Table 2.

A sample of quotes from top kratom subreddit posts made between June 2019 to July 2020 detailing kratom self-treatment, kratom opioid substitution, and kratom addiction, tolerance, and withdrawal.^±

Kratom self-treatment for SUD, drug dependence, or drug withdrawal	Long-term use as opioid substitute	Kratom addiction, tolerance, and withdrawal
“I had a comparable experience switching to kratom. I went *cold turkey* off 100 mg of METHADONE, and it worked 100%. There were no withdrawals, and even a little relaxation and euphoria.” “I’ll admit, kratom absolutely helped me decrease my daily amount from around 600mg to around 300mg, but I still have a long way to go.” “After realizing that 100mg of hydro at once wasn’t even doing the trick anymore, I “quit” using it with the help of kratom, the “fantastic and not at all harmful” plant. Two years of excessive kratom use later, I was forced to quit by way of a six-month backpacking trip to South America.” “I’ve been taking it since the first day of withdrawal, and it makes me feel ALMOST entirely normal. I still feel slightly out of it, but have been experiencing no chills, shits, global apathy, or body pain. Though I’m still taking quite a bit at once.” “in the last three to four months I’ve begun IV use and it could just be me, but the withdrawal seems so much worse now. Kratom is barely helping at this point” “I took kratom for several weeks and that really sustained me, likely couldn’t have quit [hydrocodone] without it.” Self-treating alcohol abuse with kratom I went into a drinking spiral that went on for 2 years, but I gave it up about 9 months ago. My friend told me to try kratom for withdrawals, and it really really helped. A lot. I haven’t had the urge to drink since then. Still, I nearly killed myself on several occasions when I was still drinking. Kratom has helped me stay sober, and I’m never going back to that life. “I was arrested again after blacking out, so I finally made the decision to not drink alone anymore - like most of my drinking for the last twelve years. I considered getting totally sober, but I have a medical weed card so there’s constant access and when alone, I know I can’t be sober for very long. Kratom has mostly relieved my withdrawals, so that’s good.”	“So now I’ve totally stopped using traditional opiates and opioids (I still take kratom, and plan to use kratom so long as availability persists). It easily changed my life.” “Essentially, compared with my relationship to alcohol and compared with others’ drug habits, kratom is a miracle. My life has become infinitely better - my job, marriage, really all of my relationships, fitness, general happiness! I use kratom once a day and sometimes take days off to get better effects. It saved my life.” “I let my doctor know that I’ve been using kratom for around two years for medicinal purposes and it does wonders to help me avoid using other opioids.” “I dosed 1.5g twice on my first day, and I thought, “no way”. I didn’t have restless legs. and my anxiety was lessened. It felt subtle, but oh my god, it was working!! I’m on my fourth day of kratom, and it is working. It’s been a miracle to me. I even passed up a connection for pills. I could never do this without kratom.” “I am so grateful for Kratom and thankful that I don’t have the temptation to search for pills whenever I visit someone’s home. I’m so thankful I no longer get late night panic attacks thinking of the opioid feelings. I’m so thankful I don’t have to contend with the constant urge to get back into what I left behind.” “Without kratom I would certainly be a drunken wreck today. I really wish more people were aware of kratom and how much it helps.” “I felt so fucking hopeless about ever living a normal life again. Heroin held its grip on me, and I was stuck. Some time passed and after some help from friends and family, I found kratom. Kratom relieved nearly all of the withdrawals and I got clean without feeling too sick. I was home free after the first 3-4 days I was home free.”	“In retrospect, I was addicted within six months, but I wouldn’t even consider the possibility until about 2 years ago, and it’s only been during the most recent weeks that I have admitted that this is an addiction.” “I now average around 3g - 4g per day and have for around two years so I can’t speak for people that use more, but physical withdrawals are typically minor (like a cold) and last three to four days. I’m sure if you’re using 50g per day, they’ll be much worse.” “Coming down off kratom feels similar to that of a mild anti-depressant and mild opiate… also reminiscent of Tramadol.” “The dependency is so fucking real both mentally and physically” “I’ve been off kratom for a year, but remembering the days when I was actively addicted scares me. I had little to no control over my impulses, emotional control, stuttering, poor comprehension, memory problems, and a short attention span.” “I take up to 20 grams/day now, but I re-up every couple hours and withdrawal hits really quick. I start to feel extremely uncomfortable and anxious after going more than two hours without kratom, and every morning I wake up in agonizing withdrawal. I had a full blown panic attack the last time I attempted quitting, causing my mental health to spiral out of control.” “This week I have cut down to 2.5g doses, and when the withdrawals are at their worst, I use about 16g per day (which is good for me). The withdrawals kick in at night are the most troublesome, and I’m having to dose at 2am then 6am. The restless legs and the agitation are the most severe - right along with the hot sweats and cravings to use more and make all the pain go away.” “Emotionally, it feels good to have told them, but physically, this is absolute complete hell. The worst part is the painful tingly feeling on my skin - on my arms but all over, lack of appetite, and the blacking out that happens from being dizzy when I stand up. I used to get that feeling as a runner, before I started using kratom but forgot how extreme it is. I can’t even focus on the show I planned on watching.” “It’s difficult to explain to people that haven’t experienced withdrawals of any kind. People understand having lethargy, aches, a runny nose, or nausea. Much harder to portray is the anxiety, restless legs, and sense of uneasiness, which is far and away the worst - especially when trying to sleep at night. It’s brutal when the seconds feel like hours. I struggle to explain how it actually feels even worse than what it sounds.” “I attempted a taper, but it didn’t work, and now I’m having severe withdrawals, anxiety, diarrhea, hot/cold sweats and the infamous legendary restless legs syndrome.” “My problem began when I no longer got the same feelings and effects that I had originally. I started using more and was shocked to see that before long, I was taking approximately 12g, four times a day.”

^±Upon recommendation the quotes that appear in this table do not appear verbatim. Some were taken from longer post excerpts. All have been slightly modified to help safeguard the privacy of the people who posted on Reddit and whose data were examined as part of this investigation (e.g., making reverse searching the posts more challenging). We have done this while attempting to retain substance and richness as close to the original post as possible, which is of scientific and clinical interest.