Kratom and Suboxone: Everything You Need to Know

January 2, 2023

Table of Contents

Both kratom and Suboxone are marketed as solutions for people with OUD. But only Suboxone is proven safe and effective.

In 2019, about 10.1 million adults misused opioids.[1] While Kratom is sometimes marketed - illicitly - as a treatment for OUD, there is no strong evidence that it is useful for this reason. In fact, it may have some harms. Suboxone, in contrast, is an FDA approved medication for OUD. 

What Is Kratom & How Does It Work?

Kratom is a psychoactive substance commonly consumed in tea or other liquid preparations. The two chemicals in kratom leaves (Mitragynine and 7-hydroxymitragynine) activate opioid receptors in the brain.[2] Mitragynine also functions as a stimulant by interacting with other receptor systems in the brain.

In low doses, kratom produces a mild stimulant effect, leading to enhanced energy, sociability, and alertness. At higher doses, kratom effects include pain reduction, mood changes, and sleepiness.

Because it has some activity stimulating opioid receptors in the brain, some people try to use it as an OUD treatment. This is inadvisable, has not been shown to work, and is associated with some serious health risks. 

What Is Suboxone?

Suboxone is an FDA-approved substitution treatment for OUD that contains two active components: buprenorphine and naloxone.

  • Buprenorphine is a partial opioid agonist that binds to opioid receptors in the brain and activates them. As a result, the medication decreases cravings and prevents withdrawal symptoms associated with OUD.
  • Naloxone is an opioid agonist that prevents patients from misusing the medication through snorting or injection.

Suboxone also has a "ceiling effect," meaning that the euphoric properties and respiratory suppression tend to slow down at higher doses, preventing the risk of overdose and death.

Kratom has no ceiling effect, so you can experience growing effects with increasing amounts, which may easily lead to an overdose.

This pharmacological "ceiling effect" makes buprenorphine safer than other opioid-based medications, kratom, or misused opioids.[3]

Kratom vs. Suboxone

Proven Efficacy 

Suboxone is a safe and FDA-approved medication for the treatment of OUD.

Even though kratom activates opioid receptors, it's difficult to know the full risks of its use due to lack of research. Federal regulators do not approve kratom because there's no proof that the drug has therapeutic benefits. 

Availability 

Medication for Addiction Treatment (MAT) is a proven and effective treatment method for OUD. This approach involves treatment with FDA-approved medications such as Suboxone, methadone, and Vivitrol. You must visit a doctor to get started, and some people find that intimidating.

Kratom is illegal in many European countries due to risks for addiction and dependence, but it remains legal in most states within the U.S.[4,5] You cannot get it from a medical provider. 

Side Effects

Suboxone is safe to use but may cause some side effects.[6] Common Suboxone side effects include the following:

  • Headache
  • Nausea
  • Vomiting
  • Constipation
  • Sweating excessively
  • Insomnia
  • Swollen hands and legs
  • Stomachache
  • Sense of numbness in the mouth

Kratom's side effects can include nausea, constipation, drowsiness, muscle pain, liver damage, depression, hallucinations, delusions, and difficulty breathing.

Other side effects may include:

  • Itchiness
  • Appetite loss
  • Excessive perspiration
  • Dry mouth
  • Increased urination
  • Hallucinations and seizures
Side Effects of Kratom

Withdrawal Symptoms

Suboxone may trigger opioid withdrawal symptoms if taken while other opioids are present in the system. To avoid this, patients should only take the drug under the supervision of a health care provider.

Kratom withdrawal occurs within 12 to 48 hours of the last dose, and users describe the opioid withdrawal as moderate.

Misuse Potential 

Suboxone has a lower misuse potential than kratom. It contains an opioid antagonist, and kratom does not.

By the nature of its opioid agonist and stimulant properties, kratom has the potential to be addictive like any other illicit opioid. Regular kratom use can lead to symptoms indicating the user has developed a kratom use disorder, including cravings and tolerance.[7]

Legal Risks 

Suboxone is legal.

Kratom is legal at the federal level, but state rules can vary. Several states and localities have voted to make selling, possessing, growing, or consuming kratom illegal. Other states have discouraged its use by establishing age limits on who can legally buy and use the drug.[8]

Contamination

Suboxone is made in laboratories, and batches are checked for quality.

Since kratom is not regulated in the U.S., many samples are tainted with unknown substances, and there's no way to know the true potency of any particular sample.

The FDA reported 44 kratom-related deaths in 2017.[9] Several of the deaths appeared to result from contaminated kratom or combining kratom with other substances like benzodiazepines, alcohol, or over-the-counter pharmaceuticals.

Overdose

Due to Suboxone's chemical makeup, it's incredibly difficult to overdose on the medication.

It is possible to overdose on kratom, and there is a real risk of respiratory depression and death since it is an agonist at opioid receptors. 

Cost

Suboxone is often covered through most insurance programs. Due to a lack of evidence and its potential risks, U.S. medical professionals do not prescribe kratom, and insurance does not pay for it. 

Suboxone vs. Kratom Comparison

How different are these two substances? A side-by-side comparison chart can make your choice clear.

Suboxone Kratom
Approved? Suboxone is an FDA-approved medication for the treatment of OUD. Kratom is not FDA-approved for any use and is a potentially dangerous drug.
Misuse Potential Suboxone has a lower misuse potential than kratom. It contains the opioid antagonist naloxone, which prevents patients from misusing the medication through snorting or injection. Kratom contains no such opioid antagonism. Kratom has no ceiling effect, so you can experience growing effects with increasing amounts, which may easily lead to an overdose.
Dosage Suboxone has four different strengths, each with a buprenorphine-to-naloxone ratio of 4:1.
2 mg buprenorphine / 0.5 mg naloxone
4 mg buprenorphine / 1 mg naloxone
8 mg buprenorphine / 2 mg naloxone
12 mg buprenorphine / 3 mg naloxone
Since kratom is an unlicensed substance, its fixed-dose products do not exist.
Formulations & Administration Suboxone is available in sublingual film/strip or tablet forms. Most people use kratom in the form of a tablet, capsule, or extract, which is derived from the leaves. Others may chew kratom leaves or make tea from dried or powdered leaves.
Forms Suboxone is available in both brand and generic formulations. This offers users more options, as generic formulations are generally more affordable than their branded counterparts. Branded and generic formulations for kratom do not exist. It is only available from off-market vendors.
Morphine 2–3 days
Oxycodone 1–4 days

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

Reviewed By

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Citations

  1. Opioid Crisis Statistics. U.S. Department of Health and Human Services. https://www.hhs.gov/opioids/about-the-epidemic/opioid-crisis-statistics/index.html. February 2021. Accessed September 2022.
  2. 7-Hydroxymitragynine is an Active Metabolite of Mitragynine and a Key Mediator of its Analgesic Effects. ACS Central Science. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6598159/. June 2019. Accessed September 2022.
  3. Clinical Pharmacology of Buprenorphine: Ceiling Effects at High Doses. Clinical Pharmacology and Therapeutics. https://pubmed.ncbi.nlm.nih.gov/8181201/. May 1994. Accessed September 2022.
  4. Current Perspectives on the Impact of Kratom Use. Substance Abuse and Rehabilitation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612999/. July 2019. Accessed September 2022.
  5. Kratom Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review. Pain and Therapy. https://link.springer.com/article/10.1007/s40122-020-00151-x. January 2020. Accessed September 2022.
  6. Suboxone: Rationale, Science, Misconceptions. The Ochsner Journal. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5855417/. Spring 2018. Accessed September 2022.
  7. Kratom Dependence and Treatment Options: A Comprehensive Review of the Literature. Current Drug Targets. https://pubmed.ncbi.nlm.nih.gov/32682371/. 2020. Accessed September 2022.
  8. Nine Oregon Bills to Keep an Eye on This Session That Are Not About Carbon Emissions. Salem Statesman Journal. https://www.statesmanjournal.com/story/news/2020/01/27/what-oregon-legislature-2020-bills-to-know/4590609002/. January 2020. Accessed September 2022.
  9. Statement from FDA Commissioner Scott Gottlieb, MD, on the Agency's Scientific Evidence on the Presence of Opioid Compounds in Kratom, Underscoring Its Potential for Abuse. U.S. Food and Drug Administration. https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-agencys-scientific-evidence-presence-opioid-compounds. April 2018. Accessed September 2022. 
  10. Efficacy and Safety of a Sublingual Buprenorphine/Naloxone Rapidly Dissolving Tablet for the Treatment of Adults with Opioid Dependence: A Randomized Trial. National Library of Medicine. https://pubmed.ncbi.nlm.nih.gov/27267785/. June 2016. Accessed September 2022.

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