Kratom Abuse, Treatment and Withdrawal
Kratom is a mind-altering substance that comes from the Mitragyna speciosa tree, which is indigenous to Southeast Asia.
The leaves and stems are dried and either chewed or brewed into tea for stimulant effects at low doses and opioid-like effects at higher doses, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) reports. Kratom is particularly popular in Thailand where it is sometimes mixed with iced-down caffeinated soda or codeine-containing cough syrup into a drink called 4×100 for its alcohol-like effects.
Kratom can cause euphoria, or a “high,” within 5-10 minutes of ingestion, the DEA reports, and that high may last for 2-5 hours. The active ingredient in kratom, mitragynine, increases energy and alertness at low doses and has sedative and pain-blocking effects when more of the substance is taken.
In the United States, kratom is not a controlled substance by the Drug Enforcement Administration (DEA), although it is listed as a “drug of concern.” Bars in Florida are selling kratom for recreational use in the form of a drinkable tea. The drug may also be purchased in bars or stores in New York, Colorado, and North Carolina, although it is likely more commonly obtained online, Business Insider reports. Recent trends in America, which may indicate a rise in kratom abuse, have caused four states – Wyoming, Indiana, Tennessee, and Vermont – to ban kratom, USA Today publishes.
Some people claim that kratom is useful in helping to kick a heroin addiction; however, this claim is greatly disputed by experts. In addition to potential negative side effects like suppressed respiration, nausea, vomiting, itching, constipation, and loss of appetite, kratom may also lead to dependence and addiction much like opioid drugs themselves do, Fox News states.
Kratom may be marketed and sold as a dietary supplement. In 2014, the U.S. Food and Drug Administration (FDA) issued an import alert on the substance. In January 2016, the FDA placed a ban on imports of products containing kratom, detaining one marketed as RelaKzpro. The FDA decided that kratom does not have any legitimate use as a dietary supplement and banned products claiming otherwise from being imported into the United States. In addition, the FDA placed businesses selling known kratom-containing products onto a RED LIST, allowing blanket seizure of any form of kratom, including capsules, resins, leaves, and liquids containing the leaves.
Understanding Kratom Abuse
Kratom may be abused as a “legal” way of getting high and may therefore appeal to individuals who deem it safer than illicit drugs, such as younger adults and teens. Bars may sell kratom in powdered form or mixed into a drink. Kratom is also known by slang names, such as Thom, Ketum, Biak, Kakuam, and Thang. Kratom may not be detectable on drug tests either, even though it may behave much like other narcotics. Its abuse has been banned in Thailand for years, The New York Times reports.
Since this drug is relatively new on the recreational drug scene in the United States, its full mechanism may not be completely understood yet, although the general consensus is that it does have psychoactive effects and can lead to dependence and addiction.
When Abuse Becomes Addiction
Dependence and addiction are closely linked, but they are not actually the same thing. A dependence on a drug is when physical changes are made to brain chemistry due to regular drug use or abuse. Since kratom is thought to act like opioid drugs, this means that some neurotransmitters, which are the brain’s chemical messengers that signal pleasure, may be impacted. Since kratom may interfere with the natural production of “happy cells” like serotonin, when the drug leaves the bloodstream, the brain may have lower than normal levels of these neurotransmitters. As a result, withdrawal symptoms can occur that may include depression, fatigue, drug cravings, and trouble feeling pleasure.The DEA reports that long-term kratom abuse may lead to weight loss or anorexia, a frequent need to urinate, constipation, dry mouth, skin discoloration on the face, and insomnia. Withdrawal side effects may also include hostility, uncontrollable jerky movements, muscle and bone aches, aggression, and runny nose. In some cases, psychotic episodes including hallucinations, confusion, and delusions may occur.
The National Institute on Drug Abuse (NIDA) published a study that reported on psychiatric illness and significant withdrawal symptoms in Thai individuals who abused kratom for a long period of time, citing muscle aches, insomnia, and irritability as the most common symptoms. In addition, hallucinations, paranoia, trouble feeling pleasure, and decreased cognition were also reported.
Addiction is considered a brain disease. Drug dependence is one of the signs and potential side effects of the disease. However, NIDA reports that in order to be diagnosed with addiction, according to the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must exhibit compulsive and drug-seeking behaviors and continue to use drugs with no regard to the negative consequences that may result. Compulsive means that drug use is no longer in the person’s direct control and much of the person’s time is spent trying to get the drug, using it, and coming down from the drug’s effects. Drug abuse may even constitute an obsession, and other interests may go by the wayside.
Some of the behavioral, emotional, social, and physical changes to look for when trying to pinpoint addiction include the following:
- Change in physical appearance: weight loss and decreased interest in personal hygiene
- Irregular sleep patterns: sleeping at odd times, or sleeping more frequently
- Mood swings: from excitability and euphoria when taking kratom, to depression, aggression, irritability, and even potentially suicidal thoughts when withdrawing from kratom
- Increased risk-taking behaviors: lowered inhibitions when on kratom, encouraging users to potentially do things that may be out of character
- Irresponsibility: unfilled obligations and decline in grades or work performance
- Interpersonal relationship conflict: a shift in personality as well as increased secrecy and social withdrawal that lead to relationship problems
- Financial strain: working less, job loss, or spending significant funds on kratom
- Legal troubles: increased risky or even dangerous behaviors, leading to run-ins with law enforcement
Getting Help for Kratom Abuse and Addiction
Therapy and counseling are part of the therapeutic treatment model and may be offered in a residential or outpatient setting. Residential treatment means that a person will stay onsite in a specialized treatment center to receive continual care in a safe and secure environment in order to heal and recover. Days are scheduled with meetings, sessions, educational opportunities, set meal and sleep times, and potentially holistic or complementary medicine offerings like yoga or massage.
Outpatient programs generally fall into two main categories. Intensive outpatient treatment generally follows a similar schedule to a residential program. General outpatient programs may be more flexible and tailored around a person’s specific schedule requirements.
Stress may be effectively managed with new coping strategies taught during group and individual CBT sessions.
Counseling may include family sessions, as well as individual ones, where communication skills can be explored and improved. Support groups and 12-Step programs may be part of continuing, or aftercare support services, and may be beneficial during recovery as they can provide healthy connections to peers in similar circumstances. Relapse is considered a normal facet of addiction, and support groups can help to minimize the duration and severity of relapse in recovery.
Detox and Withdrawal
Due to its similarity to opioid drugs, kratom detox is best handled with medical detox in order to ensure an individual’s safety and comfort.
Since withdrawal side effects may be significant and potentially dangerous, kratom may be slowly weaned, or tapered off, in order to minimize the symptoms. Medical detox usually lasts between 5-7 days, and medical professionals are available 24 hours a day to monitor vital signs, smooth out withdrawal symptoms, and ensure clients’ safety.
As in opioid withdrawal, medications may be useful during medical detox from kratom as well. EMCDDA reports that antidepressants, anxiolytic drugs, anti-inflammatory medications, and other pharmacological agents may be useful to treat kratom dependence. For opioid dependence, partial opioid agonists, like methadone and buprenorphine products, may be used during detox to replace full agonists and help individuals manage withdrawal and drug cravings.
The duration and type of detox, as well as the intensity of withdrawal, may be influenced by specific factors related to a person’s dependency on kratom. The amount of drug taken each dose as well as the length of time abusing kratom can increase dependence, for example. Abusing drugs at a young age may increase the risk that the person will suffer from a substance use disorder later in life, NIDA publishes, since drugs like kratom may damage regions of the brain responsible for regulating emotions, making decisions, and controlling impulses before they are fully formed in adulthood. Abusing other drugs or alcohol in conjunction with kratom can increase the potential side effects and risks for a negative interaction between the substances, and may also influence detox and withdrawal timelines. Underlying medical or mental health conditions as well as environmental factors, such as chronic stress, childhood trauma, and other outside influences, may also contribute to a person’s level of dependency.
Mostly Legal but Not without Risks
In conclusion, plant-based kratom may appear harmless as a “dietary supplement” or herbal drug that is technically legal in the United States; however, this perception is false. Purchased over the counter at head shops, gas stations, and music stores, as well as over the Internet, kratom leaves may be chewed or ground up and dissolved in drinks such as tea for stimulating effects.
When taken in higher doses, kratom may have sedative and euphoric effects similar to opioid drugs, and when taken regularly, individuals may become dependent on it. This dependence may lead to addiction, as control over its use may become difficult or even not possible without professional help.
Treatment for kratom abuse, dependency, and addiction may include a combination of pharmacological and therapeutic methods in a comprehensive substance abuse treatment program. Detox may be the initial step in kratom addiction treatment to help individuals reach healthy physical balance, and medical detox may be useful for managing withdrawal side effects and drug cravings. Detox should be followed with a more complete drug abuse treatment program that may be done in an outpatient or residential setting, depending on the needs of the individual.
Addiction is not the same for everyone. What works for one person may not be as helpful for someone else, which is why substance abuse treatment professionals should work directly with a person to determine what treatment model may work best. With proper care, individuals can leave kratom abuse in the past and move toward a healthy future.
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