Raul J. Rodriguez, M.D., DABPN, DABAM


The word “natural” can be very misleading when used in marketing campaigns for consumable products. People often assume that natural products are safe and healthy. This actually is true much of the time, but not always. There are 2 “natural”, plant-derived products that have been rapidly growing in popularity, but are far from safe and are certainly not healthy. Kava-Kava and Kratom are widely promoted online and locally in Kava bars as having relaxing properties and many health benefits. Most individuals who start to consume these products have no knowledge of the inherent risks.

Kava-Kava, also known as Yaqona, has been traditionally consumed in many Polynesian Island cultures for its relaxing effects on the human brain. In places such as Vanuatu, Fiji and parts of Australia, it has been used for medicinal, religious, political, cultural and social purposes. Formal Yaqona ceremonies will often accompany important functions, usually involving a ritual presentation of the bundled roots as a sevusevu or gift, and drinking of the Kava itself. The significance and respect that Kava holds in these cultures is evident. The complications that it can cause are becoming increasingly evident now as well.

When someone walks into a Kava bar, the last thing they are thinking of is going away to rehab in the next few months. Kava actually does have relaxing properties. The problem is that it can be abused and cause physical dependence with regular usage. The Polynesian cultures have depicted in great detail the patterns of abuse with this substance as well as the physical manifestations. Heavy users exhibit overall poor health, a swollen face, and scaly rash. In a manner resembling what happens with heavy regular use of alcohol and sedatives, cessation of regular use of Kava can also lead to a chemical withdrawal syndrome. This syndrome is characterized by anxiety, tremor, sweating and possibly even seizures. These problems can develop in an individual without any prior addiction problems.

Kratom is another popular Kava bar item and has even greater physical dependence implications. Kratom is a leaf collected from a tree in the coffee family that has significant psychoactive properties. There are many purported medicinal uses for this substance, including serving as a natural alternative to treat depression, anxiety, addiction, diabetes, chronic pain and fatigue. Many individuals experience an increase in energy, elevations of mood, relief of pain and a general sense of well-being when on Kratom. The effects wear off and then the natural inclination is to take more. The benefits can be reproduced but soon physical dependence develops. The nature and severity of the physical dependence caused by regular Kratom use resembles that seen with opioids such as oxycodone and heroin. Affected individuals experience flu like symptoms, sweating, goose flesh, hot and cold flashes, body aches, leg cramps, weakness, fatigue, depression, nausea, vomiting and diarrhea. These symptoms usually last a week or longer in a dependent individual. Most people cannot stand it longer than a day or two and go back on the Kratom. It is at this point that individuals feel trapped and do not know how to get off. A full inpatient or outpatient opioid detoxification is required at that point. I have detoxed numerous such individuals that have been caught in this chemical trap. This effect is especially prominent in anyone who has a history of opioid addiction.

Individuals with a history of addiction, even with an otherwise strong recovery, are especially vulnerable to the chemical effects of Kava and Kratom. They usually develop physical dependence very quickly, or are triggered to relapse onto their drug of choice.
Some Kratom products that are made with grain alcohol will also cause full alcohol dependence as well as the opioid dependence. These substances are an ever-present threat on the internet. Local recovery communities, including the one in Delray, are devastated by all of the relapses caused by Kava bars selling to unsuspecting and vulnerable individuals. This has been made worse by the deliberate strategic placement of Kava in close proximity to hallway houses and recovery-meeting houses. The problem has grown to such a degree that specialty drug testing laboratories have long since developed tests to detect Kratom. Drug testing helps create accountability for vulnerable populations and facilitates early detection of a relapse.

The number of relapses caused by these substances is alarming and community efforts have arisen to try and address the problem. A number of municipalities, including both Broward and Palm Beach Counties, have made attempts to ban Kratom. Both of these local
counties were unsuccessful in this endeavor. I actually testified at one of these county commission meetings. The degree of bias in favor of the Kava bars that was demonstrated by some of the county commissioners was obscene. This matter finally reached the state level though and an actual statewide ban was passed at one point. Due to misleading public outcry from the consumers and purveyors of Kratom, this measure was thwarted and the substance remains legally and readily available. As of yet, nothing definitive has been done to curtail the negative community effect of these establishments and the problem continues to worsen. The urgency of the escalating heroin and fentanyl crisis has also drawn some attention away from this recalcitrant problem. Really it is all part of the same opioid epidemic, just the more insidious and less recognized part of it. Greater awareness and vigilance with regards to the high risks of consuming these substances, especially for individuals in recovery, will continue to be the primary means of trying to contain this public health crisis until a definitive legal solution can be found.

Dr Rodriguez is the founder and Medical Director of the Delray
Center For Healing, the Delray Center for Brain Science, and the
Delray Center For Addiction Medicine. He is board certified in
both Adult Psychiatry and Addiction Medicine, with a clinical focus
on Treatment Resistant Depression, Bipolar Disorder, Anxiety
Disorders, Addiction and Eating Disorders. The Delray Center is
a comprehensive outpatient treatment center that incorporates the
most advanced psychotherapeutic and medical modalities, such as
Dialectical Behavioral Therapy (DBT) and Transcranial Magnetic
Stimulation (TMS), in the treatment of complex and dual-diagnosis