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Kratom and Suboxone: Everything You Need to Know

July 2, 2022

Table of Contents

What Is Kratom?

Kratom is a psychoactive plant indigenous to Southeastern Asia. Its leaves were consumed by day laborers in parts of Asia who were working in hot, strenuous conditions.

In recent years, kratom has become more frequently used in the US and Europe. 

Since it doesn’t grow naturally in these regions, commercial preparations are more common, like powders or liquids. Kratom is most commonly consumed by drinking in tea or other liquid preparations.

The two chemicals found in kratom leaves — Mitragynine and 7-hydroxymitragynine — activate opioid receptors in the brain.[1] Mitragynine also functions as a stimulant by interacting with other receptor systems in the brain. 

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

In the US, the most commonly reported reason for kratom use is for self-medicating chronic pain. It is also used as substitution therapy for opioid use disorder (OUD), which is the clinical term for opioid addiction.

Substitution therapy helps people with OUD regain control of their lives and prevent relapse using medications that activate the same brain receptors as abused opioids. 

Even though kratom activates opioid receptors, it’s difficult to know the full risks of its use due to a significant lack of research. However, some studies conducted in rodents show that kratom is addictive and can cause toxicity, organ dysfunction, and withdrawal.

Is Kratom Legal?

Kratom is illegal in many European countries due to addiction and dependence potential but remains legal in most states within the US. 

However, several states and localities have voted to make it illegal to sell, possess, grow, or consume kratom. Other states have discouraged its use by establishing age limits on who can legally buy and use the drug. 

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

The Food & Drug Administration (FDA) warns that Kratom “should not be used to treat medical conditions, nor should it be used as an alternative” for prescription opioid addiction. Similarly, the Drug Enforcement Agency (DEA) does not recognize “any legitimate medical use for kratom.”

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

Due to lack of evidence and its potential risks, Kratom is not prescribed by medical professionals in the US, and insurance does not pay for it.

Kratom Side Effects

Side Effects of Kratom

Kratom 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

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. 

By 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 a set of symptoms indicating the user has developed a kratom use disorder which includes cravings and tolerance.

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

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.

Furthermore, buprenorphine binds to receptors more weakly than full opioid agonists such as most illicit opioids or methadone.[4] At higher dosages, the medication loses its ability to activate opioid receptors.

This is also known as a pharmacological “ceiling effect,” making buprenorphine safer than other opioid-based medications, kratom, or abused opioids.

Suboxone Side Effects

Suboxone is safe to use but may cause side effects.[3] Common Suboxone side effects include:

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

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 healthcare provider.

Suboxone vs. Kratom Comparison

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. 

Kratom is not FDA-approved for any use and is a potentially dangerous drug, whereas Suboxone is a standard-of-care and well-studied treatment that is known to help people recover from OUD. 

1. Usage

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

Kratom is not approved by federal regulators because there's no proof that the drug has any therapeutic benefits. In fact, kratom is commonly regarded as an addictive narcotic.

2. Abuse Potential

Suboxone has a lower abuse 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.

Further, 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.

3. Dosage Differences

Suboxone comes in 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.

4. Formulations and Administration

Suboxone is available in sublingual film/strip or pill forms. Both forms dissolve in less than 15 minutes when administered beneath the tongue or between the cheek and gums. The effects may last for up to 72 hours.[2]

Although both Suboxone formulations are equally effective, there are a couple of significant differences to be aware of: 

  • The film formulation dissolves faster than the tablets, and both should be left in place for at least 15 minutes for maximum absorption. 
  • Some patients may prefer the flavor of one over the other, but this is a personal choice.

Most people use kratom in the form of a tablet, capsule, or extract, which are derived from the leaves. Others may chew kratom leaves or make tea from dried or powdered leaves.

5. Forms (Brand vs. Generic)

Suboxone is available in both brand and generic formulations. This offers users more options as generic formulations are generally more affordable than their brand counterparts. 

Brand and generic formulations for kratom do not exist. It is only available from off-market vendors. 

Learn More About Bicycle Health’s OUD Treatment Options

Curious whether Suboxone or an alternative OUD treatment is right for you? Book an enrollment call or call us at (844)943-2514 to learn more.

Claire Wilcox, MD

Claire Wilcox, MD, is a general and addiction psychiatrist in private practice and an associate professor of translational neuroscience at the Mind Research Network in New Mexico; and has completed an addictions fellowship, psychiatry residency, and internal medicine residency. Having done extensive research in the area, she is an expert in the neuroscience of substance use disorders. Although she is interested in several topics in medicine and psychiatry, with a particular focus on substance use disorders, obesity, eating disorders, and chronic pain, her primary career goal is to help promote recovery and wellbeing for people with a range of mental health challenges.

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Citations

1. Kruegel AC, Uprety R, Grinnell SG, et al. 7-Hydroxymitragynine Is an Active Metabolite of Mitragynine and a Key Mediator of Its Analgesic Effects. ACS Cent Sci. 2019;5(6):992-1001. doi:10.1021/acscentsci.9b00141

2. Webster L, Hjelmström P, Sumner M, Gunderson EW. Efficacy and safety of a sublingual buprenorphine/naloxone rapidly dissolving tablet for the treatment of adults with opioid dependence: A randomized trial. J Addict Dis. 2016;35(4):325-338. doi:10.1080/10550887.2016.1195608

3. Velander JR. Suboxone: Rationale, Science, Misconceptions. Ochsner J. 2018;18(1):23-29.

4. Kumar R, Viswanath O, Saadabadi A. Buprenorphine. In: StatPearls. StatPearls Publishing; 2021. Accessed September 24, 2021. http://www.ncbi.nlm.nih.gov/books/NBK459126/

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