Kratom Addiction What is Kratom? Kratom is an herbal extract that comes from the leaves of an evergreen tree (Mitragyna speciosa) grown in Southeast Asia. Kratom leaves can be chewed, and dry kratom (ground leaves) can be swallowed or brewed. The Kratom industry is a billion-dollar business with an estimated 3-5 million Americans reportedly trying it in the last couple of years. Kratom is a supplement that is sold as an energy booster, mood enhancer, pain reliever and antidote for opioid withdrawal. Users seek the potential benefits to treat a variety of conditions including: Chronic pain Mood disorders (anxiety, depression, PTSD) Opioid withdrawal The Rise of Kratom Drug Abuse Abuse While many seek out Kratom as a medical treatment, still others use it to get high. It appears that a majority of Kratom-dependent users had a prior substance use disorder or were seeking relief from a chronic pain condition but wanted to avoid opioid use. Kratom stimulates the same opioid receptors as oxycodone and heroin. Users who find themselves physically dependent or addicted to Kratom have to seek inpatient or outpatient treatment for opioid use disorder. Kratom Addiction and Dependence The FDA stated Kratom had a “high potential for abuse” and no accepted medical use leading them to recommend temporary placement on the Schedule 1 banned substances. The FDA was ready to put it on the Schedule 1 banned substances list but in a rare reversal, they tabled their decision under heavy opposition by innumerable Kratom users and over 50 congressmen. Clinical trials have suggested a correlation between increased consumption of Kratom and risk of dependency development, the severity of withdrawal symptoms, and cravings for Kratom. This is of great concern with the ongoing and worsening opioid crisis in the US. Studies on the effects of kratom have identified many safety concerns and no clear medicinal benefits. Physical withdrawal symptoms manifested as: Muscle aches Diarrhea Anorexia Fever Pain and runny eyes/nose. The psychological withdrawal was characterized by: Mood swings such as anger Depression Restlessness Insomnia Tension and Sadness. The severity of Kratom dependence symptoms appears to be milder compared to opioid withdrawal. Kratom addiction can be treated in a similar manner with buprenorphine or methadone and subsequent tapering. Identifying Kratom Addiction Presently, there is no “point of care” (in office) urine testing for Kratom, so it has to be sent out to a lab for liquid chromatography/mass spectroscopy testing. This is a more expensive method of urine drug screen (UDS) testing and therefore is done less frequently by doctors doing UDS testing. This results in fewer Kratom users being identified and fewer users being helped through treatment. Treating Kratom Addiction Personally, I have treated about a dozen patients for Kratom dependency/addiction. I have had to use buprenorphine in each case for Kratom detoxification and treatment. This is the same methodology as I would treat someone for oxycodone, heroin or fentanyl addiction. From my perspective, as an addiction medicine specialist, Kratom appears to be a wolf in sheep’s clothing. It plays a part in the opioid epidemic rather than being part of the solution. The fact that it stimulates the same opioid receptors as oxycodone, heroin and fentanyl, has a similar withdrawal syndrome and is available at convenience stores, gas stations and head shops is a disastrous combination. This is like having Vicodin and Percocet being sold over the counter at 7-Eleven type convenience stores. No rational person would think that acceptable.