Kratom has emerged as a significant public health concern, with increasing numbers of people developing addiction to this botanical substance and its concentrated derivatives. While often marketed as a natural alternative for pain relief or opioid withdrawal, kratom carries substantial risks for dependence, addiction, and serious health complications. This comprehensive guide provides essential information about kratom’s effects, the dangers of self-medication, and evidence-based treatment options for those struggling with kratom addiction.
What is Kratom?
Kratom (Mitragyna speciosa) is a tropical evergreen tree native to Southeast Asia, particularly Thailand, Malaysia, and Myanmar. The leaves contain naturally occurring compounds called alkaloids, primarily mitragynine and 7-hydroxymitragynine (7-OH), which interact with opioid receptors in the brain.
According to the National Institute on Drug Abuse (NIDA), kratom has both stimulant and opioid-like effects, which vary depending on the dose consumed.
Traditional vs. Modern Use
- Traditional use: In Southeast Asia, kratom leaves have been chewed or brewed into tea for centuries to combat fatigue and manage pain
- Modern use: Available in various forms, including powders, capsules, extracts, and concentrated products
Understanding 7-Hydroxymitragynine (7-OH): The Dangerous Concentrate
The concentrated form of kratom known as 7-hydroxymitragynine (7-OH) represents one of the most concerning developments in the kratom market. This potent derivative poses significantly greater risks than traditional kratom products and has prompted federal regulatory action due to its high abuse potential and serious health dangers.
What Makes 7-OH More Dangerous?
7-Hydroxymitragynine is a concentrated byproduct that is significantly more potent than regular kratom:
- Potency: Research shows 7-OH can be more potent than morphine in its opioid effects
- Addiction potential: Much higher risk of dependence due to its strong opioid receptor binding
- Overdose risk: More likely to cause respiratory depression and other life-threatening effects
- Availability: Increasingly sold in vape shops, gas stations, and online, often in appealing forms like gummies and flavored products
Recent FDA Action on 7-OH
The FDA has taken significant action regarding 7-OH products, recommending scheduling under the Controlled Substances Act due to:
- Growing availability in consumer-friendly formats that appeal to youth
- Lack of clear labeling about 7-OH content
- Products are sometimes disguised or marketed as regular kratom
- Potential for abuse and addiction
The Drug Enforcement Administration (DEA) continues to monitor kratom and its derivatives for potential scheduling actions.
How Kratom Affects the Brain
Kratom’s effects on the brain are both complex and dose-dependent, involving multiple neurotransmitter systems that create its unique profile of stimulant and opioid-like properties. Understanding these mechanisms helps explain why kratom can be both appealing and dangerous for individuals seeking relief from pain or opioid withdrawal.
The Dual Nature of Kratom's Brain Effects
At lower doses, typically 1-5 grams, kratom primarily acts as a stimulant through its interaction with adrenergic receptors and other non-opioid pathways. Users experience increased energy and alertness, enhanced sociability and talkativeness, and improved focus and motivation. These effects occur because mitragynine, kratom’s primary alkaloid, stimulates the release of norepinephrine and affects serotonin systems, creating an energizing experience similar to caffeine but more pronounced.
As doses increase, typically above 5-10 grams, kratom’s opioid-like effects become dominant. The alkaloids begin to more strongly activate mu-opioid receptors in the brain, the same receptors targeted by prescription opioids and heroin. This produces significant pain relief, sedation and relaxation, euphoric feelings, and, unfortunately, respiratory depression—especially with concentrated 7-OH products. At these higher doses, kratom can be as dangerous as traditional opioids.
Complex Receptor Interactions
Recent scientific research has revealed that kratom’s effects extend far beyond simple opioid receptor activation. Mitragynine and 7-hydroxymitragynine interact with multiple brain receptor systems simultaneously. They bind to mu-opioid receptors with high affinity, creating the pain-relieving and euphoric effects, while also affecting kappa-opioid receptors, which can produce dysphoria and may contribute to the drug’s complex mood effects.
Additionally, these compounds interact with alpha-2 adrenergic receptors, potentially mimicking medications like clonidine that are used medically to treat opioid withdrawal. They also affect serotonin and dopamine systems, which influence mood, motivation, and reward processing. This multi-receptor activity explains why kratom’s effects can feel different from traditional opioids and why some people find it appealing for self-medication.
The Critical Metabolism Factor
One of the most important recent discoveries about kratom involves how the body processes it. Research published in the journal ACS Central Science has shown that when mitragynine is consumed, the liver’s cytochrome P450 3A4 enzymes convert it into 7-hydroxymitragynine (7-OH), which is significantly more potent at opioid receptors than the original compound. This metabolic conversion is crucial because it means that even “regular” kratom use results in exposure to the more dangerous 7-OH compound.
This metabolic process explains several important clinical observations. It clarifies why kratom is often more effective when taken orally rather than by other routes—oral consumption allows for this liver conversion to occur through first-pass metabolism. It also explains why kratom’s effects can be unpredictable, as individual differences in liver enzyme activity mean people metabolize kratom at different rates and to different degrees.
The conversion to 7-OH also means that users may be unknowingly exposing themselves to a much more potent opioid compound than they realize. While someone might think they’re using a “natural” plant product, their liver is actually producing a substance that can be more potent than morphine. This metabolic reality significantly increases the addiction potential and overdose risk of what might appear to be a relatively mild botanical product.
Tolerance and Dependence Development
Regular kratom use leads to tolerance as the brain adapts to the constant presence of opioid-active compounds. The brain reduces its natural production of endorphins and becomes dependent on kratom to maintain normal mood and pain perception. This neuroadaptation process is similar to what occurs with prescription opioids, creating physical dependence that manifests as withdrawal symptoms when kratom use is discontinued.
According to the Substance Abuse and Mental Health Services Administration (SAMHSA), understanding the mechanisms of addiction is crucial for effective treatment planning.
The brain’s reward system also becomes dysregulated with regular kratom use. Dopamine pathways that normally respond to natural rewards like food, social interaction, and accomplishment become less responsive, leading to anhedonia (inability to feel pleasure) and the need to use kratom just to feel normal. This neurochemical change drives the compulsive use patterns characteristic of addiction.
The Dangerous Practice of Using Kratom for Opioid Withdrawal
One of the most concerning trends in kratom use is its adoption as a self-treatment for opioid withdrawal and dependence. While this practice may seem logical given kratom’s opioid-like effects, it creates significant health risks and often delays access to effective, evidence-based addiction treatment. Understanding why people turn to this approach and the serious dangers it presents is crucial for anyone considering kratom as a solution to opioid addiction.
Why People Turn to Kratom
Many individuals struggling with opioid addiction turn to kratom as a self-management strategy for withdrawal symptoms. The appeal is understandable: kratom remains legally available in many areas, can temporarily reduce the discomfort of opioid withdrawal, and is often perceived as a “natural” alternative to pharmaceutical treatments. For those who face barriers to traditional addiction treatment—whether due to cost, accessibility, or stigma—kratom may seem like an accessible solution.
Why This Approach is Dangerous
While kratom might provide temporary relief from opioid withdrawal symptoms, using it as a substitute creates several serious risks that can ultimately worsen addiction outcomes.
The most significant concern is that individuals are essentially trading one addiction for another. Kratom has substantial addiction potential on its own, particularly the concentrated 7-OH compounds. Users frequently develop tolerance, requiring progressively larger amounts to achieve the same relief from withdrawal symptoms. This pattern can lead to a kratom addiction that proves just as difficult to overcome as the original opioid dependence, with its own set of uncomfortable and prolonged withdrawal symptoms.
The unregulated nature of kratom products presents another major safety concern. Unlike pharmaceutical medications used in medically supervised withdrawal, kratom products vary dramatically in their alkaloid content and purity. There is no standardized quality control, meaning users cannot predict the potency or safety of what they’re consuming. Products may be contaminated with other substances or contain much higher concentrations of active compounds than expected, increasing the risk of overdose or adverse reactions.
Perhaps most critically, relying on kratom for opioid withdrawal delays access to comprehensive addiction treatment. Self-medication may temporarily mask withdrawal symptoms, but it doesn’t address the underlying psychological, social, and behavioral aspects of addiction. Without professional treatment, individuals miss opportunities to develop healthy coping strategies, address co-occurring mental health conditions, and build the support systems necessary for long-term recovery. This approach often results in a higher risk of eventual relapse to the original opioid substances.
Medical complications add another layer of risk, particularly when kratom is combined with other substances or medications. Potential concerns include dangerous drug interactions, liver toxicity, cardiovascular effects, and an increased seizure risk when mixed with certain substances. Without medical supervision, these risks can become life-threatening emergencies.
Signs of Kratom Addiction
Recognizing kratom addiction can be challenging because it often develops gradually and may be disguised as legitimate pain management or self-medication. However, understanding the warning signs is crucial for early intervention and successful treatment outcomes.
Physical Signs
- Increased tolerance (needing more to achieve the same effects)
- Withdrawal symptoms when not using
- Weight loss
- Dry mouth
- Nausea and constipation
- Sleep disturbances
Behavioral Signs
- Compulsive use despite negative consequences
- Inability to control or stop use
- Neglecting responsibilities
- Social isolation
- Continued use despite health problems
- Spending significant money on kratom products
Kratom Withdrawal Symptoms
When individuals who have developed physical dependence on kratom attempt to stop using, they typically experience a range of uncomfortable withdrawal symptoms. Understanding these symptoms helps both users and their families prepare for the detoxification process and underscores the importance of professional medical support.
Withdrawal from kratom can include:
- Physical symptoms: Muscle aches, runny nose, irritability, nausea, vomiting
- Psychological symptoms: Anxiety, depression, mood swings, cravings
- Duration: Symptoms typically peak within 2-3 days and may last 5-10 days
- Post-Acute Withdrawal: Some individuals experience prolonged symptoms, including anxiety and cravings
Professional Treatment Options
Overcoming kratom addiction requires comprehensive, evidence-based treatment that addresses both the physical dependence and the underlying factors that contribute to substance use. Professional treatment programs offer the medical expertise, therapeutic support, and structured environment necessary for safe withdrawal and long-term recovery success.
Medical Detoxification
Professional medical detoxification provides the safest approach to overcoming kratom addiction. Under supervised medical care, individuals receive around-the-clock monitoring to ensure their safety during withdrawal. Healthcare providers can administer medications to ease uncomfortable withdrawal symptoms, provide nutritional support and hydration, and intervene quickly if complications arise. This medically supervised approach significantly reduces the risks associated with withdrawal and provides a more comfortable transition into recovery.
Evidence-Based Treatment Approaches
Modern addiction treatment centers employ multiple evidence-based therapies to address kratom addiction comprehensively. Medication-Assisted Treatment (MAT) may include buprenorphine to help manage withdrawal symptoms, naltrexone to prevent relapse by blocking opioid receptors, and various comfort medications to address specific symptoms like nausea, anxiety, or sleep disturbances.
Behavioral therapies form the backbone of addiction treatment, helping individuals understand and change the thought patterns and behaviors that contribute to substance use. Cognitive Behavioral Therapy (CBT) teaches practical skills for managing cravings and avoiding triggers, while Dialectical Behavior Therapy (DBT) focuses on emotional regulation and distress tolerance. Motivational interviewing helps individuals find their internal motivation for change, and contingency management provides positive reinforcement for maintaining sobriety.
A comprehensive treatment approach addresses not just the addiction itself, but the whole person. Individual counseling sessions provide personalized attention to address specific challenges and goals. Group therapy offers peer support and the opportunity to learn from others facing similar struggles. Family therapy helps repair relationships and build a strong support system for recovery. Additionally, psychiatric evaluation and treatment for co-occurring mental health disorders like depression or anxiety is crucial, as these conditions often contribute to substance use.
Flexible Treatment Settings
Treatment programs are designed to accommodate different needs and life circumstances. Outpatient programs allow individuals to receive professional addiction treatment while maintaining their work, school, or family responsibilities. These programs typically involve scheduled therapy sessions and check-ins while providing the flexibility to live at home. For those needing more intensive support, Intensive Outpatient Programs (IOP) offer more frequent sessions and closer monitoring while still allowing individuals to return home each day. In cases of severe addiction or when individuals need to be removed from triggering environments, residential treatment programs provide 24/7 care and support in a controlled, therapeutic setting.
Safer Alternatives for Opioid Withdrawal
For individuals struggling with opioid dependence, professional medical treatment offers safer and more effective alternatives to self-medication with kratom. These evidence-based approaches address both the physical and psychological aspects of addiction while minimizing health risks.
Instead of self-medicating with kratom, consider these evidence-based approaches:
Medical Supervision
- Medically supervised detox programs
- FDA-approved medications like buprenorphine, methadone, or naltrexone
- Professional monitoring for safety and comfort
The National Institute on Drug Abuse emphasizes that medication-assisted treatment, combined with counseling and behavioral therapies, is the most effective approach for opioid addiction treatment.
Comprehensive Treatment Programs
- Addressing underlying causes of addiction
- Mental health support
- Life skills development
- Relapse prevention training
Research from the National Institute of Mental Health (NIMH) shows that addressing co-occurring mental health conditions is essential for successful addiction recovery.
Support Systems
- Peer support groups
- Family therapy
- Sober living environments
- Community resources
When to Seek Professional Help
Determining when to seek professional treatment for kratom use can be difficult, especially when the substance is often viewed as a natural or harmless alternative to traditional medications. However, certain warning signs indicate that professional intervention is necessary for safe and successful recovery.
Contact a healthcare provider or addiction specialist if you or a loved one:
- Uses kratom daily or in increasing amounts
- Experiences withdrawal symptoms when not using
- Has tried to quit kratom unsuccessfully
- Continues using despite negative consequences
- Uses kratom to manage withdrawal from other substances
- Experiences concerning physical or mental health symptoms
If you need immediate help finding treatment, the SAMHSA National Helpline (1-800-662-HELP) provides free, confidential, 24/7 treatment referral services.
Getting Started with Treatment
Taking the first steps toward kratom addiction treatment can feel overwhelming, but understanding the process and knowing what to expect can help reduce anxiety and increase the likelihood of successful recovery. Professional treatment providers are equipped to guide individuals through each stage of recovery with compassion and expertise.
The growing popularity of kratom and its concentrated derivatives presents significant public health challenges that require informed awareness and appropriate clinical response. While marketing and cultural perceptions may present kratom as a benign natural remedy, the scientific evidence reveals a more complex and concerning reality.
While kratom may seem like a natural solution for pain or opioid withdrawal, it carries significant risks for addiction and health complications. The concentrated form, 7-OH, is particularly dangerous and has prompted federal action due to its high abuse potential.
Professional treatment offers safer, more effective approaches to overcoming opioid dependence and managing chronic pain. Evidence-based treatments, medical supervision, and comprehensive support systems provide the best chance for long-term recovery and improved quality of life.
For additional information about opioid addiction and treatment options, visit the CDC’s Opioid Overdose Prevention resources and the National Institute on Drug Abuse for the latest research and treatment guidelines.
Medically Reviewed By:
Dr. Sanjai Thankachen
Dr. Sanjai Thankachen graduated from Adichunchanagiri Institute of Medicine in 2000. He completed his residency in psychiatry in 2008 at Creedmoor Psychiatric Center in New York. Dr. Thankachen is currently working with Pacific Neuropsychiatric Specialists in an outpatient practice, as well as working at multiple in-patient psychiatric and medical units bringing his patients the most advanced healthcare treatment in psychiatry. Dr. Thankachen sees patients with an array of disorders, including depression, bipolar illness, schizophrenia, anxiety, and dementia-related problems.
Edited for Clinical Accuracy By:
Sean Leonard, Psychiatric Nurse Practitioner
Sean Leonard is a board-certified psychiatric nurse practitioner. He received his master’s degree in adult geriatric primary care nurse practitioner from Walden University and a second postmaster specialty in psychiatry mental health nurse practitioner from Rocky Mountain University. Sean has experience working in various diverse settings, including an outpatient clinic, inpatient detox and rehab, psychiatric emergency, and dual diagnosis programs. His specialty areas include substance abuse, depression, anxiety, mood disorders, PTSD, ADHD, and OCD.