Can Kratom (Mitragyna speciosa) use lead to withdrawal symptoms?

Kratom Withdrawal Syndrome: Clinical Features and Management

Yes, Kratom (Mitragyna speciosa) use can lead to significant withdrawal symptoms upon discontinuation, particularly in regular users. Research demonstrates that Kratom dependence and withdrawal are real clinical phenomena that should be recognized and managed appropriately 1, 2.

Pharmacology and Mechanism

Kratom contains over 40 alkaloids, with mitragynine and 7-hydroxymitragynine being the primary psychoactive compounds. These alkaloids act as:

• Partial mu-opioid receptor agonists
• Also affect adrenergic, serotonergic, and dopaminergic pathways 3
• Function as atypical opioids with narcotic-like properties

Withdrawal Symptoms

Regular Kratom users experience both physical and psychological withdrawal symptoms upon cessation:

Physical Withdrawal Symptoms:

• Muscle spasms and pain
• Sleeping difficulty
• Watery eyes/nose
• Hot flashes and fever
• Decreased appetite
• Diarrhea
• Tremors
• Sweating
• Yawning
• Joint pain 4, 2

Psychological Withdrawal Symptoms:

• Restlessness
• Tension and anxiety
• Irritability
• Anger
• Sadness
• Nervousness
• Craving for Kratom 4, 2

Risk Factors for Severe Withdrawal

The severity of Kratom withdrawal is dose-dependent. Users who consume ≥3 glasses of Kratom per day have higher odds of:

• Developing severe Kratom dependence
• Experiencing more intense withdrawal symptoms
• Having difficulty controlling Kratom cravings 2

Onset and Duration of Withdrawal

Similar to opioid withdrawal, Kratom withdrawal symptoms typically:

• Begin within 12-24 hours after the last use
• Peak around 2-3 days
• May persist for 5-7 days 5, 4

Clinical Assessment

Assessment should include:

• Quantity and frequency of Kratom use
• Duration of regular use
• Presence of polysubstance use (common in Kratom users)
• Previous withdrawal experiences
• Underlying medical and psychiatric conditions

Management Approaches

Detoxification Options:

1. Buprenorphine-naloxone (Suboxone):

   • Most promising treatment for detoxification
   • Effective for maintenance replacement therapy 4

2. Alternative detoxification regimens:

   • Dihydrocodeine and lofexidine combination has shown effectiveness 6
   • Clonidine (intravenous) for inpatient detoxification 4

3. Gradual tapering:

   • Preferable to abrupt discontinuation
   • Significantly reduces severity of withdrawal symptoms 5

Supportive Care:

• Hydration and nutrition support
• Symptomatic treatment for specific withdrawal symptoms
• Monitoring for complications

Special Considerations

1. Polysubstance use: Many Kratom users also use other substances, which can complicate withdrawal management 3

2. Underlying conditions: Kratom is often used to self-medicate pain, psychiatric symptoms, or other substance use disorders 1

3. Potential for hepatotoxicity: Monitor liver function during withdrawal period 3

4. Risk of seizures: Although rare, seizures have been reported with Kratom use and withdrawal 3

Long-term Considerations

• Physical dependence on Kratom develops with regular use, similar to opioids 7
• Withdrawal symptoms reflect functional changes in brain circuits involved with reward, conditioning, and stress reactivity 7
• Long-term management should address underlying reasons for Kratom use

Kratom withdrawal follows patterns similar to opioid withdrawal but is generally considered less severe than withdrawal from traditional opioids. Nevertheless, it requires appropriate clinical attention and management to minimize patient discomfort and prevent relapse.