Can You Take Suboxone and Kratom at the Same Time?
It may seem counterintuitive but certain drugs are used to help people fight addiction and get off other drugs. You may have heard of Suboxone (generically known as buprenorphine/naloxone), a drug used to ease the withdrawal symptoms from opioid addiction. You may be less familiar with kratom, an herbal remedy used to treat opioid addiction. The kratom leaves were first used by ancient Asian populations to enhance their daily lives and treat pain. Indigenous Southwestern Asian populations have found many different purposes for kratom, using the plant as an energy booster, stool regulator, antitussive (cough suppressant), antidiabetic, pain reliever, and intestinal deworming vehicle.
Is Kratom Addictive?
While kratom has had many holistic health purposes in the past, it has become popular in helping those with substance use disorders to stop using their drug of choice. It works especially well in combating addiction. Over the past 10 years, people have started to use kratom to self-medicate during opioid withdrawal. An herbal remedy seems like a positive and healthy way to overcome opioid addiction, but with kratom that might not be the case. Kratom delivers a euphoric effect that is similar to opioids, making it likely that people who use kratom will switch their addiction from opioids to this herbal alternative. Users may then require another drug to rid themselves of their kratom addiction and manage withdrawal – this is where Suboxone reenters the recovery world. The question then arises: is it safe to take Suboxone and kratom at the same time?
Kratom Withdrawal Symptoms
Kratom use is counterintuitive for substance abuse recovery because individuals that replace opioid use with kratom are then at risk for a kratom use disorder (KUD) as well as withdrawal from the KUD. The unfortunate truth is that the withdrawal symptoms from kratom will feel the same as the unpleasant withdrawal symptoms from opioids. Opioid withdrawal side effects have been known to include nausea, diarrhea, sweating, chills, body aches, tremors, sudden movements, runny nose, watery eyes, sleep disturbances, and emotional issues ranging from anger to anxiety. Like any drug, the experience of kratom withdrawal differs for every user and the intensity of symptoms depends on a variety of factors such as polysubstance abuse, quantity, consistency of use, and how long the user has been using kratom as a replacement for opioid use.
Suboxone vs Kratom
Many studies have been conducted in which Suboxone was used to treat kratom addiction by softening the withdrawal. Suboxone comes to the rescue for opioid use disorders after kratom use because it is approved by the Federal Drug Administration (FDA) as a maintenance treatment for opioid dependence.
Kratom is sought out as a safe herbal remedy but it is not FDA approved, leaving users at risk each time they use the plant to fight off opioid withdrawal. Of course, the danger of kratom use varies from person to person and the experience is dose-dependent. Kratom at low doses mixed with another drug may not lead to any serious consequences, but if it is mixed potently with other drugs, then it is most likely not safe and certainly not recommended by health professionals for opioid use disorders. While kratom has shown potential to alleviate withdrawal symptoms from opioid dependence (anecdotally and only for some individuals at certain doses) there is not enough reputable research available to conclude that it is safe to use or to mix with another drug. While kratom may have a similar purpose to Suboxone, it has not been verified in the same way. An article published by American Addiction Centers explained how kratom “has not been studied thoroughly, so this claim [that kratom is as positively accepted for opioid withdrawal as Subxone] is not verified. Meanwhile, the dangers posed by kratom are well documented.”
Is Kratom Dangerous?
Although not FDA approved, kratom use has continued to increase, resulting in more emergency calls to poison control centers in the US. Unfortunately, by the time that phone call is placed, it’s likely there has already been an overdose. In fact, in late February of 2019 an article was published from the U.S. National Library of Medicine stating that “the number of phone calls to US poison control centers about kratom exposures increased from 13 in 2011 to 682 in 2017, often for serious unanticipated effects of the supplement, according to a study published…in the journal Clinical Toxicology”. As this data has come in, the Drug Enforcement Administration (DEA) has classified kratom as a “drug of concern” in the US.
While herbal remedies have the reputation for being gentle and healthy holistic replacements for regular drug use, there are herbal alternatives to drugs, like kratom that can lead to death. The FDA reported that by November 2017, there were 36 kratom-related deaths, with the number of reported deaths increasing to 44 by February of 2018. It is important to note that there have been other death reports due to polysubstance abuse involving kratom and other drugs, both legal and illegal. When kratom is ingested with another substance the risk for fatal overdose increases exponentially due to negative drug interactions. For example, a fatal overdose was reported when the antipsychotic medication, quetiapine, (used to treat depression, bipolar, and schizophrenia) was consumed with kratom. Kratom use can lead to death with or without other substances involved.
Mixing Kratom with Other Substances
One leading reason kratom can be harmful is the high chance of negative drug interactions that can occur when it is co-ingested with another drug. According to 2019 reports from the DEA, one possible negative drug interaction with kratom involves cough syrup and caffeine: “A popular drink with young Muslims in southern Thailand, 4×100 is a mixture of the plant-based kratom and either a codeine-based cough syrup or caffeinated beverage that produces an effect similar to being drunk from alcohol.” Mixing any drugs runs a risk, but combining kratom with other drugs, especially ones that are psychoactive, can result in unfortunate interactions, such as seizures.
In the Journal of Analytical Toxicology, researchers analyzed 9 fatal cases of central nervous system (CNS) depression toxicity from mitragynine (the primary alkaloid in the plant Mitragyna speciosa, known by users as kratom) and O-desmethyl tramadol (tramadol), which shows that it is harmful to human health to ingest kratom with less potent opioid analgesics (pain relievers). Taking into account the possible negative drug interactions, it is essential to ensure that your healthcare provider is aware of your drug history and the drugs you are currently consuming if you are also using kratom. Having a knowledgeable and accountable psychiatrist during your recovery, as we do at Boardwalk Recovery Center, ensures that you are equipped to safely experience life without your drug of choice.
Can Suboxone Treat Kratom Addiction
As kratom is still relatively new to the recovery community in the western world, there is no concrete treatment plan on how to treat KUD. However, Suboxone (or the FDA-approved generic buprenorphine/naloxone) has been shown to transition kratom users to Suboxone maintenance to recover from KUD in many case studies. In the Journal of Addiction Medicine, a case study from 2018, showed “that buprenorphine can be used to treat kratom dependence and underlying chronic pain that drives its use.” A newer study published in the March-April 2021 issue of Journal of Addiction Medicine outlined an empirically based hypothesis “that there would be a correlation between the amount of kratom used and the amount of buprenorphine-naloxone required for opioid agonist therapy.” Accounting for eight case studies, the researchers used the Pearson correlation coefficient calculation and found a strong correlation of 0.84 between these variables, consistent with the researchers’ hypothesis. At Boardwalk Recovery Center, we not only deliver the necessary medical care to people struggling with kratom abuse, but also encourage our clients to heal through talk therapy, group process sessions, and the development of positive skills for curbing drug use.
Combining Suboxone and Kratom
Can you take Suboxone and kratom at the same time? Well-established research has shown that kratom is dangerous when co-ingested with other drugs. In addition to the fact that Suboxone is used to wean people off of kratom, there is a lack of support from health professionals when it comes to combining the two substances. If you consider the biological mechanisms of the drugs, they are both partial opioid agonists that work to prevent or block opioid receptors from firing properly. When these agonists are taken together, they have the potential to “potentiate” each other, meaning that their function will be enhanced by their collaborative effects. While it may seem beneficial that these drugs would work even better to lower the opioid receptors in the individual using drugs, there is a danger in experiencing respiratory arrest due to the suppressed function. While respiratory arrest is not inevitable, the possibility remains. An even more prevalent side effect from mixing kratom and Suboxone is a feeling of euphoria. Experiencing this high defeats the purpose of opioid receptor agonists. Considering all the case studies and research, Suboxone has proven to be effective on its own without the intense withdrawal and euphoric high that comes with kratom. Suboxone’s optimal function can decrease or become life-threatening when taken in combination with kratom.
Coming off of drugs is the goal in recovery. Play it safe and listen to your healthcare professional’s expert opinion. Keep in mind that when powerful drugs are taken together they can have unexpected and undesired effects. At Boardwalk Recovery Center, we are proud to have a staff that is well-equipped to consider how drugs interact with one another and what they do in the human body that is in recovery.