Kratom Addiction: Signs and Side Effects of Kratom Abuse

Kratom comes from the leaves of a tropical evergreen plant native to Southeast Asia. People use it as a natural stimulant, pain reliever and for relieving the symptoms of opioid withdrawal. Unfortunately, many don’t understand the risks of taking it.

It isn’t classified as a federally controlled substance in the United States, and the FDA hasn’t approved it for medical use. The lack of federal regulations can make it hard for people to understand its high-risk and addictive nature. Because kratom dependence can lead to severe symptoms and side effects, it’s important to recognize the signs and seek support if you or a loved one develops a dependence on it.

Many people believe that it’s safe to use kratom because it isn’t regulated and comes from a plant. However, it still carries a risk of addiction.

Kratom is a complex substance that has both stimulant and sedative properties, depending on the dosage. Lower doses cause a stimulant effect, making users more alert and energetic, while higher doses can reduce pain and produce a sedative effect, making people feel calm and less anxious. It contains several active alkaloids, including mitragynine and 7-hydroxymitragynine, that bind to the μ-opioid (mu-opioid) receptors in the brain.

Unlike traditional opioids, such as morphine or heroin, these alkaloids act as partial agonists, meaning they activate the receptor to a lesser extent. They also act on other chemical systems of the brain, including serotonin, dopamine, norepinephrine and kappa opioid receptors, which may contribute to its stimulant and mood-altering effects.

Kratom’s pain relief and euphoric effects can result in psychological and physical dependence. Many long-term users develop tolerance from prolonged use, contributing to dependence and leading to misuse and addiction.

It’s possible to engage in kratom misuse without progressing to addiction, although there’s often an overlap between the two. Clinicians now use the terms “misuse” to refer to abuse and “substance use disorder” (SUD) to refer to addiction.

Kratom abuse involves taking it in higher doses, more frequently or in riskier ways than intended. 

Signs of kratom abuse include:

• Manic behavior, such as being overly talkative, erratic or aggressive
• Failing to meet personal responsibilities due to use
• Showing preference for using the drug over previously enjoyed activities
• Investing significant time in obtaining, using or recovering from kratom
• Using it in hazardous situations
• Using it despite knowing the risks
• Taking higher doses than intended or for longer periods than planned
• Participating in recreational kratom use or combining it with other substances

Individuals who abuse kratom aren’t necessarily addicted. If they can control their use and stop when they choose, even if stopping causes side effects or discomfort, it’s a sign that misuse hasn’t progressed to addiction. 

Kratom addiction is characterized by compulsive use despite harm and may result in severe cravings and an inability to stop using despite attempts to quit. Unfortunately, it’s relatively easy to progress from misuse to addiction. Studies show that roughly a quarter of kratom users fit the qualifications for an SUD, many of whom began by using it recreationally.

Regular recreational use can lead to increased tolerance and dependence, which can cause users to escalate their dosage and frequency to avoid withdrawal symptoms. If they keep taking it, they can develop psychological and behavioral symptoms that can cause kratom cravings and compulsive drug-seeking behavior.

When people become addicted to kratom, attempts to quit may trigger symptoms similar to opioid withdrawal, making recovery difficult without support. Relapse is common, and the cycle of abuse and addiction can continue for years until a person seeks treatment.

Kratom can cause dependence, particularly in long-term users who may need increasing doses to function as their physical dependence and tolerance levels grow. One study found that among those who had used the drug for 1 year, 66.7% met diagnostic criteria for an SUD. 

A person who abuses kratom can develop the following types of dependence on the drug: 

• Physical dependence: After repeated use, the body adapts to the presence of the drug, leading to physical dependence. As the body becomes reliant on kratom, stopping use can cause physical symptoms and discomfort. 
• Psychological dependence: This refers to the mental or emotional need for a substance, which users may rely on to cope with stress, anxiety or other issues. It primarily involves emotional and behavioral symptoms, and it may cause people to start using it compulsively. They may be unable to stop despite serious consequences due to perceived emotional and psychological benefits. 

If you suddenly stop taking kratom, symptoms can mimic opioid dependence due to a strong similarity in the way they impact the brain. This makes self-dosing for opioid withdrawal even more dangerous, as people may end up trading one addiction for another.

User behavior varies from person to person. However, there are some common kratom abuse warning signs and symptoms you can watch for. 

When a person is addicted to kratom, it can begin to interfere with their work, school and personal relationships. 

Behavioral changes due to kratom addiction:

• Secrecy
• Isolation and social withdrawal 
• Loss of interest in other activities
• Drug-seeking behavior
• Inability to cut back
• Using kratom multiple times a day
• Increasing doses

Kratom’s physical symptoms may be the easiest to identify and can worsen with high-dose or long-term use. 

Physical signs of kratom addiction:

• Nausea
• Sweating
• Weight loss
• Appetite changes
• Fatigue
• Tremors
• Sleep problems

The emotional symptoms of kratom addiction can be the most difficult to manage, as they often continue through withdrawal and into recovery. 

Emotional symptoms of kratom abuse:

• Irritability
• Anxiety
• Depression
• Mood swings

Speak to a doctor as soon as possible if you use kratom and experience these symptoms. If a loved one uses it and you notice concerning behavior, taking the time to have a loving, honest and nonjudgmental conversation is one of the best ways you can help. As with many addictive substances, the sooner medical intervention occurs, the better.

Kratom withdrawal symptoms can start within hours of the last dose. Detox effects vary with dosage and length of use, with high-dose, long-term users facing the most severe symptoms.

Common symptoms include:

• Insomnia
• Anxiety
• Agitation
• Depression
• Muscle aches
• Runny nose
• Nausea
• Fatigue
• Fever
• Sweating and chills
• High blood pressure
• Restlessness
• Visual distortions
• Difficulty concentrating

The kratom withdrawal timeline varies, but most users follow a similar pattern: 

• Within 6-12 hours of the last dose, early withdrawal begins and can include physical and psychological symptoms.
• During the first 1-3 days, side effects reach their peak. These symptoms can be severe and dangerous, and medically supervised detox is recommended to maintain safety and comfort.
• After 4-10 days, physical symptoms should subside. However, psychological symptoms can take longer to resolve. 

Some long-term or high-dose users experience post-acute withdrawal syndrome (PAWS). Individuals with PAWS experience psychological symptoms, such as cravings, depression and mood swings, for weeks or even months after they stop taking it.

The symptoms of kratom withdrawal are similar to those of opioids or caffeine. However, the severity of symptoms varies significantly, with caffeine being the least severe, followed by kratom, and opioid withdrawal being the most severe.

Although it’s often marketed as natural, the side effects of kratom abuse can be hazardous, and long-term or high-dose users may experience severe side effects, such as hallucinations. Some of these effects are short-term and resolve once an individual stops using kratom, while others can cause permanent damage that leaves users with lifelong health issues.

Short-term side effects of kratom abuse:

• Nausea
• Dry mouth
• Constipation
• Dizziness
• Paranoia
• Anxiety
• Mood swings
• Drowsiness
• Trouble breathing
• Hallucinations
• Delusions

Long-term use can lead to liver damage, memory issues, weight loss and skin discoloration. 

Kratom toxicity and overdose are also possibilities with each use. However, the exact amount required to cause an overdose isn’t well established.

Signs of a kratom overdose include:

• Nausea and vomiting
• Rapid or irregular heartbeat
• High blood pressure
• Agitation, anxiety or irritability
• Drowsiness or excessive sleepiness
• Confusion or psychosis
• Seizures
• Coma
• Respiratory depression

While it’s rare to overdose on kratom alone, mixing it with other substances, such as opioids, stimulants, benzodiazepines or alcohol, increases the risk significantly.

Just as not all alcohol drinkers develop alcoholism, not all kratom users become addicted. However, determining who’s at risk for addiction is complicated, as it’s often the result of numerous factors working together.

Common kratom addiction risk factors include:

• A history of substance abuse or mental health issues
• Chronic pain or physical health issues
• Exposure to trauma
• Taking it to self-medicate for pain, anxiety or opioid withdrawal
• Lack of medical oversight 
• Ease of accessibility through online retailers

However, it’s possible to develop an addiction without any obvious risk factors. Kratom is an unregulated substance, and there’s no medically safe dosage or use pattern according to FDA guidelines.

The diagnostic process for kratom addiction is similar to that of other substance use disorders, such as stimulants and opioids. Medical practitioners use a set of criteria established in the DSM-5, and those who experience at least two of these symptoms within 12 months may receive an addiction diagnosis.

DSM-5 kratom addiction criteria include:

• Taking it in larger amounts or over a longer period than intended
• Unsuccessful attempts to cut down or control use
• Spending a significant amount of time trying to obtain, use or recover from it 
• Cravings and other withdrawal symptoms
• Continued use despite the drug causing or worsening social or interpersonal problems 
• Giving up or reducing important social, occupational or recreational activities as a result of use
• Using it in physically hazardous situations
• Continuing to use it despite physical or psychological problems caused or worsened by kratom.

It’s important to seek a professional evaluation at the first signs of a substance use disorder. Diagnosing kratom addiction requires a medical and psychological assessment by a professional, as well as a commitment to honesty from the patient about use frequency and dosage. 

Many patients hide their usage due to feelings of shame surrounding their condition. However, that can prevent them from getting help and leaves them open to potential negative drug interactions and other issues.

If you or someone you love is experiencing the side effects of kratom abuse, seek help immediately. Addressing the problem early improves outcomes and increases the likelihood of long-term recovery.

Substance abuse can have a persistent, negative impact on individuals and families. However, help for addiction is available. Speak to a doctor right away if you need kratom recovery support.

If you’re not sure where to get help for kratom abuse, RehabNet is a free, confidential source of information. Contact our helpline to find the right treatment center and take the first step toward recovery.