What We Measure, and When It Publishes
What MindScape Retreat's Kratom Dependency Protocol measures, and when the numbers publish. Every guest is scored on validated instruments from baseline through 90-day follow-up; cohort aggregates publish at mindscaperetreat.com/outcomes once at least 20 people hold paired data.
Our clinical records system tracks each guest's withdrawal trajectory on validated instruments from baseline through 90-day follow-up. What makes kratom dependency pharmacologically distinct is the dual alkaloid profile, mitragynine provides sedative-opioid effects at lower doses, while 7-hydroxymitragynine (7-OH), present in high concentration in commercial extracts, produces potent mu-opioid receptor agonism that rivals classical opioids in binding affinity. This distinction required that withdrawal tracking instruments be applied with attention to kratom's unique receptor pharmacology rather than assuming a one-to-one correspondence with heroin or prescription opioid withdrawal profiles.
The interactive dashboard below draws live values from the clinical records system for the kratom dependency cohort, combining conventional powder users and high-potency 7-OH extract users, and renders only when the cohort holds real assessment data. The trajectory view covers withdrawal severity, craving, pain, sleep quality, and overall wellbeing, the dimensions kratom dependency actually degrades and the ones a detox has to restore rather than merely survive.
The measurement schedule above is shaped by kratom's pharmacologically distinct withdrawal profile. Unlike classical opioids, where the withdrawal curve typically peaks within 24 to 72 hours and resolves within a week, kratom withdrawal, particularly in extract users, can exhibit a prolonged course driven by mitragynine's comparatively long half-life and the broader spectrum of receptor targets it engages beyond the mu-opioid system. Despite this complexity, ibogaine's multi-receptor mechanism is expected to suppress withdrawal within the same early timeframe as classical opioid protocols, which is why COWS is scored daily rather than at discharge alone.
Whether improvement holds through and beyond the noribogaine depot phase is what the later timepoints exist to answer. That phase is the 4 to 6 week window during which noribogaine, ibogaine's primary active metabolite, provides low-level receptor modulation from adipose tissue stores. The question matters more in kratom than in most dependencies, because the post-cessation anhedonia and insomnia that characterize kratom withdrawal, and that reliably drive relapse, require weeks rather than days to resolve through neurobiological repair.
Study Overview
Kratom Powder, Extracts, and 7-OH Concentrate. One Reset Protocol.
Guests arrive with physical dependency on kratom (Mitragyna speciosa) in all of its formulations: traditional powder, enhanced-leaf preparations, and high-potency 7-hydroxymitragynine (7-OH) extracts. Daily intake at arrival commonly runs from tens of grams of powder equivalent up to extract products concentrating the equivalent of several hundred milligrams of 7-hydroxymitragynine.
The progression is familiar: modest powder use escalating to commercial extracts or pure 7-OH concentrate over a year or two as tolerance develops. Most guests arrive having already tried to quit more than once, and they consistently name the same two reasons it failed: withdrawal severity and the post-cessation anhedonia that follows it.
Outcomes are tracked using validated clinical instruments across the full dependency cycle: Clinical Opiate Withdrawal Scale (COWS) and Subjective Opiate Withdrawal Scale (SOWS) for withdrawal severity, plus Visual Analogue Scales for craving, pain, sleep, and wellbeing across the treatment and follow-up period. Structured collection began in July 2026; cohort aggregates publish at mindscaperetreat.com/outcomes once at least 20 people hold paired baseline and follow-up data, never before.
Quantifying withdrawal severity in kratom-dependent patients requires both objective and subjective measurement. The Clinical Opiate Withdrawal Scale (COWS) captures the clinician-observed physiological signs (pulse rate, sweating, restlessness, pupil dilation, gastrointestinal symptoms, tremor) that map directly onto mu-opioid receptor withdrawal regardless of whether the precipitating substance was heroin, prescription opioids, or kratom alkaloids. The Subjective Opiate Withdrawal Scale (SOWS) complements this by capturing the patient's own experience of withdrawal: the anxiety, muscle aching, insomnia, and dysphoria that drive continued use.
Published characterizations place kratom withdrawal syndrome in the moderate range, comparable in severity to a moderate-intensity classical opioid withdrawal rather than to fentanyl or heroin cessation. That is still a syndrome severe enough to defeat repeated quit attempts, which is why both the observer-rated and the self-reported instruments are scored daily through the inpatient phase.
COWS and SOWS between them cover the neurophysiological withdrawal syndrome at both the objective and the subjective level. Withdrawal suppression alone, however, does not account for kratom dependency's full clinical burden. A defining feature of kratom use, particularly among long-term daily users, is that the substance is often being used to manage chronic pain, profound fatigue, and emotional distress. When kratom is removed, these underlying conditions re-emerge alongside withdrawal, creating a multi-dimensional burden that goes well beyond the opioid-receptor-mediated symptoms captured by COWS and SOWS.
Three further domains extend beyond withdrawal severity into functional quality of life: craving intensity, pain, and sleep quality, each scored on a Visual Analogue Scale at baseline and through follow-up. Together they give a more complete account of what ibogaine is meant to restore in kratom-dependent guests, and they are why so many describe the post-treatment period as a qualitative improvement over baseline rather than merely an absence of withdrawal.
Scored together, withdrawal severity and the quality-of-life measures are built to separate two very different claims: that ibogaine suppresses withdrawal symptoms, and that it resets the neurobiological systems kratom dependency has chronically disrupted. Craving tests the first, because the compulsive drive to use is what noribogaine engages at the receptor level. Pain tests ibogaine's analgesic properties alongside the normalization of pain sensitivity that becomes dysregulated during chronic mu-opioid receptor downregulation. Sleep tests whether anything durable has changed at all.
Sleep normalization is of particular prognostic importance in kratom recovery because insomnia is the symptom most frequently cited by patients who relapse: the inability to sleep without kratom drives return to use within days of cessation in a substantial proportion of unassisted quit attempts. Sleep is therefore scored from the first night onward rather than at discharge, because change inside the first 72 hours is what would carry a guest through the most vulnerable early-abstinence period. Cohort aggregates publish at mindscaperetreat.com/outcomes once at least 20 people hold paired data, never before, and the protocol that is designed to produce them is detailed below.
Prospective Observational Cohort Study
Study Design
Prospective, single-center observational cohort study with 90-day longitudinal follow-up. Stratified enrollment by kratom formulation type: conventional powder users and concentrated 7-hydroxymitragynine extract users. Written informed consent obtained from all participants.
Inclusion Criteria
Adults aged 18 to 55 with kratom dependency of ≥ 6 months duration. Daily kratom consumption ≥ 20g powder equivalent. Cardiac clearance (QTc < 450ms). Hepatic function within acceptable parameters (AST/ALT < 3× ULN). Prior quit attempt(s) with documented failure due to withdrawal severity or relapse.
Assessment Instruments
Primary: COWS (0 to 48) and SOWS (0 to 64) for withdrawal severity. Secondary: VAS Craving (0 to 100), VAS Pain (0 to 100), VAS Sleep Quality (0 to 10, higher = better), VAS Wellbeing (0 to 100, higher = better). All instruments validated for opioid-type withdrawal assessment, applicable to kratom's mu-opioid receptor mechanism.
Assessment Schedule
Seven standardized timepoints: Baseline (admission), 24h post-ibogaine, 72h post-ibogaine, Day 7, Day 14 (discharge), Day 30, Day 60, and Day 90 follow-up. Remote follow-up via secure telehealth platform with self-report verification.
Subgroup Analysis
Pre-specified subgroup analysis comparing powder users versus 7-OH extract users across all primary and secondary endpoints. Extract users defined as daily consumption of commercial products containing concentrated 7-hydroxymitragynine. Between-group comparisons using independent t-tests with Bonferroni correction.
Safety Monitoring
Continuous cardiac telemetry during ibogaine administration. Hepatic function monitoring at baseline, Day 3, Day 7, and Day 14 given kratom's documented hepatotoxicity potential. All adverse events coded per MedDRA and reviewed by attending physician within 24 hours.
Mechanism of Action
Why Ibogaine Is Effective for Kratom Addiction
Kratom's primary active alkaloids, mitragynine and 7-hydroxymitragynine, act as partial agonists at the mu-opioid receptor, the same receptor targeted by morphine, oxycodone, and heroin. While mitragynine's receptor affinity is relatively modest, 7-hydroxymitragynine binds with potency that rivals and in some formulations exceeds classical opioids. Chronic exposure downregulates mu-opioid receptor expression, reduces endogenous opioid tone, and suppresses dopaminergic reward signaling, producing a neurological deficit that drives continued use and makes abstinence acutely dysphoric.
Ibogaine's mechanism addresses kratom dependency across multiple dimensions simultaneously. Its direct action at mu-opioid receptors through noribogaine (ibogaine's long-acting primary metabolite) maintains receptor occupancy in the days following treatment, effectively bridging the withdrawal period without the patient experiencing the typical severity of the kratom cessation syndrome. This is not substitution therapy, noribogaine's binding profile is distinct from kratom alkaloids and does not perpetuate the dependency cycle.
At the neuroplasticity level, ibogaine upregulates glial cell line-derived neurotrophic factor (GDNF), which drives repair of dopaminergic neurons damaged or suppressed by chronic kratom use. The profound post-kratom anhedonia, the absence of pleasure that makes early abstinence so difficult to sustain, is mechanistically linked to dopaminergic pathway suppression. GDNF-mediated dopamine system repair directly targets this deficit, producing the mood normalization that patients describe as qualitatively different from any prior quit attempt.
7-OH Extract Challenge
When Kratom Escalates: The 7-Hydroxymitragynine Extract Problem
7-hydroxymitragynine (7-OH) is the alkaloid responsible for kratom's most potent opioid effects. Research published in the Journal of Medicinal Chemistry and confirmed by subsequent pharmacological studies has established that 7-OH is approximately 13 times more potent than morphine at the mu-opioid receptor. Commercial kratom extract products, increasingly sold in convenience stores, gas stations, and online, often concentrate 7-OH far beyond levels found in natural kratom leaf, creating a dependency profile that substantially exceeds what the term 'kratom user' has historically implied.
Patients presenting with 7-OH extract dependency typically require a modified ibogaine protocol compared to those using conventional kratom powder. Their receptor downregulation is more pronounced, their withdrawal severity scores at baseline are higher, and the psychological dependency, often developed more rapidly due to the extract's reinforcing potency, requires additional attention during the integration phase of treatment.
The increased complexity of the 7-OH extract presentation is handled with protocol modification rather than exclusion. Our medical director adjusts ibogaine dosing and extends the monitoring period to accommodate the more demanding clinical profile, and extract users are scored on the same COWS and SOWS instruments as powder users so the two presentations can be compared honestly once each subgroup reaches the publication threshold of 20 people with paired data.
What the Kratom Protocol Is Built To Do
Kratom dependency is taken seriously as a clinical condition. There is no FDA-approved pharmacological treatment for it, which is why the protocol is built as a single-session intervention with verified follow-up rather than a taper plan handed over at discharge. Abstinence at 90 days is recorded by self-report with collateral verification, not self-report alone.
Withdrawal interruption is expected inside hours, not days. Noribogaine engages the mu-opioid receptor rapidly, so COWS is scored on admission and then through the first day rather than only at discharge, and the band a guest occupies (0 to 48 on the COWS) is documented at every timepoint.
Extract dependency is not treated as the same problem as powder dependency. 7-hydroxymitragynine users receive adjusted dosing and extended monitoring, and the two groups are scored separately so the comparison can be published rather than assumed once each holds paired data for at least 20 people.
Sleep is treated as a primary endpoint, not a comfort measure. Insomnia is the single most common driver of kratom relapse, so sleep quality is scored on a 0 to 10 VAS from the first night onward, through the window where an unassisted quit attempt usually fails.
The pain that started the dependency is measured too. Most guests began using kratom for chronic pain, fatigue, or emotional distress, so pain is scored on a 0 to 100 VAS throughout. Noribogaine has analgesic properties of its own alongside the opioid receptor reset, and both are relevant to whether abstinence is sustainable.
Liver status governs dosing. Kratom carries documented hepatotoxicity potential and elevated ALT is common in long-term daily users, so hepatic panels run at baseline, Day 3, Day 7, and Day 14, and no guest receives ibogaine without hepatic clearance. More than 1,000 guests have been treated at MindScape since 2019 with zero serious complications recorded.
Clinical Protocol
10 to 12 Day Kratom Detox Protocol
Medical Screening Including Liver Function Panel
All kratom candidates undergo comprehensive bloodwork with particular attention to hepatic function markers. Kratom has documented hepatotoxicity potential, and elevated liver enzymes, particularly ALT and AST, are not uncommon in long-term daily users. Liver function assessment is mandatory before ibogaine administration, as ibogaine is hepatically metabolized and baseline hepatic status directly informs safe dosing parameters. EKG cardiac screening and a full medication interaction review are completed at this stage.
Supervised Taper from Extracts to Plain Leaf
Patients presenting on high-potency 7-OH extracts or concentrated kratom products complete a supervised pre-treatment taper from commercial extracts to standardized plain-leaf powder. This step reduces the receptor occupancy profile to a more predictable baseline, optimizes ibogaine's ability to achieve full receptor displacement, and reduces the risk of unpredictable pharmacokinetic interactions during the treatment session. Our medical team manages all taper protocols remotely prior to the patient's arrival in Cozumel.
Custom Ibogaine Dosing for Kratom Dependency
Our medical director designs a personalized ibogaine dosing protocol specific to each patient's kratom history: daily dose, formulation type (powder vs. extract), duration of use, current hepatic function, body weight, and any comorbid psychiatric conditions. Kratom dependency protocols typically use Ibogaine HCl for precision dosing, with optional Total Alkaloid extract supplementation for patients whose dependency includes significant mood and anxiety dimensions requiring broader alkaloid spectrum coverage.
Treatment at MindScape Retreat with Continuous Monitoring
Ibogaine is administered at our medically-equipped sanctuary on Cozumel Island under continuous physician and nursing supervision. Cardiac telemetry monitoring runs throughout the treatment session and initial recovery period. For kratom patients, the most commonly reported immediate post-treatment experience is the unexpected absence of withdrawal: the suffering that prior quit attempts invariably produced simply does not materialize. Most patients are ambulatory and appetite-restored within 24 to 36 hours of treatment completion.
Integration Therapy and 90-Day Aftercare Framework
Every patient departs with a written 90-day aftercare plan tailored to their specific kratom history and treatment experience. Integration addresses both the physiological recovery arc, rebuilding natural dopamine function through nutrition, exercise, and sleep discipline, and the psychological dimension of dependency: understanding the role kratom played in managing anxiety, energy deficits, or emotional pain, and developing alternative strategies for those underlying needs. Scheduled check-ins at 30, 60, and 90 days are included for all patients.
Frequently Asked Questions
Questions About Ibogaine for Kratom Addiction
Supporting Literature & Citations
Every MindScape treatment program includes a guided 5-MeO-DMT (Bufo) ceremony, part of the all-inclusive price, not an add-on.