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Kratom Withdrawal & Detox Guide

Medically Reviewed By: Benjamin Caleb Williams RN, BA, CEN

Written By: Phillippe Greenough

Article Updated: 09/24/2020

Number of References: 16 Sources

Kratom enjoys a popular reputation as a “safe and natural” drug or an effective method for detoxing from opioids, but this is not the case in reality. Yes it is natural, but it is natural in the same sense that heroin and cocaine are natural; they are all compounds extracted and refined from plants. Kratom should be approached with the same caution as one would approach these drugs, as kratom is absolutely habit-forming, quite addictive, and potentially dangerous. Kratom withdrawal is initially very similar to opioid withdrawal, although less intense, and it includes some unique additional risks. Below we will look at the exact symptoms of kratom withdrawal, the timeline progression, and the specific effects that withdrawal produces.

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Overview

Contrary to popular belief, kratom is addictive and it produces very unpleasant withdrawal symptoms when a chronic user suddenly stops taking kratom. These symptoms can be severe if someone was using large amounts, and entering a kratom detox center is recommended if someone is expecting to undergo withdrawal from kratom and they have other health issues. The symptoms of kratom withdrawal are very similar in appearance to opioid withdrawal although not as severe, as kratom works in a similar manner to classical opioids. That being said, there are additional symptoms that are unique to kratom and do not appear during withdrawal from the more common opioids.

In describing and illustrating the symptoms of kratom withdrawal it would be helpful to know exactly how kratom works, but this is still somewhat mysterious at present. While several of the most potent psychoactive compounds have been identified and are fairly well understood, there are over 40 active compounds present in kratom. Currently, the best understanding is that mitragynine and 7-hydroxymitragynine are the main contributors to the euphoric effects of kratom. These drugs work by activating opioid receptors, among other interactions, thereby reducing pain and anxiety, reducing stress, and promoting a relaxed and calm state of mind. These compounds may also produce stimulant-like effects that are dose-dependent.

The way that the active compounds in kratom produce these effects is similar but distinct from other opioids. Kratom activates the κ (Kappa), μ (Mu), and δ (Delta) opioid receptors, with the strongest affinity for the κ receptor. The opioid system performs a variety of vital roles in the brain and body which includes moderation of pain signals, maintenance of steady metabolism, regulation of cardiovascular rhythm, proper immune system function, and plays a role in emotionally induced feelings of euphoria.

Through chronic use of kratom, the brain will begin to adapt to the continuous stimulation of opioid receptors by decreasing the sensitivity of these receptors. This process is referred to as downregulation and is the brain’s attempt to protect itself from neurotoxic damage caused by chronic overstimulation. The immediate effect of downregulation is the development of tolerance, as decreased sensitivity at these opioid receptors requires more stimulus to produce the same effect. If someone continues to use kratom then dependence will develop, and withdrawal symptoms will begin to appear when they go a time without using kratom.

The kratom withdrawal syndrome may be divided into 2 distinct phases; acute and post-acute withdrawal. The acute phase is by far the most intense, both physically and psychologically. It is the first phase of withdrawal that a kratom addict would experience, beginning between 12 and 24 hours from the last time they had used kratom. The post-acute phase is much less intense with no physical symptoms but it can last much longer.

Kratom Withdrawal Symptoms

The acute phase of kratom withdrawal will begin soon after a kratom addict has stopped using the drug and will typically last around one week. Acute withdrawal is similar to opioid withdrawal, although it is less intense and slightly longer-lasting compared to, say, oxycodone withdrawal. This phase is characterized by physical symptoms which may become severe and potentially dangerous, depending on underlying health conditions and someone’s kratom use habits. While rarely fatal in and of itself, acute withdrawal from kratom can complicate any underlying or pre-existing medical issues which may be very dangerous.

Some of the most commonly reported symptoms of kratom withdrawal include:

  • Anxiety
  • Depression
  • Mood Swings
  • Paranoia or Psychotic Episodes (this is rare but it does occur)
  • Insomnia
  • Cravings for Kratom
  • Fatigue and Lethargy
  • Lack of Concentration and Focus
  • Reduced or Absent Appetite
  • Diaphoresis (constant sweating)
  • Rhinorrhea (extremely runny nose)
  • Diarrhea and Stomach Cramps
  • Cardiac Abnormalities (rapid heart rate or high blood pressure)
  • Shaking or Tremors
  • Muscle or Joint Pain
  • Seizures
  • Hallucinations (this is quite rare but it has been documented)

The exact cause for seizures and hallucinations during withdrawal is unknown, but this does happen. Seizures during withdrawal, while not necessarily common, are a very real concern. Suffering a seizure while driving or walking down a staircase for example could lead to some serious problems. As far as hallucinations are concerned, it is known that drugs that interact strongly with the κ opioid receptor are known to produce hallucinations during use and withdrawal, although the mechanisms are currently unclear.

Acute kratom withdrawal is the most uncomfortable and risky phase of withdrawal. While fairly short-lived, this phase is characterized by physical and psychological symptoms which will escalate quickly in the days immediately after kratom use has ceased. The intensity of acute withdrawal is affected by a series of factors and the severity can vary between individuals. After roughly one week, these symptoms should be greatly reduced, and this marks the transition into the post-acute phase of withdrawal.

Symptoms of Post Acute Kratom Withdrawal

Post-acute withdrawal from kratom is much less intense than the acute phase, however, the tradeoff is that it lasts much longer. This phase is characterized by strictly psychological symptoms, some of which may take months or even years to fully resolve. While the timeline varies quite a lot between individuals, the symptoms set remains fairly standard.

Some of the symptoms most commonly reported during post-acute withdrawal from Kratom include:

  • Cravings for Kratom
  • Anxiety
  • Depression
  • Low Energy Levels
  • Lack of Motivation

While the physical symptoms may be resolved during post-acute kratom withdrawal, the psychological symptoms may linger unchanged for several weeks or months. Medications are often needed to manage and reduce these symptoms as they can be intense and exhausting due to their persistence. These symptoms are due to opioid system downregulation and the subsequent neurological “rewirings” that are produced through chronically altered levels of these systems. The brain is capable of upregulation fairly quickly, but undoing these rewirings is a slow process and will take time. There are several factors that can affect the duration of post-acute withdrawal, but this phase will last for several months at the very least. The symptoms will begin to fade with time, but this is nevertheless a mentally uncomfortable time.

Kratom Withdrawal Timeline

The timeline of withdrawal can vary somewhat between people, but for the most part, it follows a fairly standard timeline. Kratom withdrawal is comparable in duration to opioid withdrawal as these drugs act in a similar manner, however, kratom withdrawal seems to last a little longer on average. The acute phase may last between 7 to 10 days while the post-acute phase may persist for many months.

The half-life of mitragynine, the main psychoactive ingredient in kratom, is about 20 hours. This means that it takes 20 hours to go from the maximum blood levels of mitragynine to 50% of the maximum blood levels. This is in contrast to morphine which has a half-life of about 3 hours. The half-life is not the sole determining factor regarding the withdrawal timeline as there are a variety of other factors that play a role in the time to withdrawal onset and duration. This illustration may be useful in getting an idea for why kratom withdrawal may be slower to begin and last longer than classical opioid withdrawal. For the most part, an individual’s kratom use habits play the largest direct role in the kratom withdrawal timeline.

First Week

Within a day or two from the last use of kratom, withdrawal symptoms will begin to appear. The first symptoms to emerge are typically an increase in anxiety and nonstop sweating. About a day after these symptoms begin, they may be joined by an increasingly runny nose and shakiness. By the second night since withdrawal symptoms have begun sleep will often be difficult even though someone feels completely drained of mental and physical energy. Restlessness and irritability will lead someone to constantly toss and turn throughout the night and this will be joined by muscle and joint pain. Stomach issues such as nausea and diarrhea may be expected around the third day and appetite should be suppressed by this point as well. By the third or fourth day, cardiovascular issues may appear which frequently include increased heart rate and elevated blood pressure, although these are often the result of increased anxiety and a lack of rest and not directly symptoms of kratom withdrawal. These symptoms should steadily increase in intensity for the rest of the first week.

Second Week

The beginning of the second week may be difficult. This is usually when the withdrawal symptoms are at their peak, and several days of reduced sleep and food will only worsen the subjective experience. Aside from the physical symptoms, the psychological symptoms have only just begun to ramp up. While anxiety has been present all throughout the experience so far, it may be joined by depression and intense cravings for kratom early on in the second week. Mood swings may be expected as well, and this may worsen the subjective experience further. Thankfully by the tenth day since withdrawal symptoms began, some relief should be in sight. Between days 7 and 10 is usually when the peak intensity of physical symptoms is reached and they will begin resolving from this point forward. The physical symptoms usually subside more quickly than it took them to appear an increase. The depression, anxiety, cravings, and mood swings will still most likely be present.

Third Week

The third week since withdrawal began will be much easier from a physical standpoint, however, the psychological symptoms will still be present and quite intense. Insomnia may not be an issue any longer, but getting to sleep will often take a long time, and staying asleep may remain difficult. Anxiety may have increased slightly since the last week and usually manifests in the form of social anxiety, making social gatherings very uncomfortable. The levels of depression and cravings should remain fairly steady throughout the third week. Someone’s mood may be lightened somewhat by an increasing ability to get a healthy amount of sleep as well as the return of their appetite.

Fourth Week and Onwards

The beginning of the fourth week should exhibit a marked improvement in someone’s state of mind. While still experiencing relatively mild anxiety, depression, and cravings the most intense stage of symptoms will be over. This is not to say that the next few months may not be a struggle. These symptoms commonly persist for months and will require medications and treatment if someone is to stand the best chances of successful recovery. Furthermore, someone may begin to experience very vivid dreams of using kratom or other drugs and this can increase the risk of relapse. While the worst may be over, there are still steps someone must take if they are going to remain free from kratom addiction.

The Importance Of Kratom Detox

Kratom withdrawal is an unpleasant experience and, in extreme cases, can present unique and unpredictable risks. The fact that so little is actually known about the main psychoactive compounds, the dozens of totally mysterious or unidentified chemicals present in kratom, as well as the variety in growing and refining methods, means that withdrawal can produce different symptoms in different people since kratom itself varies in quality so much. Additionally, the variation in symptoms intensity is great and there is currently no reliable predictor of the exact symptoms or severity, other than the amounts of kratom someone used. Because of this as well as the discomfort of kratom withdrawal, it is recommended for someone to enter a kratom detox center if they are trying to quit using kratom.

Kratom Detox Center Guide

What Happens to the Body During Kratom Withdrawal?

The medical and clinical research into the exact physical effects of kratom withdrawal is ongoing, but at present, there are some known and fairly well-understood effects. A major contributor is the effects that kratom use causes in the opioid system of the brain. The downregulation that occurs in the opioid system has a cascade effect on many physical processes all throughout the body. Additionally, it is known that kratom can affect norepinephrine and serotonin systems in the brain which likewise can produce a wide range of varied physical systems. The exact manner of these serotonin and norepinephrine interactions is currently unclear, but kratom certainly interferes with the normal operation of these systems.

-Gastrointestinal Effects

There are several ways that withdrawal can affect digestion and all of them are very uncomfortable. The most direct way this occurs is through opioid receptor downregulation. Even though kratom interacts most potently at κ opioid receptor sites, it’s interactions at μ opioid receptor sites are almost as strong. The μ opioid receptors exist not only in the brain, but they are also found in large numbers in the intestines. In the gut, these receptors help to slow and moderate digestion and aid in effective nutrient absorption. The downregulation that occurs through kratom addiction reduces their sensitivity to natural opioids, and this reduces their calming effect on intestinal muscle function during withdrawal. The end result is diarrhea and muscle pain or cramping.

-Cardiovascular Effects

The effects on heart rate and blood pressure produced through kratom withdrawal have multiple contributors which all work to raise these functions above their normal levels. Heart rate will increase and blood pressure will rise several days into withdrawal. This has both direct and indirect causes. Indirectly, anxiety and the stresses of the other physical symptoms will produce mild elevation, but the direct neurological contributors play a much greater role.

The effect kratom has on norepinephrine systems is probably the largest single contributor. Norepinephrine is a neurotransmitter that is heavily involved in adrenaline production and function. Disruption to norepinephrine systems through addiction to kratom can disturb the smooth function of adrenaline, and result in increased levels during withdrawal. Adrenaline has a very strong and direct impact on heart rate and blood pressure, commonly being released en masse during “fight-or-flight” situations to boost physical performance.

The opioid system also plays a role in cardiovascular regulation and these withdrawal symptoms are again a result of opioid receptor downregulation. Once withdrawal has begun the body’s normal opioid peptides will have a reduced effect on moderating heart rate and contractility. This can contribute to both heart rate and blood pressure increases.

-Peripheral Effects

There are a variety of other physical systems that are affected during withdrawal. Tremors and joint pain are most likely due to opioid system disruptions. Among other things, the opioid system is responsible for moderating pain signals and natural opioid peptides act as natural painkillers. Due to downregulation, these natural peptides have a greatly reduced effect. During withdrawal from stronger opioids such as heroin, this can result in a condition called allodynia which is when someone experiences pain from a stimulus which is normally not painful. Since kratom withdrawal is less intense than withdrawal from classical opioids, this will not be as severe, and a common result is a consistent ache in the muscles or joints.

Some disparate effects which may result from norepinephrine disruptions include symptoms such as:

  • Shaking or Tremors
  • Reduced or Absent Appetite
  • Diaphoresis (constant sweating)
  • Rhinorrhea (extremely runny nose)
  • Insomnia

The increase in adrenaline production or effects will result in someone feeling physically “amped up” with shaking, lack of appetite, heavy sweating regardless of the temperature, a very watery running nose, and an almost total inability to sleep.

Seizures are also known to occur during kratom withdrawal, although this is not exactly common. The mechanisms for this are a complete mystery and it may have to do with one or more of the several dozen unidentified compounds which are present in kratom aside from mitragynine.

Psychological Effects of Withdrawal

Kratom withdrawal, similar to many other classical opioids, is known to produce depression and anxiety both during and for a long period after withdrawal. These often linger to some degree for many months after kratom use has ceased. These psychological symptoms may be the biggest hurdle someone has to overcome during withdrawal due to their long duration. The mental pain and discomfort caused by these symptoms may increase someone’s chances of relapse, and it is highly recommended to obtain medical help to overcome these effects. Aside from depression and anxiety, kratom exhibits some symptoms which are distinct and unique from other, more classical opioids.

-Anxiety

Due in part to the physical symptoms as well as the opioid system, and secondary serotonin and norepinephrine disruptions, anxiety is possibly the most common effect of kratom withdrawal. This can be severe in the first few weeks when the physical symptoms can amplify the neurologically sourced anxiety and they compound each other. Once the physical symptoms have resolved, anxiety will still persist for many weeks or months. This is most likely due to a combined opioid system disruption, and the subsequent neurological changes this produces, and medications may be extremely effective at managing these symptoms in the short term. These will resolve with time as the brain has time to “reset” to pre-kratom function, but this is an exceptionally slow process.

-Depression

The emergence of depression during withdrawal is extremely common. The opioid system plays a role in mood regulation and disruptions in this system through kratom addiction and subsequent withdrawal will lead to depressive symptoms and general negative affectivity. This can be very demotivating and difficult to overcome, and medications may be extremely effective in helping to reduce these symptoms. Depression will resolve with continued kratom abstinence as the brain works to undo the changes made in these systems during chronic kratom use.

What Factors Influence The Intensity of Withdrawal?

The intensity of kratom withdrawal can vary quite a bit between individuals. Some of these factors are totally beyond someone’s power to control or change, while others involve voluntary choices or behaviors. Additionally, the duration of withdrawal seems to vary quite a lot between people. Some people will return to normalcy very quickly, while other people will have more severe symptoms that linger for a long time after quitting kratom use.

Some of the factors which greatly influence the intensity and duration of kratom withdrawal include:

  • The amounts of kratom that someone used
  • The length of time that someone used kratom
  • Genetic predisposition for addictive behavior
  • Personal history of depression or mental illness

The amounts of kratom and the length of time that someone used plays the largest role in both the intensity and duration of their withdrawal symptoms. The more kratom someone uses, the larger the degree of downregulation performed by the brain in response to the drug. During withdrawal, this results in more severe symptoms. Additionally, the longer someone uses kratom the more complete this downregulation becomes, thus the longer it takes to reverse. These factors are the largest contributors and they are also completely within someone’s power to affect. That being said, addiction is a mental illness so it is often the case that the more kratom someone uses, and the longer they use it, the more they want to use kratom. This is a vicious cycle that will act to amplify and deepen itself over time; this is a self-reinforcing cycle and one of the reasons addiction is so difficult to overcome.

Genetics plays a role in the potential for someone to be imprisoned by addiction. While the exact mechanisms are unclear, it is certain that addiction runs in families and therefore involves a genetic component. While anyone may become addicted to kratom if they use it enough, someone’s genetic predisposition may shorten the time needed to become a full-fledged kratom addict. Additionally, a heavy family history of addiction may indicate that someone will experience more intense withdrawal symptoms sooner than someone with no family history of addiction.

While tangentially related to a family history of addiction, a personal history of mental illness is certainly a large contributor to someone’s likelihood or susceptibility for addiction. While contributing in a more indirect manner, mental illnesses such as depression and anxiety occur much more commonly in those with addictions than in the general population. This indicates that mental health problems can accelerate and encourage someone to find relief in drug use, including kratom.

Kratom Withdrawal Treatments

Since kratom is a fairly new drug of abuse in the United States, there is currently no standard treatment for kratom addiction. At present, the most common treatment regime utilizes medications and therapies which have been found useful in the treatment of other drug withdrawal syndromes. Since kratom withdrawal exhibits symptoms very similar to more classical opioids, the preferred treatment options include those techniques which are commonly used in the treatment of opioid withdrawal.

Medications

There are currently no FDA approved medications for the treatment of kratom withdrawal. That being said, there are many medications that have been used effectively for treating individual symptoms as they arise. Different medications may have more or less success between individuals, but there are several classes of medications have can offer relief from the withdrawal symptoms.

Some of the most commonly used medications for treating kratom withdrawal include:

  • Opioid Antagonists
  • Antidepressants
  • Anti-Anxiety Medications
  • Antidiarrheals
  • Specific Blood Pressure Medications (for treating anxiety)
  • Sleep Aids

These are broad classes of medications and there are several effective choices in each class. Some people will respond better to certain medications, and while figuring out which one works can be a frustrating process, having professional help will be invaluable in this regard. Some medications are typically used only short term, such as antidiarrheals and sleep aids. Other medications may be helpful over longer periods such as antidepressants, blood pressure medications, opioid antagonists, and anti-anxiety medications.

Therapies

The therapies that have been found most effective for the treatment of withdrawal include those whose aim is to promote personal connections and examine the interplay of thoughts, emotions, and behavior. These are effective for a wide range of drug addiction treatments, and especially so for opioid and kratom withdrawal treatment. That being said, individuals may find different therapies more or less effective depending on their unique experiences or circumstances.

Some of the most commonly used therapies for kratom withdrawal treatment include:

  • Behavioral Therapies (CBT or DBT)
  • Group and Individual Counseling
  • Addiction Education
  • Coping Skills Development
  • Therapeutic Fitness
  • Support Services and Aftercare Planning

These options are just a few of the most frequently used, but there are many other therapies that may benefit someone undergoing kratom withdrawal treatment. If someone is a victim of trauma, they may benefit from additional therapies, and being honest with their treatment provider will allow them to receive the most directed and comprehensive care possible.

Seeking a kratom detox center will provide a variety of resources and often provides the most effective course of treatment. These centers specialize in kratom detox and addiction treatment and can provide a solid foundation upon which someone can begin to build a new life. It is possible to have a life after kratom addiction, but it does require work. Kratom detox and continuing treatment will help provide the tools someone needs to begin this work.

References For This Article

  1. 1 ACS Central Science: 7-Hydroxymitragynine Is an Active Metabolite of Mitragynine and a Key Mediator of Its Analgesic Effects
  2. 2 Journal of the American Chemical Society: Synthetic and Receptor Signaling Explorations of the Mitragyna Alkaloids - Mitragynine as an Atypical Molecular Framework for Opioid Receptor Modulators
  3. 3 Pain and Therapy: Kratom Pharmacology, Clinical Implications, and Outlook - A Comprehensive Review
  4. 4 Journal of the American Osteopathic Association: Pharmacology of Kratom - An Emerging Botanical Agent With Stimulant, Analgesic, and Opioid Like Effects
  5. 5 Child Mind Institute: Kratom - A Legal Drug That’s Dangerously Addictive
  6. 6 Neuroscience & Biobehavioral Reviews: From Kratom to Mitragynine and its Derivatives - Physiological and Behavioural Effects Related to Use, Abuse, and Addiction
  7. 7 Addiction: Self-Treatment of Opioid Withdrawal Using Kratom (Mitragynia Speciosa Korth)
  8. 8 Brain Research Bulletin: Neurobiology of Kratom and its Main Alkaloid Mitragynine
  9. 9 Multiple Sclerosis - Perspectives in Treatment and Pathogenesis: Endogenous Opioids in the Etiology and Treatment of Multiple Sclerosis
  10. 10 Drug Design, Development, and Therapy: Pharmacokinetics of Mitragynine in Man
  11. 11 Update in Anaesthesia: Pharmacology of Opioids
  12. 12 Drug and Alcohol Dependence: Kratom (Mitragyna Speciosa) Dependence, Withdrawal Symptoms, and Craving in Regular Users
  13. 13 Innovations in Clinical Neuroscience: Kratom and the Opioid Crisis
  14. 14 Anesthesia and Analgesia: Opioid Induced Hallucinations - A Review of the Literature, Pathophysiology, Diagnosis, and Treatment
  15. 15 Journal of Investigative Medicine High Impact Case Reports: Kratom, an Emerging Drug of Abuse, Raises Prolactin and Causes Secondary Hypogonadism
  16. 16 Arizona Osteopathic Board: Kratom Fact Sheet for Healthcare Professionals

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