Marianne Chai, MD, director of the Center for Living in New York, first encountered kratom a few years ago when a teenage boy came to her office for addiction treatment. “He had been drinking it as a tea to help with anxiety and ultimately ended up in the school’s student health center in acute opioid withdrawal,” she says.

Kratom is a substance derived from the leaves of a plant native to Southeast Asia. At low doses, it produces stimulant effects comparable to medications commonly used to treat ADHD; at higher doses, the substance functions as an opioid. However, kratom doesn’t require a prescription, and unlike “street” opioids such as heroin, it is currently legal and easy to purchase. And there’s the rub: Because it’s legal and made from a plant, there’s a misperception that kratom is safe. In fact, it’s addictive.

“High school and college students are surrounded by kratom these days — in smoke shops and on the internet, says Mike Milham, MD, PhD, a child and adolescent psychiatrist who is vice president of research at the Child Mind Institute. “For students especially, you can imagine the allure of the stimulant effects, but once you start experiencing the euphoria of the opioid aspect, you’re at risk for addiction.”

Students say kratom helps them study and counters anxiety. “Initially it helps you with your all-nighters, and it helps you with your stress,” says Dr. Milham. “But then you’re stuck.”

What is in kratom?

Kratom is sold in powder form and can be taken in capsules or made into a tea: some states even have “bars” devoted to it.

One of the substances found in kratom leaves, mitragynine, interacts with receptor systems in the brain to produce stimulant effects. Mitragynine and another compound, 7-α-hydroxymitragynine, interact with opioid receptors in the brain, producing the pleasurable, pain-reducing effects of opioids, especially when users consume large amounts of the plant.

It is sometimes advertised as “safe kratom,” and touted as able to relieve everything from anxiety to diabetes. Proponents believe kratom can be a lifesaver for opioid addicts since you don’t need a prescription to get it, and it may help reduce withdrawal symptoms. To date, however, there have been no well-controlled scientific studies showing that kratom is effective for opioid abuse withdrawal or any other conditions in humans. There is also no research on how kratom may interact with other medications.

Kratom addiction

David Seitz, MD, the medical director of Ascendant, a New York based rehab program, reports seeing an increase in cases of kratom addiction. “I think the major challenge is a perceptual one,” he notes. Young people using think it’s harmless because it’s touted as natural. “They don’t consider it a drug until they get into trouble with it.”

One father reports that his son started using kratom in boarding school, where he was introduced to it in his dorm and was told it was a tea. He started using it for social anxiety, but then he got addicted. “We noticed that he seemed angrier and had an explosive temper,” his dad said. “He realized he had a problem and stopped, but had some relapses before stopping completely. It was a scary thing.”

Kratom addiction is also particularly challenging to treat. There are a lot of substances in kratom, Dr. Seitz explains, “some of which haven’t even been properly identified.” Among those other substances, he says, seems to be something that acts like a benzodiazepine, an anti-anxiety medication.

When you treat a patient withdrawing from kratom with medications used for opioid addiction, like Methadone or Suboxone, they deal with the opioid effect but not with the effects other substances in the plant. Patients withdrawing from kratom may become so anxious they give up on treatment. “It appears that just treating the opioid effect is often not enough,” Dr. Seitz says. “If you just use the Suboxone, the person is likely to leave treatment.”

Dr. Seitz, who is also a diplomate of the American Society of Addiction Medicine, notes that few physicians realize how complicated kratom is. He reports hearing from other doctors and medical students who are frustrated with their kratom patients. “They’re seeing the patient and they’re like, ‘I’m giving opioids and you can’t be having the symptoms you’re having because I’m giving you this.’ And it just doesn’t work that way. There’s another effect in there.”

Kratom and regulation

Kratom is not regulated by the Food and Drug Adminstration (FDA), so there’s no way to know how potent any given amount is, or if a batch contains other substances as well; in April 2019, the FDA released results of a laboratory analysis that found significant levels of lead and nickel in 30 kratom products — enough to potentially cause heavy metal poisoning.

Dr. Milham, who is also the founding director of the Center for the Developing Brain at the Child Mind Institute, acknowledges that there are challenges in determining how exactly kratom should be regulated or classified.

“Making it completely illegal isn’t necessarily a good idea, because at this point you do have portions of the community that actually are using it to help with opioid withdrawal, and to just make it illegal and take it completely off schedule doesn’t really make sense.”

The best solution, says Dr. Milham, is to make kratom a Schedule II drug — a classification by the Drug Enforcement Administration that’s applied to medications “with a high potential for abuse, with use potentially leading to severe psychological or physical dependence.”

With that classification,  kratom could be used in a controlled fashion, with reliable quantities of active ingredients. “Drugs with addictive potential,” he argues, “should be in the hands of the healthcare providers to prescribe.”

What should parents do? 

 In addition to the fact that it’s easy to purchase over-the-counter, kratom stands out because it does not show up on standard drug tests, further increasing its appeal for some users. Testing can be done by certain labs, but this is expensive, and, at the moment, kratom is not something most people think to test for.

Dr. Milham’s takeaway for parents: “Educate yourself, and don’t be fooled if your child dismisses your concerns, saying it’s just a tea, it’s legal and sold in stores.”

It’s important that parents have a conversation with teenage children about kratom, to let them know what the dangers are, whether or not they are aware that a child is using the drug. Dr. Chai notes that parents are very often unaware of the extent of their child’s substance use.  “Parents don’t realize until their kid has progressed much further along to the point of having consequences,” she says. “Parents are often the last to know what their child is really doing.”

If you suspect your child might be developing a kratom addiction, here are some of the symptoms to be on the lookout for, according to Dr. Chai:

  • Runny nose
  • Muscle aches
  • Joint and bone pain and
  • Spastic, jerky movements
  • Mood swings
  • Depression
  • Anxiety
  • Irritability
  • Tremors, chills, sweating, pin-point pupils, gooseflesh (typical of opioid withdrawal)

If your teen or young adult child is using kratom, the conversation should be not only about why they should stop using it, but what it’s doing for them, and how they might find healthier alternatives.  “You need to be able to figure out,” as Dr. Seitz puts it, “if your kid is using it, why is your kid using it?”

If eliminating kratom proves to be difficult, or if your child is struggling with withdrawal symptoms, then an evaluation by an addiction professional is in order.

Dr. Seitz notes that it’s important to have open communication with kids about drug use, to keep it from being driven underground. “It can become sort of a cat-and-mouse game, where what parents are concerned about is catching their kid. And then it doesn’t serve any function.”

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