Associate Director of Clinical Services
Kratom, a relatively new plant drug, has been openly sold in the U.S. since 2007 as an herbal supplement for energy and pain relief. It possesses opioid-like properties that can, in some cases, lead to dependence and addiction. In fact, as of October 2025, the County of Los Angeles has recorded six fatal overdoses tied to 7-OH, a powerful synthetic compound of kratom [1].
People typically use kratom by swallowing raw plant matter in capsule or powder form, mixing kratom powder into food or drinks, brewing the leaves as a tea, or taking liquid kratom extract. Kratom products vary in quality, so effects are difficult to predict.
In this article, I explain what kratom is, the signs of dependence and addiction, withdrawal symptoms, and the available treatment options for those seeking help.
Kratom and 7-OH have rapidly risen in popularity, with a corresponding increase in calls to poison control centers and instances of dependence. An estimated 1.6 million Americans used it in 2023 [2].
The U.S. Food and Drug Administration (FDA) has warned people not to use kratom because of the possible harm it can cause. And the U.S. Drug Enforcement Administration calls kratom a drug of concern.
But in the US, it’s legal to sell in many states and is widely advertised online, in stores, and even in gas stations as an “alkaloid” or herbal supplement. Federal agencies are taking action to fight false claims about kratom.
“Kratom” refers to both a tree (Mitragyna speciosa) native to Southeast Asia and to products derived from its leaves that are marketed as herbal supplements. The most well-studied of the many compounds related to kratom are the alkaloids mitragynine and 7-hydroxymitragynine (7-OH).
Like heroin and oxycodone, they bind to the mu-opioid receptor in the brain and spine. Mitragynine, the primary alkaloid in the kratom plant, is metabolized to 7-OH in the liver, resulting in a high that mimics that of opioids [2].
Kratom has a complex pharmacological profile with the potential for sedative, stimulant, and opioid effects. 7-OH is a potent opioid that usually makes up a very small percentage of the kratom leaf but can be concentrated and added to products to increase their activity.
Concentrated synthetic 7-OH products are more concerning than the natural plant material and have been implicated in multiple fatal overdoses [1]. And overdose risk is elevated when 7-OH is taken alongside other intoxicants, particularly alcohol, benzodiazepines, and/or unregulated street drugs.
Some people who use kratom have reported mild side effects, such as nausea, constipation, dizziness, and drowsiness. Medical reports document a wide range of rare but serious adverse effects, including [3]:
Research is ongoing to better understand how kratom and its compounds work.
Studies suggest people may experience mild to moderate withdrawal symptoms when they stop regular kratom use. More research is needed to understand the extent to which people develop symptoms of substance use disorder related to kratom.
Preliminary data from anonymous users of kratom suggest a minority of people report experiencing kratom-related withdrawal symptoms. A smaller minority report experiencing substance use disorder symptoms related to kratom use.
One study of kratom users reported that after a single missed dose, the five most endorsed symptoms were kratom craving, low energy, irritability, fatigue, and anxiety. Higher frequency/day was associated with higher odds of experiencing 19 of 23 withdrawal symptoms [4].
Researchers have observed that the way kratom compounds activate opioid receptors may reduce the potential for addiction compared with opioids. The addictive potential of mitragynine and 7-OH may also differ from one another, and further research is needed [3].
Withdrawal and substance use disorder symptoms related to kratom use have not been extensively studied. However, some people who use kratom report experiencing withdrawal symptoms resembling those from opioids [3].
Regular use, particularly more than about 5 g per dose and more than three times daily, is associated with a higher risk of physical dependence and withdrawal.
For risk of withdrawal symptoms, the kratom dose typically taken may be less important than the regularity of dosing. One study, using standard rating scales, showed that withdrawal symptoms were generally mild to moderate, and the risk of experiencing these symptoms goes up more with how often someone takes kratom rather than just how much they take at once [4].
Overall, kratom withdrawal symptoms are generally milder than observed with chronic frequent opioid, sedative, or stimulant users and generally are more tolerable and self-manageable. Craving levels appear widely variable [5].
Commonly reported withdrawal features when cutting down or stopping include:
Acute effects can include:
Kratom products are unregulated; potency and adulterants vary, which increases overdose and toxicity risk [6].
There are currently no approved medical therapies specifically for kratom dependence and addiction. Some researchers have reported using medications and other therapies to address withdrawal and substance use disorder symptoms related to kratom use in humans and animal models.
Robust clinical trials are still needed to evaluate these and other experimental treatment options [3].
The American Psychiatric Association recommends that kratom overdoses should be treated as opioid overdoses, including the administration of naloxone, followed by immediately calling 911 [7].
For those with mild to moderate kratom use, it may be possible to taper dosage gradually at home. However, if unmanageable symptoms develop, medical care is essential.
Management often mirrors opioid use disorder care: gradual tapering, symptomatic medications (for sleep, anxiety, pain, and digestive tract upset), and psychosocial treatment.
Medically supervised withdrawal management to safely and comfortably cope with withdrawal symptoms reduces the risk of relapse.
Research shows that medications used for opioid addiction, such as buprenorphine-naloxone (Suboxone), methadone, and naltrexone, are promising for managing cravings and withdrawal during detox from kratom. While this may help some patients, reports note that treating only the opioid‑receptor effect may not fully relieve distress, so close monitoring and flexible plans are important.
Other options, such as clonidine and lofexidine, can also help alleviate specific symptoms.
Detox is only the first step. To address the underlying causes of addiction, long-term recovery often involves residential treatment with evidence-based behavioral therapies, where appropriate, such as:
Support groups are also important for developing a recovery network and aiding in relapse prevention once residential treatment has finished.
Alta Mira Recovery Programs is a high-end, top-tier residential addiction center specializing in the treatment of substance use disorders and complex co-occurring mental health issues.
Our exceptional team of highly credentialed addiction treatment professionals provides the most sophisticated level of clinical care and diagnostic services, reflecting our appreciation for your unique qualities. Contact our compassionate admissions team to learn more.
[1] County of Los Angeles Public Health. 2025. Additional Fatal Overdoses Tied to Synthetic Kratom in Los Angeles County.
[2] California Department of Public Health. 2026. Kratom and 7-OH may lead to addiction, serious harm, overdose or death.
[3] National Institute on Drug Abuse. 2022 Kratom.
[4] Rogers, J. et al. (2024). Kratom addiction per DSM-5 SUD criteria, and kratom physical dependence: Insights from dosing amount versus frequency. Drug and alcohol dependence, 260, 111329.
[5] Henningfield, J. et al. (2023). Kratom withdrawal: Discussions and conclusions of a scientific expert forum. Drug and alcohol dependence reports, 7, 100142.
[6] Mayo Clinic. 2024. Kratom: Unsafe and ineffective. Mayoclinic.org
[7] American Psychiatric Association. What is Kratom and Why is It Raising Concerns?
