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Kratom has been dubbed “a drug of abuse” by the U.S. Drug Enforcement Administration, because its consumption can lead to addiction. The drug comes from the leaves of a tree in Southeast Asia, and is legally bought and sold as an herbal supplement in many states. When ingested, the drug binds to multiple receptors that govern the body’s central nervous system (CNS), activating some and blocking others. The cumulative effects are, paradoxically, analgesia (pain relief), sedation (calming), and stimulation, and they help to explain why recreational use of kratom has become increasingly popular.
Kratom’s euphoric and analgesic properties—these tend to be felt when large amounts of the drug are consumed—have also gained the drug some popularity in recent years as an alternative treatment for chronic pain and opiate dependence. Other conditions that kratom has sometimes been used for: generalized anxiety disorder, major depressive disorder, and social phobia— although none of these uses for kratom has received any systematic scientific study or the blessing of medical professionals.
In fact, because kratom is a “natural” supplement and can be legally acquired with ease, what many users fail to apprehend is that the drug can cause dangerous side effects, and that stopping the drug can result in withdrawal symptoms.
Kratom Withdrawal Symptoms
Given that kratom modulates multiple receptors in the CNS, it should not be a surprise that over time, regular use of kratom can actually change the brain and body’s makeup and chemistry. Once kratom use is discontinued, this altered physiology can no longer sustain itself in the absence of the drug, and both brain and body must reacclimatize themselves to functioning without kratom. This process of re-acclimatization is what constitutes “withdrawal” and can be characterized by various symptoms.
The following list of withdrawal symptoms from Mental Health Daily has been compiled with the help of kratom users:
- Agitation, in the form of anxiety and restlessness, tends to peak in the early stages of kratom withdrawal.
- Aggression, due to neurochemical imbalances, autonomic dysfunction and/or sleep disturbances, is usually more severe during the first days of withdrawal and lessens with time.
- Anger stems from a combination of excessive excitatory transmission (particularly norepinephrine) and overactivation of the sympathetic nervous system.
- Anxiety will be more severe for kratom users who have existing anxiety-related disorders, but can happen to anyone in withdrawal once kratom’s sedative effects (via a depressed CNS) are no longer operative.
- Changes in appetite can include either an increase or decrease in appetite, depending on how kratom affected the appetite, and may take months to stabilize.
- Brain fog has been described as operating in a dream-like state or as if underwater, without mental clarity or quickness.
- Chills are quite common during kratom withdrawal. They may be explained by the fact that kratom increases body temperature, so that in kratom’s absence, the body experiences an adaptive cooling effect. Usually chills peak during the first couple weeks of kratom withdrawal.
- Cognitive deficits involve executive functions like attention, critical thinking, planning, reasoning, self-regulation and memory.
- Confusion can accompany the acute stages of kratom withdrawal, and may involve difficulties making sense of conversations or new material.
- Cravings can happen to those who are used to imbibing high doses of kratom, who therefore crave the big dopamine hit they are no longer receiving (in the absence of the drug). Cravings are most intense in early recovery from kratom, so that at six months, someone who has been kratom-free should have much less cravings than someone who has been kratom-free for only one month.
- Delirium is a state of severe mental confusion characterized by abnormal speech, restlessness and bizarre perceptions. Delirium is usually brought on by an abrupt cessation of kratom use in those who are long-term users and/or were using kratom in high amounts. Thankfully, delirium should be short-lived during withdrawal.
- Depersonalization can consist of not feeling like oneself, feeling as if your surroundings are not real, or feeling disconnected from reality (disassociation).
- Depression is more likely to occur in kratom users with preexisting psychiatric conditions, and can happen when kratom, which generates antidepressant effects, is no longer present to activate the mu-opioid receptor.
- Diarrhea can be extreme but thankfully is only most severe during the first few weeks after cessation of kratom.
- Dizziness, one of the more common symptoms of withdrawal, is most severe among long-term kratom users who discontinue their use of the drug too abruptly, without a more gradual taper.
- Fatigue can vary from mild energy problems to an inability to carry out basic personal hygiene or home chores.
- Flu-like symptoms can include chills, fatigue, headaches, muscle aches and runny nose. These will be the most severe for long-term kratom users, and tend to be at their peak within the first 3-7 days of withdrawal from kratom.
- Frequent urination—the reverse of what happens with kratom use (urinary retention)—probably happens because of sustained noradrenergic signaling and sympathetic activation.
- Headaches or migraines, from intracranial blood vessel constriction and intracranial blood vessel dilation, respectively, are very common during kratom withdrawal— possibly because of overactivation of the sympathetic nervous system and excessive norepinephrine signaling.
- Hot flashes (unexpected heat flares in body temperature) are also not uncommon, due changes in hormone levels, neurotransmitter signaling and the activation of brain regions associated with thermoregulation.
- Increased blood pressure can also happen as the result of a kratom-induced increase in noradrenergic signaling, which lasts even after discontinuation of the drug. Spikes in blood pressure can lead to serious medical complications such as aneurysm, cognitive deficits, hearts or failure, stroke, and/or torn blood vessels.
- Insomnia can include a combination of excessive sleeping and inability to fall or stay asleep. For example, someone who has been a long-term, high-dose kratom user, may find they sleep excessively for the first days of withdrawal, then in subsequent days or weeks cannot sleep.
- Irritability tends to go hand in hand with agitation, anger, aggression and depression, and is directly related to the elimination of kratom, (which may have induced a peaceful sense of wellbeing), from your system.
- Itching is both a side effect of kratom and a withdrawal symptom. During withdrawal, changes in the activation of the central and peripheral opioid receptors, as well as changes in histaminergic signaling, may be the explanation.
If these were not enough, here are still other symptoms associated with kratom withdrawal, as reported by kratom users themselves, according to the same article in Mental Health Daily:
- Lack of motivation
- Memory impairment
- Restless legs
- Runny nose
- Sleep problems
- Spasms or tremor
- Stomach aches
- Suicidal thoughts
- Visual changes
- Watery eyes
- Weight changes
Kratom Withdrawal Timeline
The “withdrawal timeline” for kratom refers both to the length of time it takes for kratom to leave your system and the duration of symptoms that accompany the detox process. In both respects, the withdrawal timeline can vary from one person to another on the basis of factors like:
- Mode of discontinuing the drug
- Strain of kratom used
- Length and severity of use
- Level of dosage
- The presence of any co-occurring psychiatric disorders and/or health issues
- The concomitant use of alcohol and/or other drugs
- Recovery lifestyle
The above variables will undoubtedly influence how long and how hard a detox from kratom will be. That said, based on the fact that kratom has a half-life of more than 23 hours, it is estimated that a complete detox from the drug, (meaning the time it takes for your body to fully eliminate kratom), should take roughly six to seven days. For many users, withdrawal symptoms will peak in their severity during this timeframe— usually within a couple days of a final dose of kratom. For other users, however, withdrawal symptoms will only increase in their severity after Day 6 or 7.
Kratom withdrawal has in fact been divided into three stages:
- Acute (Stage 1) – which usually starts between Day 1 and Day 7 and can persist as late as Day 17; and can be characterized by the most severe withdrawal symptoms, including anxiety, chills, depression, diarrhea, dizziness, fluctuations in body temperature, headaches, insomnia, and nausea.
- Intermediary (Stage 2) – starting between Day 10 and Day 17 after last use of kratom and continuing anywhere between two and six weeks; can be marked by anxiety, depression, fatigue, headache, insomnia, and muscle cramps.
- Post-Acute (Stage 3), which refers to “post-acute withdrawal syndrome” or PAWS, an experience that many low-dose, short-term kratom users manage to elude; long-term, high-dose kratom users who go through PAWS may take an additional three to six months—even one year—to fully recover and be symptom-free.
Inpatient Treatment for Kratom
The gold standard for treating substance use disorders, including kratom addiction, is inpatient treatment, which consists of a medically supervised withdrawal (detox) from one or more drugs, paired with medication(s) where appropriate and behavioral therapies.
Detox from kratom consists of:
- An in-depth evaluation – the measuring of how much kratom is in the blood and a detailed screening and assessment of other health conditions and family, genetic and addiction history
- Stabilization – consists of helping the client transition safely and completely to becoming kratom-free, sometimes with the help of medication(s) and dual diagnosis treatment (treating any co-occurring mental disorders). The medications dihydrocodeine and lofexidine (Lucemyra), which have been used to treat opiate withdrawal, have also been used to treat kratom withdrawal. Nonsteroidal anti-inflammatory drugs (NSAIDS), antidepressants and anti-anxiety drugs are also sometimes prescribed to ease withdrawal.
- Treatment – administering group and individual behavioral therapies that address the client’s individual recovery needs
Ultimately, the goal of inpatient detox and treatment is to help you become permanently kratom-free.
Outpatient Treatment for Kratom
Outpatient treatment for kratom, though less comprehensive than inpatient treatment, may be an option for those who are short-term, low-dose kratom users. (Inpatient treatment is the better choice for those with more serious addiction.) For those for whom inpatient treatment is not an option because of job, family or insurance reasons, an outpatient program for kratom may also be the better choice. The advantage of most outpatient treatment programs is that clients can commute to them, receiving detox and treatment without having to live on campus. Usually an outpatient program will offer the same set of treatment services, only at a lower level of intensity.
Can Kratom Detox Be Done at Home?
Kratom detox at home is not an ideal option for anyone— because of the unknowns. Some withdrawal symptoms can pose serious medical risks, as evidenced by the potential complications of high blood pressure, depression and suicidal thoughts, among other problems.
These risks are magnified by a serious kratom addiction (high doses and long-term use) and the presence of co-occurring mental disorders and/or other health issues. Often, too, a person may not be aware that they have these medical risk factors.
For these reasons, a medically supervised detox is always recommended in cases where kratom is the drug of use.
Tapered vs. Cold Turkey
A common concern related to detox from kratom is whether to quit “cold turkey,” as in all at once, or more gradually wean off the drug. In the first case (quitting cold turkey), immediately and abruptly ceasing all use of kratom will intensify withdrawal symptoms and complicate recovery. That’s because the body—and, in particular, the CNS which was most affected by one’s use of kratom—has no time to adjust. If, on the other hand, you gradually taper off of kratom, incrementally reducing the level of dose, your withdrawal symptoms will be both less intense and less in number. This is why professional detox and treatment will usually apply a more gradual taper.
Considerations/How to Decide What Is Right for You
Any decision about treatment for a kratom addiction will involve individual considerations, such as:
- Cost and whether your insurance plan will cover inpatient or outpatient treatment
- Whether to pursue out-of-state treatment or stick closer to home
- What therapies will best address the roots of your addiction
- How long you can take off from work or whether to continue working while undergoing treatment
Only you can answer these questions for yourself, in deciding what is right for you.
Recovery Success and Aftercare Services for Kratom
Another important factor to consider: what aftercare services will you need in order to sustain your recovery from kratom? Any trusted treatment provider should have some basic aftercare services in place, on the basis of studies that show that aftercare services can boost recovery success rates. Here are some things to look for when considering any program of treatment:
- Individual maintenance therapy
- Medication maintenance
- Recovery groups, like 12-step peer support groups
- Alumni offerings
- Drug testing
Who Needs Kratom Detox?
Anyone who is using kratom may need detox and treatment. In addition to its classification by the DEA as a “drug of concern,” kratom has been linked with a number of dangerous episodes of psychosis, marked by hallucinations, delusion and confusion. Kratom also has no known medical use and has received little scientific scrutiny. We therefore know little about its long-term effects, which may be more dangerous than we can even guess.
Don’t play with fire: if you’re using kratom, consider a medically administered detox today.
For information related to kratom detox, check out these articles:
- The Science of Drug Addiction
- What to Consider Before Deciding to Detox at Home
- Alternative Methods for Managing Pain Without Opiates
- 7 Benefits of Inpatient Rehab