Kratom Addiction Treatment

Inspiration Health Addiction Treatment Center (IHAT) is a premier outpatient addiction clinic with several locations across Virginia. Learn about the innovative ways we treat Kratom addiction.

What is Kratom (Mitragyna speciosa)?

Kratom is a tropical evergreen tree native to Southeast Asia that is linked to the coffee plant.

It is also known as krathom, kakuam, ithang, thom, ketum, biak-biak, and mambog.

Indigenous People used it as a stimulant to increase stamina and relieve exhaustion, as well as to treat pain and opioid addiction.

Traditionally used as an antidiarrheal, cough suppressant, anti-diabetic, and intestinal deworming agent, it has been used in traditional medicine for centuries.

Kratom has gained popularity in the West over the last decade and is used to increase energy, relieve pain, self-manage opiate withdrawal, quit or reduce the use of prescription or illicit opioids, as well as for mood or anxiety disorders, or for its euphoric effects.

Kratom Modes of Use

Fresh leaves are chewed (1-3 at a time) and swallowed; salt is added to reduce the effects that lead to constipation.
The leaves are dried and ground into a powder that can be used in tea.
Lemon juice is frequently used to aid in the extraction of active alkaloids.
To disguise the bitterness of the tea, sugar or honey is traditionally added.
The leaves can also be dried and smoked, though this is less common.
It is sometimes prepared as a cold cocktail in Thailand because of its alcohol-mimicking effect, called “4×100.” This cocktail contains leaves, a caffeinated soft drink, and a codeine-containing cough syrup; ice cubes, an anxiolytic, an antidepressant, or an analgesic can also be added.

Kratom Products

Over-the-counter kratom products are sold as dietary supplements in stores and online for a low price.
The leaves may be dried or crushed into powders.
Liquids or “shots” are often made from its extracts like gum or resin.
Tablets and capsules are the most popular forms.
Online prices are lower than in-store prices, especially when purchased in larger quantities.
The powder may cost $20 per 100 grams while 500 capsules (250 grams of powder) sell for $60.

Lack of Quality Control

In the production and selling of commercially accessible kratom formulations, there is a lack of quality control and standardization.
The FDA discovered that Kratom products contained levels of nickel and lead that were dangerously high.
Salmonella outbreaks have been linked to kratom products, according to reports.
Although the active ingredients (as well as other agents) are occasionally specified on the products’ package, the amount of active ingredients (as well as other agents) is unknown.

How Many Types of Kratom Are There?

Generally, there are 3 different types of kratom leaves.
Red Vein, White Vein, and Green Vein Kratom are further subdivided into any number of other kinds or strains, each with its own set of characteristics that may be achieved by combining the three types.
As the alkaloid concentrations in a kratom leaf change over time, the color of the vein changes as well.

The Legal Status of Kratom

The use and sale of kratom are illegal in Australia, Poland, Denmark, Sweden, Malaysia, and Vietnam.
In the US, kratom was legal to grow and purchase in all 50 states until 2015 when the DEA identified kratom as a substance of concern.
In 2016, the DEA wanted to place kratom into Schedule I of the Controlled Substances Act but did not proceed due to a large public outcry from the kratom-user community.
As of February 2020, kratom is illegal to buy, sell, and use in Wisconsin, Indiana, Rhode Island, Vermont, Arkansas, and Alabama.
It is also illegal in San Diego, CA, Washington, DC, Denver, CO, and Sarasota, FL.

Widely Used but Not FDA Approved

Kratom is not regulated or approved by the FDA.
3 to 5 million Americans use kratom regularly.
According to an internet survey of 10,000 kratom users, most are college-educated, employed white men, ages 31 to 50 who take kratom to:
- treat chronic pain (68%)
- treat anxiety or depression (65%)
- reduce symptoms of opioid withdrawal from use of illicit drugs (7.7%) or use of prescription opioids (26%)
- 41% had disclosed their use of kratom to a healthcare provider

What Does Kratom Do from a Pharmacology View?

Kratom exhibits dose-dependent effects:
- a mild stimulant at low doses (< 5 grams of raw leaves)
- opioid-like effects, (analgesia, constipation, euphoria), at 5-15 grams
- sedation at doses > 15 grams
After taking a few grams of dried leaves:
- invigorating effects and euphoria are felt within 10 minutes, which can last for 1-1.5 hours
After taking large doses, 10-25 grams, of dried leaves: –
- initially sweating, dizziness, nausea, and dysphoria may occur, which quickly subside followed by calmness, euphoria, and a dream-like state which can last up to 6 hours. Contracted pupils (miosis) are often noted.
The initial effects of kratom typically begin within 10 to 20 minutes of consumption.
The full effects are experienced in 30-60 minutes and can last several hours

Adverse Effects

Stimulant effects– anxiety, irritability, or increased aggression
Opioid-like effects– sedation, nausea, constipation, or itching
These effects are dose-dependent and vary from one individual to another.
Chronic (>1 year), high-dose usage is often associated with skin hyperpigmentation, tremors, weight loss, insomnia, extreme fatigue, and constipation.
There have also been reports of seizures, delusions, hallucinations, respiratory depression, hepatotoxicity, coma, and death.
An emerging concern is the potential development of fatty liver infiltrates leading to cholestatic liver damage.
There have been increased numbers of calls to poison control centers related to kratom.
OVERDOSE – some reports of mixed results when used while taken with Naloxone.
55% of regular users of kratom become dependent.
Kratom has a high risk of relapse due to cravings (78%-89% at 3 months).

Kratom Related Deaths

As of February 2018, the FDA had received reports of 44 deaths associated with kratom.
There have been reports of fatal overdoses involving kratom, particularly when co-ingested with other agents, including one case involving Seroquel.
There have also been reports of deaths attributed to kratom alone. In one such case, a 35-year-old man had a fatal cardiac arrest due to kratom use with no other co-ingestants.
Among the reports of deaths in which kratom was the only substance consumed, the mitragynine blood levels were higher than the levels after consuming traditional kratom teas.

Kratom Withdrawal Syndrome

Abrupt discontinuation of high-dose, long-term kratom use can produce withdrawal symptoms that resemble those of opioid withdrawal.
Nausea, diarrhea, sweating, chills, muscle and joint pain, tremors and twitches, jerky limb movements, rhinorrhea, lacrimation, and mydriasis may occur.
Insomnia, restlessness, irritability, fatigue, anxiety, and mood disturbances are concerns.
Symptoms start 12-24 hours after the last use of kratom and can last up to 7 days.
Withdrawal intensity is correlated to the daily amount consumed, and the duration and frequency of use.
In 2 case reports, the newborns of women who used kratom during pregnancy experienced Neonatal Abstinence Syndrome.

So What Does It All Mean?

Kratom use is on the rise with increasing probability of developing

opioid-type dependence due to chronic use,” states Joanna Missygar, PA-C for Symetria Recovery. “Therefore, greater awareness among health professionals and users about its risks is necessary. There is evidence that patients with kratom use disorder can be successfully transitioned to maintenance with Suboxone, which should be considered especially if the use of kratom is high risk, involves high doses, and meets DSM-5 diagnostic criteria for a moderate or severe use disorder. Consideration should also be given to referral of patients for counseling or enrollment in treatment programs. Further research on the possible therapeutic uses, toxic effects, and abuse potential of Kratom is needed.

Medication Assisted Treatment for Kratom Use Disorder (KUD)

Our addiction medicine specialists and medical professionals at Inspiration Health Addiction Treatment Center address Kratom substance use disorders. The following are some of the medications utilized by Inspiration Health Medical practitioners to help people cope with withdrawal and overcome their Kratom addiction:

To date, no guidelines exist for long-term management of Kratom Use Disorder (KUD).

There are a few case reports in literature that have used buprenorphine naloxone (BUP/NLX or Suboxone) to treat kratom use disorder (KUD), and the patients were then successfully transitioned to BUP/NLX maintenance.

Modafinil: aids in the treatment of irregular sleeping patterns
Fluoxetine: aids in the treatment of psychiatric problems
Clonidine: can help with anxiety, impatience, and racing thoughts
Trazadone: an anti-insomnia medication that also enhances mood and appetite
Buspirone: helps to reduce irritability by reducing anxiety, cravings, and rapid heartbeat
Tizanidine: reduces muscle spasms
Imodium: relieves diarrhea, irritable bowel syndrome, and other muscle aches and pains associated with Kratom use
Ibuprofen 800: reduces pain and discomfort

Counseling and Care Coordination to Assist our Clients Suffering from Kratom Use Disorder

Counseling

Counseling is known to be a key component in an individual’s recovery when used in addition to Medication-Assisted Treatment for the treatment of and recovery from Kratom Use Disorder. Our licensed professional counselors and other members of the counseling department are trained in substance abuse counseling and mental health counseling. They regularly conduct individual, group, and family therapy sessions. Techniques used by our Behavioral Health and Substance Use Disorder counselors include Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT), Eye-Movement Desensitization and Reprocessing (EMDR), and Acceptance and Commitment Therapy (ACT). Counseling helps clients address grief and loss, family relationships, anger management, and other underlying conditions that may be hindering recovery. Clients are also taught coping skills and given the necessary tools to identify and avoid triggers that may also be necessary for recovery.

Individual Counseling

With every effort made to make treatment as convenient as possible for those suffering from addictions of all kinds, it is feasible to see your counselor, care coordinator, and medical practitioner on the same day at the same location when seeking help at IHAT. Clients can come to individual therapy sessions in our inviting office that is a friendly, safe, and secure environment. To address the physical and psychological effects of a substance use disorder, clients will have an individual treatment plan prepared in collaboration with their physicians and counseling staff. Individual counseling sessions can help each client develop coping skills, identify substance use triggers, develop a relapse prevention strategy, and treat co-occurring psychological issues that have made maintaining sobriety nearly impossible. If a client’s schedule makes personal attendance problematic, telehealth allows them to attend individual therapy sessions; nonetheless, personal presence is encouraged whenever possible.

Group Counseling

Today, many people suffer from Kratom Use Disorder (KUD). Here at Inspiration Health Addiction Treatment Center, we want our clients to know they are not alone. Our trained counseling staff members organize and chair group counseling sessions throughout the week in our beautiful facilities. Group sessions allow clients the opportunity to hear from other people who are afflicted by KUD and process new ideas presented by the counselor on how to live healthier lives without the use of harmful substances. The support gained through open communication during group sessions has proved effective not only in the initial stages of recovery but throughout long-term sustained sobriety. Clients are also given the opportunity to join groups and counseling sessions by telehealth if a client’s schedule makes personal attendance difficult, but personal attendance is encouraged when possible.

Care Coordination

At Inspiration Health Addiction Treatment Center, we have substance use care coordinators who ensure that necessary services, including mental health services, are available to our clients. Our care coordinators and interdisciplinary team, which includes our medical doctors, make referrals, and connect clients to community resources to meet our clients’ social needs. That includes individual care plans our clients participate in that are developed in conjunction with our doctors, medical professionals, and counselors to meet our clients’ individual needs and track their progress in overcoming Kratom Use Disorders.

Choosing to Stop is Difficult. Getting Help Should be Easy

We understand that our clients have a lot on their plates, whether it’s work, family, education, or legal commitments. Inspiration Health Addiction Treatment Center offers a variety of days and times to schedule your next appointment. What if you can’t make it to the clinic for an in-person appointment? No problem. We offer telehealth appointments that clients can attend anywhere they have access to a smartphone, tablet, or computer. Telehealth is a straightforward procedure. Clients simply supply Inspiration Health Addiction Treatment Center with a valid email address, receive a link, and click on the link to attend the telemedicine appointment on the scheduled date and time. If the client has a camera on their phone, tablet, or computer, they will be able to view and talk with the doctor or licensed professional counselor as if they were in the same room.