ingesting it as a beverage either hot or cold. In this form, the effects have been primarily described as analgesic, relaxing, anti-diarrheal, antipyretic, and anti-diabetic.”
However, the pair emphasize: “Despite its traditional medical uses, kratom dependence has been known and observed for a long time and is well documented.” It’s officially banned in Malaysia (although still used regularly), and a Thai ban was lifted in 2018, but in the West, kratom was relatively unknown until recent years. In fact, the federal government doesn’t consider kratom a recognized supplement because it wasn’t available in the United States prior to the passage of the Dietary Supplement Health and Education Act in 1994. The Food and Drug Administration (FDA), however, put kratom on an “import alert” in both 2012 and 2014  and as of last fall “is actively evaluating all available scientific information on this issue and continues to warn consumers not to use any products labeled as containing the botanical substance kratom or its psychoactive compounds, mitragynine and 7-hydroxymitragynine.”
In Europe, several countries have banned kratom and its alkaloids, and laws governing kratom vary across the United States. (In Tennessee, you must be 21 to purchase it, and it must be labeled and “in its natural botanical form,” meaning synthetic versions are illegal.) Despite such concerns, however, kratom has a respectable number of advocates who use “the leaf extract and its varied formulations for a range of health reasons that primarily relate to chronic pain, mood disorders, or mitigating the withdrawal symptoms of a prescription or illicit drug dependency,” according to Veltri and Grundmann. There’s even a nationwide nonprofit devoted to the cause: The American Kratom Association was established in 2014 and “is committed to restoring full consumer access to kratom and to preserve and protect the freedom of consumers in the United States to make their own choices on their well-being and maintaining a healthy lifestyle.” 
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So Is Kratom Problematic?
That depends on what the definition of “problematic” is. The federal government certainly has its concerns: The Drug Enforcement Agency (DEA) classifies it as a “drug of concern” and lists the following physiological and psychological effects :
- “At low doses, increased alertness, physical energy, and talkativeness
- “At high doses, sedation
- “Addictive: causes hallucinations, delusion, and confusion
- “Nausea, itching, sweating, dry mouth, constipation, increased urination, and loss of appetite
- “Long-term use can cause anorexia, weight loss, and insomnia.”
In addition, health experts at the Mayo Clinic have expressed concern about its potential problems : “At one time, some researchers believed that kratom might be a safe alternative to opioids and other prescription pain medications. However, studies on the effects of kratom have identified many safety concerns and no clear benefits.” In a piece on consumer health and kratom, Mayo writers point out that:
- “Kratom has been reported to cause abnormal brain function when taken with prescription medicines.”
- “In a study testing kratom as a treatment for symptoms of opioid withdrawal, people who took kratom for more than six months reported withdrawal symptoms similar to those that occur after opioid use.”
- “Kratom also adversely affects infant development. When kratom is used during pregnancy, the baby may be born with symptoms of withdrawal that require treatment.”
- “In addition, substances that are made from kratom may be contaminated with salmonella bacteria. As of April 2018, more than 130 people in 38 states became ill with Salmonella after taking kratom.”
But is kratom the bogeyman that some authorities believe? Not so fast. Remember Grundmann, the co-author of “Current Perspectives on the Impact of Kratom Use?”  In an article last month published on the website Wired , he points to the nonexistence of a purified, highly potent version of kratom that can be injected by consumers as evidence those concerns may be overstated: “If kratom were really so powerful, why don’t we see anything like that, despite having a sophisticated underground machinery that could easily come up with extraction techniques if they wanted to? Instead, we see fentanyl and its derivatives contributing to the opioid crisis.”
Other papers suggest that there may indeed be some health benefits associated with kratom. In a 2017 paper in the journal Frontiers in in Psychiatry , Dimy Fluyau and Neelambika Revadigar suggest that historical data, as well as clinical studies, show that “there is a possibility for M. speciosa (kratom) to be medically used as a pain killer and as a better opioid substitute in the future.” In addition, they write, “It appears that M. speciosa possess antidepressant activity,” and that there may be opportunities for kratom to play a role in weight loss because of its effects on the “level of cholecystokinin, a peptide hormone of the gastrointestinal system which is associated with hunger suppression.”
However, their conclusion is that the risks vs. the rewards of kratom are still to be determined: “Our data analysis has not determined if biochemical benefits of kratom may prove to outweigh its toxicity and risks. On the contrary, it seems that its potential side effects outweigh the benefits, and severe and real health hazards can, insidiously, lead to death.”
So What ARE the Signs Someone Has a Problem With Kratom?
In the realm of addiction medicine and drug and alcohol treatment, the benefits-vs.-hazards arguments about kratom are moot points, primarily because of the nature of substance use disorders. The amount of a substance ingested by one individual may pose no problems at all, while another may find that the same amount, over time, can lead to severe consequences. For the purposes of this particular blog, we’re not concerned with the legalization of kratom or in making any statements about its potential benefits or harmful effects — only in acknowledging that there are claims to both.
And as an addiction treatment center, our job is to highlight the signs someone has a problem with kratom, so that the individuals themselves, as well as their loved ones, know what to look for in order to find a solution.
So what are the signs someone has a problem with kratom? Again, some background: According to the NIDA , “Most people take kratom as a pill, capsule, or extract. Some people chew kratom leaves or brew the dried or powdered leaves as a tea. Sometimes the leaves are smoked or eaten in food.” Reported health effects, the NIDA continues, include nausea, itching, sweating, dry mouth, constipation, increased urination, loss of appetite, seizures, hallucinations and, in some users, psychosis.
Of course, those symptoms don’t present across the board, and when they do, it doesn’t necessarily mean a kratom user has a problem. By and large, the signs someone has a problem with kratom are similar to those of other drugs, especially opioids:
- Using it excessively — several times a day;
- Using it in large amounts or quantities;
- Obsession: Kratom dominates the individual’s thoughts and conversations, and he or she spends an inordinate amount of time planning the acquisition and consumption of kratom;
- Spending money on kratom at the expense of other financial necessities;
- Lying about how much kratom is being consumed;
- Having to use an increasing amount to get the same effects;
- They appear lethargic or sedated, or more social and talkative, than usual;
- They complain of stomach or digestion issues because of the amounts they consume;
- Withdrawal symptoms similar to those brought on by opioid cessation: “irritability, dysphoria, nausea, hypertension, insomnia, yawning, rhinorrhea, myalgia, diarrhea, and arthralgias.” 
Again, an important point of emphasis: Kratom is a legal substance in many parts of the country, and like alcohol and weed, it does not pose a problem for everyone. While the science is still nebulous, however, enough research has been done to conclude that it can be problematic. If you’re looking for signs someone has a problem with kratom, the conclusions you draw should be based on the way it affects the individual’s quality of life. Too much of any substance can be problematic, but for individuals prone to addiction, as well as many others who are but don’t realize it until it rears its head, kratom can act as an addictive drug like any other.