Kratom Addiction: Withdrawal, Legality, and the Growing Need for Detox

Once marketed as a “natural alternative” for pain or stress, kratom has quietly become one of the fastest-growing substance use concerns in the United States. What started as an herbal supplement sold online and in smoke shops has evolved into a widespread issue of dependence, withdrawal and medical risk.

According to the Centers for Disease Control and Prevention (CDC), kratom was identified in nearly 1,800 overdose deaths between 2019 and 2023, often in combination with opioids or benzodiazepines. The Food and Drug Administration (FDA) continues to warn that kratom can cause addiction, liver damage and death when misused.

At Pyramid Healthcare, clinicians have seen an increase in clients struggling with kratom use, often after trying to self-treat chronic pain, fatigue or anxiety. To understand why more people are entering treatment for kratom dependence, it helps to look at how this substance affects the body and why its risks are often misunderstood.

What Is Kratom and How It Works

Kratom comes from the Mitragyna speciosa tree, native to Southeast Asia. Its two main active compounds — mitragynine and 7-hydroxymitragynine (7-OH) — bind to the brain’s mu-opioid receptors, the same receptors activated by opioids such as morphine, oxycodone and fentanyl.

At low doses, kratom can act as a mild stimulant, producing increased alertness and focus. At higher doses, it behaves like a sedative or pain reliever, creating euphoria, relaxation or numbness. Over time, the brain begins to adapt to these effects, leading to tolerance and dependence.

Because kratom’s effects develop gradually, many users don’t recognize how addictive it can become. In one National Institute on Drug Abuse (NIDA) study, about one in ten people who regularly use kratom experience dependence or withdrawal symptoms.

Kratom Withdrawal: Symptoms and Timeline

Kratom withdrawal shares many similarities with opioid withdrawal, though symptoms tend to vary in intensity depending on dose and duration of use.

Common symptoms of kratom withdrawal include:

• Anxiety and irritability
• Insomnia and restlessness
• Muscle aches and fatigue
• Sweating or chills
• Nausea or vomiting
• Tremors or nervousness
• Intense cravings for kratom

Withdrawal typically begins within 12 to 24 hours of the last dose and may last from three to seven days. For some, emotional and psychological symptoms such as anxiety or cravings persist for weeks.

Medical detox can help ease these symptoms safely and comfortably. Without professional support, withdrawal can lead to relapse, dehydration and complications caused by self-medicating with other substances.

The Legal Gray Area: Why States Are Divided

Kratom exists in a confusing legal landscape. It remains unregulated at the federal level, but individual states have taken different approaches.

• Banned states: Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin
• Regulated states: Florida, North Carolina and Pennsylvania (considering or implementing age restrictions and labeling laws)
• Ongoing review: States such as New York and California are actively assessing bans after rising reports of hospitalizations

The FDA has not approved any medical use for kratom and warns that its composition and potency vary widely. In 2024, federal health officials seized over five million dollars’ worth of contaminated kratom products, citing risks of heavy metals, synthetic additives and bacterial contamination.

Despite this, kratom remains widely available in gas stations, convenience stores and online marketplaces, often marketed as a wellness or energy product. This legal ambiguity leads many people to believe that kratom is safe simply because it’s easy to buy — a misconception that has contributed to its rapid rise in misuse.

Kratom vs. Opioids: What’s the Real Difference?

While kratom and opioids differ in potency, their mechanisms and risks are remarkably similar. Both interact with the brain’s reward system, alter pain perception and can trigger dependency with repeated use.

• Pharmacology and potency: Kratom’s alkaloids partially activate opioid receptors, whereas prescription opioids fully activate them, resulting in more immediate and intense effects.
• Overdose risk: Kratom alone rarely causes fatal overdoses, but when combined with opioids or depressants, it can slow breathing and heart rate to dangerous levels.
• Withdrawal and dependence: Both substances cause physical and psychological withdrawal. Although kratom withdrawal may appear milder, it can still significantly impact mental health and quality of life.

The DEA has labeled kratom as a “substance of concern,” and multiple U.S. toxicology reports have identified fatal cases where kratom was a contributing factor, particularly when mixed with fentanyl.

Why More People Are Entering Detox for Kratom Addiction

Treatment centers across the country, including Pyramid Healthcare, are seeing a steady rise in individuals seeking help for kratom dependence. Many report that they initially turned to kratom to manage pain or withdrawal from other substances. Over time, however, they experienced mounting tolerance, withdrawal symptoms and cravings that mirrored opioid addiction.

As one Pyramid Healthcare clinician explains, “People are surprised when they realize how difficult it is to stop using kratom. Because it’s legal in many places, they assume it’s safe. But dependence can form quickly, and stopping without medical support can be overwhelming.”

In medically supervised detox, clients receive 24-hour monitoring, hydration support and symptom management to ensure safety during withdrawal. Detox is often followed by behavioral therapy and relapse prevention programs to address the psychological roots of addiction and build sustainable recovery habits.

Taking the Next Step Toward Healing

The rise of kratom addiction shows how easily misinformation and accessibility can blur the line between “safe” and “risky.” What starts as an herbal supplement can quickly become a dependency that disrupts health, relationships and emotional stability.

At Pyramid Healthcare, our evidence-based detox and recovery programs provide comprehensive support for individuals struggling with kratom or other substance use disorders. Our multidisciplinary approach addresses both the physical and emotional aspects of addiction, helping clients regain control and rediscover a sense of balance.

If you or someone you know is struggling with kratom dependence, reaching out for help is the first step toward lasting recovery.