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Kratom & Suboxone: Understanding the Dangers

Suboxone is used to treat opioid use disorder (OUD) as part of a medication-assisted treatment (MAT) program, while kratom is commonly used recreationally for its qualities that are similar to opioids and stimulants. In addition, people use kratom to self-treat opioid withdrawal, but the U.S. Food and Drug Administration (FDA) has not approved this use.[1] 

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Is It Safe to Take Kratom & Suboxone Together?

Consuming multiple substances at once is generally never a safe idea. 

Taking kratom and Suboxone at the same time is not safe and can lead to serious health consequences. A recent study evaluating the health risks of kratom identified an increase of serious medical events following kratom use, especially when combined with other substances.[2]

Kratom is a plant from Southeast Asia that can produce a high similar to that of opioids. It has gained popularity in recent years by people using it to self-treat OUD. Because it has opioid-like effects, it may be able to reduce symptoms and discomfort associated with opioid withdrawal.[2]

However, kratom use also poses a risk of addiction, which may be treated with Suboxone as part of an MAT program. Because Suboxone is a treatment for kratom addiction, it is not safe to take the substances together. If traces of kratom are left in the person’s system when they begin Suboxone treatment, negative side effects can occur. 

Comparing Kratom vs. Suboxone 

Kratom and Suboxone are two substances that have opioid-like effects, but to varying degrees. Kratom can produce a high that is similar to that associated with other opioids, while Suboxone is designed to not induce a high or the addictive experience of opioids. 

The chart below outlines how Kratom and Suboxone compare:[3,4]

Type of DrugNatural plantOpioid antagonist
Addictive PotentialYes Low
Effectiveness for OUD TreatmentUnknownHighly Effective
Withdrawal SymptomsYes Unlikely if cessation of use is managed
FDA ApprovalNo, which means its use is not regulated and people using it are self-administering for its opioid-like effects or to self-treat OUD Yes, highly regulated and prescribed by a medical professional for the treatment of OUD
Adverse Side EffectsNausea, itching, sweating, dry mouth, constipation, increased urination, vomiting, irregular heartbeat, vomiting, drowsiness, weight loss, seizure, insomnia, and hallucinationsConstipation, headache, nausea, dizziness, vomiting, fatigue, sweating, dry mouth, insomnia, fever, blurred vision, muscle cramps and pains, and heart palpitations 
FormsTablet, capsule, extract, powder, or leafSublingual film 

Suboxone is recognized as a safe treatment method for a kratom addiction. Use can begin as soon as eight hours after last exposure to kratom.[5]

Why You Should Not Take Kratom & Suboxone Together

Kratom and Suboxone should not be taken together. Doing so can lead to negative side effects and precipitated withdrawal.[6]

Kratom produces opioid-like effects, including the potential for respiratory depression.[7] Since buprenorphine (the primary ingredient in Suboxone) is also a central nervous system depressant, combining these two substances can be dangerous, potentially leading to slowed or even stopped breathing.

Precipitated withdrawal involves the onset of rapid and uncomfortable withdrawal symptoms, such as nausea, vomiting, muscle aches, shaking, anxiety, and restlessness, among others.[8] If you experience precipitated withdrawal, seek medical care immediately.

Dangers of Combining Both Substances

Polysubstance use, or combining multiple substances at once, can be very dangerous, as drug effects are often intensified when mixed.  The active ingredients in kratom act on opioid receptors in the brain, just like Suboxone. Both kratom and Suboxone have similar side effects, including sedation, pain relief, and possible irregular heartbeat.[9] 

Combining kratom and Suboxone increases the risk of more serious negative side effects associated with each substance. A 2019 study on kratom use found that people who mixed kratom with other substances were more likely to require admission to a healthcare facility and more likely to experience serious medical problems than people who only used kratom.[2] 

If you are taking Suboxone as part of MAT, using kratom is a sign of relapse. If you have used kratom, talk to your treatment team about this. They can help you plan on how to get back on track with your recovery and avoid future kratom use.

Updated April 2, 2024
  1. FDA and kratom. U.S. Food and Drug Administration. Published 2019. Accessed March 18, 2024.
  2. Post, S., Spiller, H., Chounthirath, T., and Smith, G. Kratom exposures reported to United States poison control centers: 2011-2017. Clinical Toxicology. 2019;57(10):847-854.
  3. Drug fact sheet: Kratom. Department of Justice/Drug Enforcement Administration. Published April 2020. Accessed March 18, 2024.
  4. Buprenorphine. Substance Abuse and Mental Health Services Administration. Published March 8, 2024. Accessed March 18, 2024.
  5. Lei, J., Butz, A., and Valentino, N. Management of kratom dependence with buprenorphine/naloxone in a veteran population. Substance Abuse. 2021;42(4):497-502.
  6. Spadaro A, Faude S, Perrone J, et al. Precipitated opioid withdrawal after buprenorphine administration in patients presenting to the emergency department: A case series. Journal of the American College of Emergency Physicians Open. 2023;4(1).
  7. Chinnappan J, Casini D, Navari Y, Palanisamy N, Parikh N, Seedahmed E. Kratom-induced acute respiratory distress syndrome (ARDS). European Journal of Case Reports in Internal Medicine. Published March 29, 2023.
  8. Dunn KE, H. Elizabeth Bird, Bergeria CL, Ware OD, Strain EC, Huhn AS. Operational definition of precipitated opioid withdrawal. 2023;14.
  9. Arhin, M., Mobley, J., Hamad, H., and Remick, P. Successful management of kratom use disorder with buprenorphine and naloxone. Cureus. 2023;15(6).
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