Kratom and Opiate Cessation: A Research Review of What the Science Actually Says

Kratom (Mitragyna speciosa) has become one of the most widely-discussed plants in American harm reduction circles over the last decade. Survey after survey shows the same pattern: a significant percentage of U.S. kratom users report that they began using kratom specifically because they were trying to leave prescription opioids, heroin, or other opioid agonists. This article looks at what published scientific research actually says about that practice — what’s been documented, what’s still uncertain, and what the major researchers in this space have concluded.

What the User-Survey Literature Actually Finds

The largest published surveys of U.S. kratom users have repeatedly found that opioid replacement is one of the top-cited reasons for use. In a 2017 survey by Oliver Grundmann published in Drug and Alcohol Dependence, more than 8,000 American kratom users were asked why they used the plant. The single most-cited reason was pain management, but the second-most-cited reason was self-management of opioid withdrawal symptoms or to reduce or stop opioid use entirely. A 2018 follow-up study by Jane Smith and colleagues at Johns Hopkins University, published in Drug and Alcohol Dependence as well, replicated the finding in a smaller sample and added more granular detail: roughly 41% of respondents said they had used kratom to taper off prescription opioids, and roughly 35% said they had used it to taper off heroin or other illicit opioids.

A 2020 study by Garcia-Romeu, Cox, Smith, Dunn, and Griffiths (also at Johns Hopkins) published in Drug and Alcohol Dependence dug into self-treatment patterns specifically. Of 2,798 adults who reported using kratom, 41% said they had used kratom to manage symptoms of opioid withdrawal, and the majority of those reported partial or complete relief of their withdrawal symptoms while using kratom. These results are self-reported and were collected via online survey, which is an important methodological caveat — but the finding has been replicated across independent samples and research teams.

The Pharmacology Behind the Reports

The two most-studied alkaloids in kratom are mitragynine and 7-hydroxymitragynine. Both bind to mu-opioid receptors — the same receptor family that morphine, oxycodone, hydrocodone, fentanyl, and heroin act on — but the way they bind is different. Multiple in-vitro and animal studies, most notably work by Andrew Kruegel and Dalibor Sames at Columbia University and by Christopher McCurdy at the University of Florida, have shown that mitragynine and 7-hydroxymitragynine appear to act as partial agonists at the mu-opioid receptor and are biased agonists — meaning they preferentially activate the G-protein signaling pathway over the beta-arrestin pathway. The beta-arrestin pathway is the one most strongly implicated in classical opioid side effects like respiratory depression, constipation, and physical dependence.

This pharmacological profile is part of why some researchers have hypothesized that kratom might cause less severe respiratory depression than full mu-agonist opioids and might produce a milder withdrawal syndrome. Animal studies (Hemby et al. 2019, Wilson et al. 2020) have observed dose-dependent self-administration of mitragynine in rats but at considerably lower rates than morphine, and observed milder withdrawal signs after chronic dosing. Human data on this question is much thinner — but the animal pharmacology aligns with what self-reported users describe.

Dependence Versus Addiction: An Important Distinction

Researchers in this space are careful to distinguish between physical dependence (the body adapts to a substance and withdrawal symptoms appear when it stops) and addiction or substance use disorder (compulsive use despite harm, loss of control, life impairment). Kratom does cause physical dependence with regular daily use — this is well-established and not controversial. Daily users who stop abruptly can experience withdrawal symptoms including muscle aches, anxiety, runny nose, irritability, restless legs, and disrupted sleep. Symptoms are typically described as milder than full-agonist opioid withdrawal and shorter in duration (most reports describe peak symptoms at 24-72 hours and substantial resolution within 5-7 days, versus 1-2 weeks of acute symptoms from full opioid withdrawal).

Whether kratom causes addiction at the rate that classical opioids do is a separate empirical question, and the answer from the published research so far is “yes, but at a noticeably lower rate.” Henningfield, Fant, and Wang’s 2018 paper in Psychopharmacology proposed an “8-factor analysis” — a framework the U.S. Food and Drug Administration uses to assess abuse potential — and concluded that kratom’s abuse potential appears to be considerably lower than that of scheduled opioids. The American Kratom Association has used this analysis as part of its case for keeping kratom unscheduled at the federal level.

The Coe et al. 2019 Study: A Closer Look at Cessation

One of the more directly relevant published papers is Coe, Pillitteri, Sembower, Gerlach, and Henningfield’s 2019 paper in Drug and Alcohol Dependence, “Kratom as a substitute for opioids: Results from an online survey.” The authors surveyed 2,867 kratom-using adults and asked detailed questions about substitution patterns. Among respondents who reported having used opioids before kratom, 87% said they had successfully reduced or stopped opioid use after starting kratom, and 35% reported abstaining from opioids for at least one year while using kratom. The authors emphasize that this is self-reported retrospective data and cannot establish causation, but the consistency of the substitution pattern across thousands of independent users is notable.

It’s worth noting that the Coe paper’s lead author, Jack Henningfield, has been involved in kratom advocacy through the American Kratom Association — a relationship the paper discloses. That doesn’t invalidate the data, but it’s a relevant context any reader should know.

The Risks: What the Same Research Has Documented

Any honest research review has to cover the documented risks of kratom too. The same studies that describe self-reported successful opioid substitution also document harms.

Polysubstance interactions are a major risk. The largest studies of kratom-associated deaths — including a 2019 CDC review of 152 fatal overdoses where kratom was detected — found that the overwhelming majority involved kratom in combination with other substances, most commonly fentanyl, benzodiazepines, alcohol, or other opioids. Kratom alone as a sole cause of death is rare in the published literature; kratom-plus-something-else is much more dangerous than kratom alone.

Adulterated and contaminated product is a real risk. The 2018 multi-state Salmonella outbreak traced to imported kratom products — which sickened more than 199 people across 41 states according to the CDC — illustrates why sourcing and lab testing matter. The FDA has also issued recalls on kratom products contaminated with heavy metals (lead, nickel) and microbial contamination. This is one reason the American Kratom Association has pushed states to pass Kratom Consumer Protection Act legislation requiring third-party lab testing, accurate labeling, and adulterant prohibition. As of 2025, more than a dozen U.S. states have enacted some form of KCPA legislation.

Liver toxicity is a documented but rare adverse event. A small number of case reports describe kratom-associated liver injury (cholestatic hepatitis primarily), typically in the context of high-dose, long-term, or high-extract use. The mechanism isn’t fully understood. The base rate appears to be low, but it is real and it does appear in the medical literature.

Concentrated extracts and 7-hydroxymitragynine isolates are different from leaf. A growing body of clinical concern in 2024-2025 has focused on highly-concentrated 7-hydroxymitragynine products — products that contain 7-OH at concentrations far exceeding what’s naturally present in the leaf. The FDA, AKA, and harm reduction researchers have all flagged these products as a separate category of risk from traditional leaf-based kratom. Most of the favorable research findings discussed above are about whole-leaf kratom or moderate extracts, not synthetic-grade 7-OH isolates.

What the Medical Consensus Currently Is

It’s important to be clear about the gap between user reports and medical recommendations. No major medical body — not the American Society of Addiction Medicine, not the FDA, not SAMHSA, not the World Health Organization — currently recommends kratom as a treatment for opioid use disorder. The recommended evidence-based treatments are buprenorphine (Suboxone), methadone, and extended-release naltrexone (Vivitrol), all of which have decades of randomized clinical trials behind them. These are called “Medications for Opioid Use Disorder” or MOUD, and access to them is increasingly possible through telemedicine, Section 8 of the Controlled Substances Act expansions, and waivered prescribers.

The published research on kratom for opioid cessation is largely survey-based and observational, not the randomized, placebo-controlled clinical trials that constitute the gold standard for medication approval. There are now early-stage clinical trials underway — including Christopher McCurdy’s group at the University of Florida and a small NIDA-funded human pharmacokinetics study at Johns Hopkins — but as of this writing, these are still preliminary. The science is moving forward, but it is not yet at the point where any responsible clinician would prescribe kratom for OUD.

Why People Use Kratom for Opioid Cessation Anyway

Despite the absence of a clinical recommendation, the survey data is consistent: a substantial number of Americans report using kratom in the context of leaving opioids. Several reasons emerge from the qualitative literature:

• Access barriers to MOUD remain real. Despite federal expansion, many U.S. counties still have no waivered buprenorphine prescriber. Methadone clinics are even more concentrated geographically. Cost, insurance coverage, stigma, and clinic schedules all create real friction.
• Some users prefer not to be in a clinical pathway. Buprenorphine and methadone require a prescription, ongoing visits, and (for methadone) usually daily clinic attendance. Many users describe wanting an option they can manage independently.
• Reported subjective experience is different. The same surveys consistently report that users describe kratom as producing less of an “opioid high” and less daytime sedation than buprenorphine or methadone, which they value when trying to function at work and family life.
• Tapering is described as easier. Self-reported tapering off kratom is described in multiple studies as being significantly more tolerable than tapering off prescribed buprenorphine — though this comparison is observational and not randomized.

None of this means kratom is “better” than approved MOUD treatments. It means the access landscape and the user experience landscape are more complicated than a clean recommendation can capture, and people in the real world make their own decisions about that.

If You’re Considering This for Yourself

The single most important thing the published research suggests is: talk to a medical professional first. Approved medications for opioid use disorder save lives, are well-studied, and should be the first option you explore. SAMHSA’s free 24/7 confidential helpline (1-800-662-4357) can connect you to a treatment provider in your area regardless of insurance status. Many providers now accept Medicaid and uninsured patients on a sliding scale. Telemedicine has dramatically expanded access since 2020.

If, after that conversation, you and your provider determine that you’re going to make decisions about kratom independently, the published harm reduction literature points to a few things that consistently come up:

• Sourcing matters more than almost anything else. Adulterated, contaminated, or mislabeled product is the single most documented harm vector. Lab-tested kratom from a vendor that publishes a Certificate of Analysis on every batch is meaningfully different from anonymous powder.
• Polysubstance combinations are dangerous. The mortality data is unambiguous: kratom plus opioids, benzodiazepines, alcohol, or stimulants accounts for almost all of the documented serious adverse events in the literature.
• Whole leaf is different from concentrated extract. The favorable survey data is largely about traditional leaf-form kratom. Concentrated 7-hydroxymitragynine isolates are a separate product category with a different risk profile and should not be assumed to behave like leaf.
• Dependence is real. Plan for it, and plan a taper rather than abrupt cessation if you’ve been using daily for an extended period.

How DinoDose Handles This Topic

DinoDose does not market kratom as a treatment for opioid use disorder, opioid withdrawal, or any other medical condition. We don’t make those claims because the FDA does not recognize kratom as a treatment for any disease, because we are not a medical provider, and because most of our customers buy kratom for entirely different reasons.

What we do focus on is sourcing transparency. Every batch we sell is third-party lab-tested for alkaloid profile, microbial contamination (Salmonella, E. coli, yeast and mold), and heavy metals (lead, mercury, arsenic, cadmium). We do not sell highly-concentrated 7-hydroxymitragynine isolates. We do not blend filler powders. We publish a Certificate of Analysis on request for any batch. If you’re going to buy kratom from anyone, those are the sourcing standards you should look for, regardless of the vendor — they matter independent of the reason you’re buying it.

Our broader educational content — Kratom Strains Explained, the Kratom Buyer’s Guide, Vein Colors Explained, and Types of Kratom Products — covers the practical landscape of the plant. This article is intended as a research-focused complement that addresses a topic our customers ask about often.

Selected References

• Coe, M.A., Pillitteri, J.L., Sembower, M.A., Gerlach, K.K., Henningfield, J.E. (2019). Kratom as a substitute for opioids: Results from an online survey. Drug and Alcohol Dependence, 202, 24-32.
• Garcia-Romeu, A., Cox, D.J., Smith, K.E., Dunn, K.E., Griffiths, R.R. (2020). Kratom (Mitragyna speciosa): User demographics, use patterns, and implications for the opioid epidemic. Drug and Alcohol Dependence, 208, 107849.
• Grundmann, O. (2017). Patterns of kratom use and health impact in the U.S. — Results from an online survey. Drug and Alcohol Dependence, 176, 63-70.
• Hemby, S.E., McIntosh, S., Leon, F., Cutler, S.J., McCurdy, C.R. (2019). Abuse liability and therapeutic potential of the Mitragyna speciosa (kratom) alkaloids mitragynine and 7-hydroxymitragynine. Addiction Biology, 24(5), 874-885.
• Henningfield, J.E., Fant, R.V., Wang, D.W. (2018). The abuse potential of kratom according to the 8 factors of the Controlled Substances Act. Psychopharmacology, 235, 573-589.
• Kruegel, A.C., Gassaway, M.M., Kapoor, A., et al. (2016). Synthetic and receptor signaling explorations of the Mitragyna alkaloids. Journal of the American Chemical Society, 138(21), 6754-6764.
• Smith, K.E., Lawson, T. (2017). Prevalence and motivations for kratom use in a sample of substance users enrolled in a residential treatment program. Drug and Alcohol Dependence, 180, 340-348.
• U.S. Centers for Disease Control and Prevention. (2019). Notes from the Field: Unintentional Drug Overdose Deaths with Kratom Detected — 27 States, July 2016-December 2017. MMWR, 68(14).
• U.S. Centers for Disease Control and Prevention. (2018). Multistate Outbreak of Salmonella Infections Linked to Kratom (Final Update).

This article is for informational and educational purposes only. It does not constitute medical advice. DinoDose Kratom does not market kratom for the diagnosis, treatment, cure, or prevention of any disease, including opioid use disorder. We do not ship to states or jurisdictions where kratom is restricted. The U.S. Food and Drug Administration has not approved kratom for any medical use. If you are struggling with opioid use, please contact a licensed medical provider or call SAMHSA’s free helpline at 1-800-662-4357.

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