Kratom and Treatment Options

You are about to start kratom to get off opioids, or you are treating kratom withdrawal with another product from the same shelf. Do not start kratom to quit opioids. If kratom is already the problem, see a clinician. There is no approved medicine for kratom withdrawal. Medicines that are approved for opioid use disorder are a different door.

If someone cannot breathe, will not wake, or is having a seizure, call 911. For a mental health crisis, call or text 988.

Not an approved treatment

Kratom comes from the leaves of Mitragyna speciosa, a tree native to Southeast Asia. Products made from those leaves are sold in the United States. People report using them for pain, cough, diarrhea, anxiety, depression, opioid use disorder, and opioid withdrawal. There is no legally marketed prescription or over-the-counter drug that contains kratom or its known alkaloids. Until safety and effectiveness are evaluated, FDA keeps warning the public not to use kratom for medical treatment. A personal report is not an approval.

It is not appropriate as a dietary supplement. Supplements that contain it are adulterated, because there is not enough information to show they do not present a significant or unreasonable risk of illness or injury. Added to food, kratom is an unsafe food additive. It is not lawfully marketed as a drug, a dietary supplement, or a conventional food additive. States may set their own rules. A state health department is the place for that question.

In 2021, about 1.7 million Americans age 12 or older, about 0.6 percent, used kratom in the past year. The COVID-19 pandemic affected data collection for that survey. The count is not a finding that the products are safe. Researchers have not shown kratom safe or effective for any medical purpose, including opioid withdrawal. Early laboratory interest is not a reason to start a product from a shop.

What can go wrong

Serious reports include liver toxicity, seizures, and substance use disorder. In rare cases, deaths have been associated with kratom, usually together with other drugs, and FDA says kratom's contribution is unclear. Some products have been contaminated with Salmonella or heavy metals. Effects are hard to predict. They can depend on the amount, the potency, how it is taken, other drugs, medical conditions, and prior experience. Mild reports include nausea, constipation, dizziness, and drowsiness. Case reports also describe confusion, tremors, high blood pressure, slow breathing, and liver injury that seems to strike unpredictably in a small minority of long-term heavy use.

The compounds researchers study most are mitragynine and 7-hydroxymitragynine. Both can act on mu-opioid receptors. In the natural leaf, 7-hydroxymitragynine is under 2 percent of the alkaloid content. It is substantially more potent at those receptors than mitragynine, and more potent than morphine. In laboratory models, 7-hydroxymitragynine can slow breathing in a way naloxone reverses, while the body's conversion of mitragynine happens slowly. A lab model is not a shop product. Concentrated products are a different risk from a leaf. Do not use either compound as a home experiment.

Most severe reports involve other drugs as well. That wider pattern is in polysubstance use. Fentanyl in the drug supply is a separate overdose risk, in fentanyl treatment. Another unapproved product sold the same way is in tianeptine products.

If kratom is the problem

Cases have included using longer or more than intended, craving, continuing despite harm, tolerance, and withdrawal when use stops. The DSM-5 does not list a specific kratom diagnosis. Withdrawal after regular use may be mild to moderate, and more research is needed on how often a related disorder occurs. Anonymous surveys suggest a minority of people who use kratom report withdrawal, and a smaller minority report disorder symptoms. Do not turn that into a label for everyone who tried it once.

There is no approved medical therapy for withdrawal or disorder symptoms related to kratom. Researchers have described medicines in very limited human and animal cases. Those reports are not a reason to start, stop, or swap a medicine because a write-up existed. See a clinician who can look at opioid use, other drugs, pregnancy, liver symptoms, and psychiatric symptoms together. What stopping can feel like is in kratom withdrawal. Who needs a medical setting for other withdrawals is in detox at home versus medical care.

If the original problem is opioids

Methadone, buprenorphine, or naltrexone is standard care for opioid use disorder, and lofexidine is approved for opioid withdrawal symptoms. Those medicines, without doses, are in medication for opioid use disorder. The drug class is on opioids. Do not stop a prescribed opioid medicine in order to switch to kratom.

Pregnancy needs its own conversation. Prolonged kratom exposure before birth has been followed by newborn jitteriness, irritability, and muscle stiffness. A 2021 report found many pregnancy cases also involve other substances, and at least five cases of opioid-like newborn withdrawal when the mother used kratom regularly and not opioids. Those infants responded to the usual treatments for that newborn withdrawal. Five cases are a signal, not a rate. Bring it up at the visit described in rehab during pregnancy.

Programs differ in whether they ask about kratom at all. Ask whether the assessment includes it, what happens if withdrawal or liver symptoms show up, and who the prescriber is. Questions worth asking at the door are in what to ask admissions.

Search FindTreatment.gov for a program that will assess this. Call or text (800) 653-9376 if you want help finding that care. Do not start kratom while you wait.

Additional Resources

Sources cited on this page:

• FDA: FDA and Kratom
• NIDA: Kratom
• NIDA: Treatment and Recovery
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

Common Questions