Exploring the Complexities of Kratom

By Jana Wu LCSW, LADC

Kratom leaves, capsules, and powder are scattered on a table.

Source: Anucha Cheechang/ iStock

You may have noticed a variety of products marked “contains kratom” in health food stores, vape shops, or gas stations. Native to Southeast Asia, kratom is a centuries-old herbal substance that has been traditionally used by laborers to help sustain energy and alleviate pain associated with the physical demands of their work. 

Today, proponents of kratom tout it as a “lifesaving natural supplement” and believe that it can treat a wide range of physical and mental health ailments including, chronic pain, opiate and alcohol cravings, low sex drive, and symptoms of PTSD, anxiety, and depression. While kratom has been useful in managing some complex conditions and symptoms, it is important to understand both sides of the issue to know when it is a safe component of any holistic wellness practice versus something causing more harm.

Kratom Regulation and Debate

Over the past two decades, kratom has experienced a surge in popularity, becoming more readily available in both physical retail locations and online marketplaces. As a result, in April 2022, the Food and Drug Administration (FDA) issued an alert to consumers, advising against the use of kratom. Since the FDA does not monitor or regulate kratom products for dosage or purity, and has yet to approve them for any use, how do we ensure the safety of its users?

Many states are in the process of creating and debating legislation about kratom’s usages, applications, and potential concerns. Most recently, the “Florida Kratom Consumer Protection Act” was signed into legislation in Florida on June 2, 2023. The new law bans the sale of the substance to people younger than 21. It also defines “kratom products” in state statutes. According to this legislation, the sale of kratom products to customers under 21 will result in a second-degree misdemeanor charge, punishable by a fine of up to $500 and up to 60 days in jail.

Why Do People Use Kratom?

Estimates vary but it is believed that over two million Americans use kratom, with some of the most popular areas located in Florida as well as the Northeast. Users are claiming kratom is “lifesaving” and offers relief from mental health conditions like anxiety, depression, PTSD, and opioid use disorder. Kratom is believed to help ease opioid withdrawal discomfort, reduce cravings, and improve mood.

And for those struggling with physical pain, one survey found that over 90 percent of the respondents indicated that kratom is “very effective” in treating their pain or medical condition, due to the substance’s analgesic properties.

As healthcare providers, it is our responsibility to maintain a curious, intellectual approach and peel back the layers of an issue that lacks public discourse and education. While some individuals might report positive experiences with kratom, we must remember that those who are self-medicating or attempting to discontinue opiate use with kratom could be at risk of developing a substance use disorder from the kratom use itself or experiencing adverse side effects.

Negative Side Effects of Kratom

Kratom has been associated with various heart problems such as elevated heart rate, high blood pressure, and even heart palpitations. According to the Mayo Clinic, other physical side effects may include:

• Weight loss
• Dry mouth
• Chills, nausea, and vomiting
• Liver damage
• Muscle pain

At high doses, kratom can also cause tremors, seizures, and psychosis. The likelihood of these reactions increases when other medications are involved. Kratom can also lead to changes in behavior and mood; users may become more irritable, withdrawn, and less interested in activities they once enjoyed.

In my professional experience, I have worked with clients who have tried using kratom to reduce opiate cravings resulting in negative effects on their family relationships, finances, and mental health. Several clients have reported that while kratom initially “helped” them manage cravings, their tolerance for kratom increased to a problematic level. Other patients reported that the new dependence on kratom negatively affected their daily living, with some stealing thousands of dollars to support their frequent kratom use, missing work, and making choices they would otherwise not make had they not been under the influence of this substance.

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As one can likely predict, when the use of kratom is stopped abruptly after prolonged use or in large amounts, individuals may experience withdrawal symptoms such as anxiety, irritability, muscle aches, insomnia, and depression.

Kratom Addiction and Misuse Treatment Options

Fortunately, there are methods to help people recover from kratom addiction starting with detox. While the kratom withdrawal process is generally not life-threatening, medical detox is recommended to help manage uncomfortable, acute symptoms. Clients struggling with kratom withdrawal have benefited from medication-assisted treatment to aid in the relief of symptoms that may be like those of opiates: chills, body aches, pains, and nausea.

To address psychological kratom dependence, it is recommended to engage in individual, group, and family therapies to discover the root cause of their kratom abuse and learn healthy ways to cope with stress, loss, or mental health challenges. Support groups are also a great way to provide people in recovery with a unique opportunity to connect with others who have faced similar challenges. Mountainside is in the progress of creating an exploratory support group for kratom users to discuss topics including, use versus misuse, effects of long-term use, how kratom affects family engagement and relationships, how to purchase kratom safely, and more.

Furthermore, wellness therapies can emphasize self-compassion, self-awareness, and empowerment. Through practices like mindfulness and meditation, individuals can develop a deeper understanding of their pain, triggers, and compulsive patterns of struggle. For those struggling with addiction, holistic practices are most effective when coupled with counseling. If you are someone self-treating with kratom for opioid use disorder, you can speak with a healthcare professional about using buprenorphine, or other medication-assisted treatments that have been extensively researched and are FDA approved.

What's Next?

We must look at the issue of kratom use from a progressive, multi-faceted stance, to ensure people are safely using the substance with informed consent and guidance from healthcare professionals. While there may be potential for kratom to alleviate a variety of ailments, there is currently mixed clinical evidence to support its effectiveness. Further research is needed on the benefits of kratom use as well as safe dosages, drug interactions, and negative side effects. Without this critical knowledge, the door remains open for dangerous, unintended short and long-term health effects.

To find a therapist, please visit the Psychology Today Therapy Directory.

Jana Wu is the Director of Cultural Integration at Mountainside treatment center. Jana is a Licensed Clinical Social Worker, a Licensed Alcohol and Drug Counselor, an Internationally Certified Alcohol and Drug Counselor, and a Credentialed Alcoholism and Substance Abuse Counselor with a master’s degree in social work from Smith College.