Walk into almost any gas station, smoke shop, or vitamin store in Philadelphia and you'll find it on the shelf — kratom, sold under names like "Maeng Da," "Red Bali," or simply labeled as an herbal energy supplement. It looks harmless. The marketing says it helps with pain, stress, even opioid withdrawal. What it rarely says is that for many people, it creates the very problem it promises to solve.
What is kratom?
Kratom (Mitragyna speciosa) is a plant native to Southeast Asia. Its leaves contain active compounds — primarily mitragynine and 7-hydroxymitragynine — that bind to opioid receptors in the brain. At low doses it acts more like a stimulant; at higher doses, the effects resemble opioids: pain relief, sedation, and euphoria.
The FDA has not approved any medical use for kratom. 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 legally available in most states — and that legal ambiguity leads many people to assume it's safe.
How does dependence develop?
Because kratom acts on opioid receptors, the brain adapts to its presence in much the same way it adapts to opioids. Over time, people need more to achieve the same effect. Many people who begin using kratom to manage opioid withdrawal find themselves dependent on kratom instead — sometimes taking 20 to 40 grams per day.
Physical dependence can develop within a few weeks of daily use. When someone stops, withdrawal typically begins within 12–24 hours and can include:
- Muscle aches, sweating, and chills
- Nausea, vomiting, and diarrhea
- Intense anxiety, irritability, and restlessness
- Insomnia and fatigue
- Depression and difficulty concentrating
Physical symptoms typically resolve within 6–10 days. Psychological symptoms — particularly depression and cravings — can persist for weeks or months.
What does treatment look like?
Because kratom binds to opioid receptors, clinical literature supports the use of buprenorphine/naloxone (Suboxone) to manage withdrawal and cravings — the same medication used for opioid use disorder. A 2021 case series published in the Journal of Addiction Medicine found a clear correlation between kratom dose and the amount of buprenorphine required for stabilization.
Beyond medication, treatment follows a similar path to other substance use disorders: structured therapy (particularly CBT), case management, peer support, and coordination for any co-occurring mental health needs. Outpatient programs — including IOP and PHP — are appropriate for most people with kratom dependence who have medical stability and a safe living environment.
At Philadelphia Recovery Solutions, we work with individuals experiencing kratom dependence through our IOP and PHP programs. If you or someone you know is using kratom daily and finding it hard to stop, reach out — we can help you figure out next steps. Contact our team →
Sources: FDA (2024); Weiss & Douglas, Journal of Addiction Medicine (2021); Virginia Recovery Centers (2025); Recovered.org (2024). This article is for educational purposes and does not constitute medical advice.