Kratom Survey: Dependence and Withdrawal
This blog is a recap of Dr. Oliver Grundmann’s and Hamilton Morris’s discussion surrounding the science behind kratom dependence and withdrawal. When possible, citations have been provided for the topics discussed.
Dr. Oliver Grundmann
Dr. Oliver Grundmann is one of the most cited kratom researchers in the world. His work regarding kratom ranges from the largest population study of kratom consumers ever conducted, all the way to detailing its neuropharmacology. He has spoken at several American Kratom Association hosted advocacy events, and continues to correct sensationalism with science.
He currently serves as the Director and faculty advisor for the online Master of Science and graduate certificate programs in Pharmaceutical Chemistry and Clinical Toxicology at the College of Pharmacy of the University of Florida.
Hamilton Morris is a renowned science and culture journalist. He directed, wrote, and hosted three seasons of the hit television series “Hamilton’s Pharmacopeia,” and his written work has appeared in Harper’s Magazine and Vice Magazine, among others. He researches drug development and pharmacology at the University of the Sciences in Philadelphia with long-time colleague Dr. Jason Wallach.
In 2017 he released his widely acclaimed documentary Kratom: The Forbidden Leaf as part of season 2 of his television series. He has returned to the subject of kratom through his role as Scientific Advisor to Top Tree Herbs.
Why Even Mention This?
This part of the conversation delves into some aspects of kratom that many advocates would like to keep hidden. Like everything in this world which can benefit your experience, there is a risk of becoming dependent on kratom. Before we continue, however, everything that we know about kratom dependency — and thus withdrawal — is anecdotal. That is why research into kratom, such as this survey, is incredibly important.
The context for this conversation is important. The “negative side” of kratom is teased out in this conversation, not because they think it is a noxious plant, but because these slight, yet real, toxicities are rarely mentioned. As Hamilton said, this is likely because kratom users are conscious of the environment in which they speak.
It’s dishonesty, but I understand why they are being dishonest.Hamilton Morris
A Prohibitionist Context
America is a country shrouded in the dark history of drug prohibition. While there are some signs that we are gradually pulling ourselves out of the failed drug war, we are not yet in the clear. States like Oregon decriminalizing the possession of small amounts of psychoactive substances is a great start, but on the federal level, there has been little more than virtue signaling.
With this, kratom users fear that this plant, which conveys great benefit to their life, may be put at risk if anything even slightly negative regarding it is talked about. Yet, as Hamilton said, denying the negatives is dishonesty, “but I understand why they are being dishonest.”
Defining Some Terms
But before we delve further into the possibility of kratom dependence, let’s continue to pile on context. First, what is dependence? Dependence is different from addiction, primarily in that addiction is referring to a set of psychosocial issues. Addiction is the inability to meet social obligations — like arriving at work on time, maintaining hygiene, or meeting family responsibilities, among other duties — because of commitment to a substance. On the other hand, dependence refers to a build up of tolerance, and thus the need to increase the amount taken to achieve the same effects, coupled with withdrawal when breaking from a habit of use.
To help flesh this out, let’s imagine a couple of examples. Coffee, and it’s main psychoactive constituent caffeine, plays an important role in many peoples’ morning rituals. How many among us have had a coffee every day for as long as we can remember? After having our regular coffee for a few weeks, we find ourselves reaching for a second, or maybe a third cup each day. This is tolerance.
If suddenly coffee is not longer consumed, either by choice or a change in environment, then you would expect to be more tired for the next couple of days. You might even experience some brain fog or mild irritability. This is withdrawal and, for coffee, should go away in a couple of days.
These same dependency and withdrawal traits can be found in a number of socially acceptable, and seemingly innocuous items. Sugar, alcohol, video games, tobacco, pornography, shopping, gambling, cannabis, and, heck, even watching television! The list could go on and on.
Is there a Scientific Basis for Kratom Dependence?
And so with this context, let’s return to evaluating these traits in kratom. Because, as with almost everything that can be of benefit to our lives, kratom too can result in dependence and withdrawal.
In responding to Hamilton’s questions regarding these traits, Dr. Grundmann first points out that, in light of what scientific understanding we do have concerning kratom, these risks increase as serving size and frequency of consumption increase. At serving sizes that account for the vast majority of user’s consumption pattern (according to his groundbreaking 2017 survey) this risk appears minimal.
What About Adverse Fatal Reactions
But let’s cut to the chase.
Dr. Grundmann states that there have been a little over 50 deaths that the FDA and CDC have blamed on kratom. Of that, all but two had other drugs in their system, often at concentrations which make it hard not to assume that the person would have overdosed even without the kratom. But contraindications, or bad mixes of substances, are real, and kratom likely also has dangerous combinations. Especially at high levels of consumption. The two cases, according to Dr. Grundmann, that reported only kratom (mitragynine) in the deceased’s blood were likely lacking in rigour. Meaning, they might not have tested for a full profile of substances.
But still, like everything (even sugar and water!), if you consume enough kratom, you can die. Hamilton mentions a case that he is aware of regarding a gentleman who was forming compressed bars out of kratom powder and eating a number of them at a time. (Citation unknown, will update periodically as Hamilton references his notes and gets back to us.)
Friend of Top Tree, Brian Gallagher wrote a story recently about a depressed teen who attempted suicide with encapsulated kratom. It’s a tragic story, but luckily for the teen, the amount of kratom she consumed, 22.5 grams, was likely nowhere near enough to cause an adverse fatal reaction on the basis of overdose alone. (Had she had a weakened or diseased liver going into it, however, the potential for adverse reactions may be greater.)
Tea as a Safety Net
This unfortunate case does allow for a nuance to be pointed out. Eating kratom leaf powder is different from drinking traditional kratom tea due to the natural inefficiency and selectivity of what alkaloids make it into the hot water. When kratom powder is eaten, everything in the kratom is introduced to the body. This not only includes all the alkaloids, but also all the insoluble fiber from the leaf matter as well as any possible contaminants.
On the other hand, tea allows for the desirable effects of kratom without having to consume the leaf powder. It also serves as a predictable medium to convey the alkaloids from the kratom to the cup. To clarify, this means that with tea the strength is dictated by how one prepares it. For example, using lemon can make the tea stronger, quicker. Additionally, the length of the steep time, as well as the water temperature play a role in what alkaloids are ultimately conveyed into the tea drinker’s blood stream, as well as how much.
Committed to Truth
These conversations concerning the side of kratom rarely discussed in the world of advocacy are important. First, we cannot let those who wish to see kratom banned monopolize the toxicology discussion. As Dr. Grundmann explained, yes, kratom can have adverse effects. Nothing is immune from possibly causing harm. But in comparison to similar legal and illegal substances, “kratom,” stated Hamilton, “is likely less dangerous than even acetaminophen.”
In short, our concern with kratom, like everything, is that the truth is allowed to be pursued.
This discussion, ultimately, is to promote Dr. Grundmann’s incredibly important population survey of kratom tea drinkers. The data from this survey will be able to further our scientific understanding of this leaf, and its consumption when prepared traditionally.
These are the crucial, final innings in the story of kratom. At the moment, it has drawn the ire of federal regulatory agencies, for whatever reason. Nobody can protect kratom by themselves. What is required is rigorous, scientific analysis of kratom, including it’s potential for both good and bad. However, given the politics surrounding kratom, the ability for scientists to experiment with it is limited.
You Can Help!
To get around this, we need a grassroots commitment to discovering the truth regarding this leaf. As such, surveys are one of our best options. The current survey that Dr. Grundmann is conducting is one of the most rigorous and controlled population surveys on kratom every conducted. Yet for the results to have any weight, it is up to you to participate.
If we fail to collect adequate data to make any meaningful conclusions, then the enemies of kratom will be able to continue to propagate their ill informed claims. In the grand scheme of things, we know surprisingly little about kratom. That means that both the claims made by advocates and kratom-haters are founded on thin evidence. To collect a meaningful amount of data from this survey would allow for a more scientific discussion to be had. Truly, all those committed to honesty above speculation will want for this survey to be widely responded to.
How To Help
If you would like to participate in this historical research project, you can purchase a discounted bag of our crushed leaf kratom tea bags. From there, it’s as simple, and pleasurable, as drinking tea! After you’ve drunk some of the tea, simply scan the QR code on the bag and fill out the anonymous survey. Or, you can go directly to the survey via https://tinyurl.com/Kratomteasurvey.