From Kratom to Suboxone: What to Know About Switching

Maybe this situation sounds familiar: You were struggling with opioid use disorder (OUD), but traditional treatment options never felt all that accessible. Or maybe the approach you tried wasn’t doing enough to ease your withdrawal symptoms or cravings. 

You heard from a friend that kratom helped, so you gave it a go. It seemed like such an easy fix. But the results have been unpredictable, leaving you swinging from feeling okay to feeling awful, from one day to the next, or even from hour to hour.  

Kratom is marketed as “natural,” doesn’t require a prescription or monitoring, and is available at a host of vape shops, gas stations, convenience stores, and even some cafés or bars. These factors make it an appealing potential harm-reduction option.

In recent years, more than 5 million people in the United States have used kratom, especially people with a substance use disorder, according to research in the Journal of Addiction Medicine.

“People turn to kratom because they are trying to solve a problem,” says Patricia Pechter, MD, a collaborating physician for Boulder Care. “Some people are trying to relieve pain or anxiety or to induce relaxation. Some are trying to relieve withdrawal symptoms or stop opioids without seeking medical care.” 

But kratom can also leave you feeling just as unstable as when using other opioids, such as heroin, fentanyl, and oxycodone. 

Suboxone, on the other hand, is an FDA-approved medication for treating OUD that actually does leave you feeling stable with fewer cravings. But it can be tough to make the switch when kratom seems like an easy fix.  

This article explores how kratom and Suboxone affect the body, why Suboxone works differently from kratom, what the research says, and how to make the switch from kratom to Suboxone if that’s your goal.

Kratom is a plant-derived substance that comes from a tree native to Southeast Asia. “What many people don’t realize is that kratom contains compounds that act on the same opioid receptors as prescription opioids,” Dr. Pechter says. 

Kratom is not an opioid itself. The 7-hydroxymitragynine (7-OH) compound found in kratom is a potent partial agonist at the mu-opioid receptor. “Although it isn’t a pharmaceutical opioid like oxycodone or morphine, it can produce opioid-like effects,” Dr. Pechter says. 

For this reason, it carries the risk of addiction, complete with the tell-tale issues of withdrawal symptoms and cravings for more when its effects wear off, according to research in the journal Current Drug Targets. It can also cause fatal overdose.

Why 7-OH is different

Kratom in plant form contains trace amounts of 7-OH.  But many kratom mimicking products sold in the United States are in fact made of a highly concentrated synthetic (meaning manmade) or partially synthetic form of the “7-OH” compound — and are advertised as such. 

To be clear, both forms, whether found in the kratom plant or synthetic “7-OH” versions, can be addictive and lead to fatal overdose, but synthetic products hold the greater risk.

The federal government is currently working to take 7-OH off store shelves due to the health risk it poses. 

One reason why kratom can leave lots to be desired when managing OUD is that commercially sold kratom products typically contain much higher concentrations of 7-OH than what would be found in the natural leaf. 

These products are not regulated by the U.S. Food and Drug Administration (FDA), so concentrations are all over the place from product to product, according to research in the Journal of Addiction Medicine.

“When treating opioid use disorder,” Dr. Pechter says, “our goal is to create stable activation of the opioid receptors so that patients aren't constantly cycling between feeling okay and feeling sick.” 

Medications for opioid use disorder (MOUDs) are designed to do that by creating stable medication levels in your system. The high variability in potency and ingredients between kratom products makes achieving that stability quite difficult. 

“For some people, kratom may temporarily lessen withdrawal symptoms,” Dr. Pechter says. “But because its effects are often unpredictable, it usually doesn't provide the reliable receptor stability that FDA-approved medications like buprenorphine or methadone are designed to provide.”

Additionally, kratom use can lead to tolerance, meaning that you will likely need more and more kratom over time to produce the same effects, according to research in the journal Drug and Alcohol Dependence Reports. Stopping kratom, or reducing use, leads to withdrawal symptoms and cravings, similar to those encountered when stopping opioids.

Suboxone is a prescription MOUD that contains the medications buprenorphine and naloxone. Buprenorphine binds tightly to opioid receptors but doesn’t activate them all the way. This helps ease withdrawal and cravings without the intense rush or sedation caused by other opioids.

Naloxone is included to cancel the effects of buprenorphine if the medication is not used as prescribed, as would be the case with snorting or injecting. But when Suboxone is used as prescribed, naloxone has no effect.

“Suboxone is one of the most extensively studied treatments for opioid use disorder,” Dr. Pechter says. “Decades of research have shown that it reduces withdrawal symptoms, decreases cravings, lowers the risk of overdose, and helps people stay engaged in treatment.”

Buprenorphine has what’s called the “ceiling effect.” This means that higher doses do not cause further effects, such as dangerous respiratory depression. In contrast, full opioid agonists — such as heroin or fentanyl, and even 7-OH — can cause fatal overdoses. 

Additionally, Suboxone is FDA approved, so you can count on consistent dosing.

The evidence for switching to Suboxone after kratom is promising but limited. Right now, the research consists of case reports and smaller studies, rather than large randomized clinical trials.

The medical community treats kratom dependence as an OUD-like condition that responds to opioid-based treatment, according to the journal Drug and Alcohol Dependence. And using Suboxone for kratom withdrawal appears to work in much the same way that using Suboxone for opioid withdrawal does. 

The Journal of Psychoactive Drugs published a case report on a 47-year-old who turned to kratom after his prescription for opioids ran out. He used kratom for a year to treat opioid withdrawal symptoms and chronic pain.

But he developed worsening depression, anxiety, and pain, and he’d developed a kratom tolerance and withdrawal symptoms. 

The clinic he presented to prescribed buprenorphine-naloxone. Follow-up at four months found that his depression and anxiety had resolved.

Another case study with a 40-something patient, presented in the journal Cureus, shows similar results. The study authors wrote, “The patient was successfully treated with buprenorphine/naloxone, which helped alleviate his withdrawal symptoms and allowed him to abstain from kratom.”

Are you wondering if you can take kratom and Suboxone at the same time? Don't do it. Mixing kratom with Suboxone can cause severely unpleasant effects because kratom interacts with Suboxone. 

“Buprenorphine binds much more tightly to opioid receptors than the active compounds in kratom,” Dr. Pechter says. “If someone starts Suboxone too soon after using kratom, buprenorphine may displace those compounds from the receptors before the body is ready, triggering what's called precipitated withdrawal.”

 Precipitated withdrawal involves the sudden and intense symptoms that ensue when buprenorphine kicks kratom, or any other opioid, off opioid receptors too quickly.

If you’re considering switching from kratom to Suboxone, your prescribing provider will guide you on how to do so. 

General guidance suggests waiting to start Suboxone until you are in early to moderate withdrawal. But do not attempt to manage the transition without medical support. “Starting Suboxone at the right time, and under the guidance of a clinician whenever possible,” Dr. Pechter says, “can make the transition much smoother.”

Suboxone is usually taken daily as a dissolvable film or tablet placed under the tongue. You take it while under the guidance of a medical professional.

“The goal is to start buprenorphine in a way that minimizes withdrawal while finding the lowest effective dose that controls cravings and withdrawal symptoms,” Dr. Pechter says. “For many patients, this means waiting until mild to moderate withdrawal has begun before taking the first dose.”

Keep in mind that the transition from kratom to Suboxone can be somewhat trickier than transitioning from an opioid to Suboxone. This is because the variable concentrations of 7-OH across kratom products create difficulty in determining the substance’s true half-life. A half-life of a drug is the time needed for 50% of it to be out of your system. 

Your kratom use history, including how much you’ve been using and specific products, can inform what dose of Suboxone you'll start on.

“In some situations, individuals may instead choose a low-dose or ‘micro-induction’ approach that gradually introduces buprenorphine while reducing kratom,” says Dr. Pechter.

When you get your dosage figured out

Once you’re on Suboxone, you can stay on it for months, years, or indefinitely. A common myth regarding Suboxone, whether switching to it from kratom or an opioid, is that you’re “trading one addiction for another.” 

However, the truth is that addiction changes your brain chemistry over time. This is true whether the addiction is to heroin or kratom. Suboxone helps stabilize your brain chemistry to interrupt the cycle of drug-seeking, feeling better, feeling sick, followed by more drug-seeking. 

Suboxone essentially helps get you out of the survival mode that addiction places you in so you can focus on all aspects of your recovery.

Proponents of kratom also champion the idea that kratom is “natural,” but, as noted earlier in the article, most of the commercial kratom products in the U.S. market are partially or completely synthetic.

Kratom also lacks evidence as a therapeutic recovery tool.

Can I take kratom while also on Suboxone?

Taking kratom while also on Suboxone is not recommended, as it can lead to precipitated withdrawal, severe withdrawal symptoms, and other negative side effects.

Can Suboxone help with kratom withdrawal?

Suboxone can help with kratom withdrawal, according to case studies, but making the transition under the guidance of a medical professional is the safest bet to avoid adverse symptoms. The timing of the transition and your use history matters.

Can kratom be used to treat opioid use disorder?

Kratom is not recommended for the treatment of opioid use disorder because it behaves like an opioid (though it isn’t one) and can lead to tolerance, in which you need higher and higher doses to get the same effects. It also leads to withdrawal symptoms and cravings when stopped.