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Kratom Tolerance: Do You Need to Take a Break?

kratom-toleranceKratom is a plant native to Southeast Asia, where the leaves are chewed, smoked, or consumed as tea recreationally to produce a mild intoxication. It’s similar in many ways to how a couple drinks are often consumed socially in the US while catching up with friends. At very low doses, kratom produces euphoric, stimulating effects; at higher doses, paradoxically, the plant produces sedative effects, which are compared to the effects of opioid drugs like opium, morphine, heroin, and OxyContin. People who abuse kratom are at risk of developing physical and psychological dependence on the drug. Consuming a lot of the substance can lead to tolerance as well.

The National Institute on Drug Abuse (NIDA) defines tolerance to drugs or alcohol as the state in which one’s body no longer responds to the original dose of a drug, requiring the person to take more to feel the original effects. Combined with dependence on the drug, the individual will take larger and larger doses to feel normal. Once the person’s behaviors become compulsive, they develop serious cravings when not taking the drug and begin to experience withdrawal if they miss a dose, the person has developed an addiction.

Kratom Abuse in the United States

In the United States, kratom is sold as a dietary or nutritional supplement, mostly online. The drug can be found as dried leaves or, more often, as a powder in capsules or a bag. It is recommended that people brew tea with a small amount of the substance, but kratom’s availability in powdered form means that people who abuse the substance may snort it, smoke it, or mix it with other substances like alcohol.

 Although kratom has been linked to psychosis and some overdose deaths, it is not currently restricted through the Controlled Substances Act (CSA); however, the Drug Enforcement Administration (DEA) lists kratom as a Drug or Chemical of Concern, and the Food and Drug Administration (FDA) has noted that they are concerned about the substance as well. There have been petitions to restrict import of kratom or control the drug through laws at the state and federal level. The DEA reports that, between 2014 and 2016, there are 15 deaths known to be caused by kratom overdose.

Kratom targets areas of the brain like the opioid receptors, so many of its effects are triggered by the release of neurotransmitters in a process like that associated with opioid drugs, including Vicodin, Percocet, and heroin. Because of the epidemic of opioid abuse and death in the US, people who start taking kratom are, for the most part, trying to wean themselves off opioid addiction. This means that people who begin abusing kratom, which has no recognized medical use in the US, including as a detox medication, already have a high tolerance to some sedative drugs.

Since the population predominantly abusing kratom in the US is trying to end their own substance abuse, anecdotal evidence states that the drug is not addictive. However, people who already struggle with addiction are the ones turning to kratom for help, and medical studies have shown that kratom can be abused, cause intoxication, and lead to addiction, dependence, tolerance, and overdose. It is not recognized as an appropriate method for detoxing off opioids, and trying to withdraw from a substance like opioid painkillers without supervision from an addiction specialist can lead to relapse.

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The Dangers of Becoming Tolerant to Kratom

When people struggling with kratom say that the drug is not addictive, part of what they mean is that their body does not develop a tolerance to the substance like it can with alcohol, benzodiazepines, or opioids. While this has been proven true by scientific research, kratom is still a dangerous drug. It may not be closely regulated at the federal level yet, but kratom is still not recognized as a medication and only as an intoxicating substance of abuse.

There are many reasons abusing kratom can be risky and tolerance to the substance is dangerous.

  • Rapid development: Since most people who take kratom are trying to stop abusing opioids, tolerance to kratom is likely to develop rapidly. This is because the drug may have cross-tolerance with opioids since they have similar effects and because people who abuse opioids may start taking a very large dose of kratom to ease their withdrawal symptoms. The body will get used to the presence of a lot of kratom, making tapering or quitting difficult.
  • Opioid relapse: When the body develops tolerance to kratom, any relief from opioid withdrawal will lessen, increasing psychological and physical cravings for more potent opioids. Kratom does not act as quickly as drugs like heroin or fentanyl, so the individual may give up kratom, or they may abuse opioids alongside kratom. This increases the risk of overdose and death.
  • Lack of oversight and regulation: Abusing kratom in the US is dangerous because the drug is not regulated. The risk that the substance has been cut with adulterants like flour or other drugs is higher because there is no oversight to the manufacturing and sale of the powder. Different brands and different packages may contain different doses of kratom. This problem increases the risk of harmful side effects, overdose, and tolerance to substances in kratom that are not just kratom alone.
  • Liver damage: Tolerance to and dependence on kratom can lead to long-term abuse, which can cause chronic health problems, especially damage to the liver. Damage to this important organ can begin after as little as 2-8 weeks of regular, high-dose kratom abuse, often in the form of tablets, capsules, or powder.

Taking a Break Is Not Enough with Kratom

Although kratom is technically legal to sell and possess in the US, the drug has no acceptable use in medical practice. It is addictive, especially for people who are opioid- or sedative-naïve. Quitting kratom cold turkey will reduce the body’s tolerance to the substance, but if one quits, then returns to drug abuse specifically to achieve the original intoxicating effects, they put themselves at risk of overdose and death. Instead, individuals should get help safely detoxing from kratom. Then, they should enter an evidence-based rehabilitation program to stay sober and avoid the dangers of substance abuse.

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