Ketum is not new, and that is part of the problem. A Universiti Sains Malaysia (USM) study of nearly 300 ketum users in the north of the Peninsula found that 55 per cent, more than half, were severely dependent, and one in three had severe withdrawal symptoms when they tried to stop. Many families miss this because ketum is drunk in the open, at coffee shops and workplaces, the way other people drink coffee or tea.
How ketum is used
Ketum leaf (Mitragyna speciosa, also sold abroad as kratom) can be chewed fresh. In Malaysia it is more often boiled into air ketum, or ketum water, and sipped through the day, one glass after another. Some users mix it into a "cocktail" with fizzy drinks, cough syrup or other substances for a stronger effect. The Ministry of Health has run enforcement operations on the sale of cough syrup suspected of going into these mixes, and seized more than 100,000 bottles in a single operation in 2017.
In the USM study, every respondent was male, 85 per cent were in work and 46 per cent were aged 18 to 25. That matches what has long been known: ketum is common among labourers and manual workers in Kedah, Perlis and Penang, who drink it to keep going through the working day and ease tiredness, not to get high.
Why it is hard to stop
Some people start on ketum to get off other drugs. A study in Kedah and Penang found that many short-term ketum users had previously used heroin, and drank air ketum specifically to ease opioid withdrawal because it is cheap and easy to find compared with formal treatment. Another study, at Taiping Hospital, found that nearly half of the patients on a methadone programme (a prescribed medicine that replaces heroin) were also using ketum, especially those whose opioid withdrawal scores were still high. So ketum is often a way of treating yourself, and a social habit only some of the time. That is what makes it harder to stop without help.
The body also builds up tolerance to ketum itself. The USM study found that people who drank four or more glasses a day were far more likely to be severely dependent, and to have severe withdrawal symptoms, than people who drank less.
Signs of dependence
- The number of glasses a day keeps creeping up, and the day feels incomplete without it.
- Poor sleep and restlessness, the two withdrawal symptoms reported most often in the USM study.
- Muscle aches, a mild fever and general discomfort when trying to stop or when a drink is late.
- Cravings that carry on even though work, money or family life are already suffering.
- Repeated attempts to stop alone that fail, with withdrawal returning as soon as the amount is cut.
- For some people, ketum becomes a stepping stone to other drugs once it stops being strong enough.
Where ketum stands in Malaysian law
This is the part families find most confusing, so here is the position as exactly as current sources allow.
Growing a ketum plant for your own use, in certain circumstances, is not listed as an offence. But mitragynine, the active compound in ketum, is listed as a controlled psychotropic poison under the Poisons Act 1952 (Act 366). Processing the leaves into air ketum for sale, exporting it, or holding large quantities is an offence under section 30 of the Act. Since 1 January 2023 the penalty has been a fine of up to RM100,000, up to five years in prison, or both (the older limit of RM10,000 and four years, reported by The Malaysian Insight in June 2022, no longer applies). Our guide Is ketum legal in Malaysia? sets out the law in full.
The National Anti-Drugs Agency (AADK) has asked since 2020 for ketum cultivation to be listed as an offence under the Poisons Act. The Poisons (Amendment) Bill 2025, passed by the Dewan Rakyat on 28 July 2025, mainly widens general enforcement powers, including over vape products, and does not specifically ban growing ketum. During that debate the Kuala Langat MP said ketum leaf seizures alone were above 30 million kilograms in 2024.
The change with the clearest effect on users is the Drug Dependants and Substance Abusers Act (Akta Penagih dan Penyalah Guna Dadah dan Bahan), an amendment to Act 283 that Parliament passed in July 2024 and that took effect on 22 August 2025. AADK Director-General Datuk Ruslin Jusoh said that before the amendment AADK's powers covered only drug dependants. They now extend to drug and substance abusers, with the emphasis on treatment and rehabilitation. The government has also discussed a framework for registering ketum products for medical and economic use, especially for farmers in Kedah, but as far as the sources show, this is not yet a final regulation.
In short, ketum is still tightly controlled and enforcement is being strengthened, while the law on treatment now leaves more room for recovery.
What treatment looks like
At Salus, every guest is seen by a psychiatrist on arrival, and the medical team manages withdrawal safely before any therapy begins. This matters with ketum, because many users are carrying other problems too, such as anxiety, poor sleep or trauma, and these need treating at the same time as the dependence itself.
The diagnosis decides the therapy: cognitive behavioural therapy, motivational interviewing, or trauma-focused work for people who started using ketum to cope with older emotional pain. For workers who came to rely on ketum to get through the day, a big part of treatment is rebuilding energy and daily routine without it. That is what the Social Prescription Model is for: a prescription for daily life, planned alongside medical care with a Salus Clinician. The 90-day programme gives the change enough time to hold after someone goes home.
What to do now
You do not need to be sure of a diagnosis to act. If two or three of the signs above sound familiar in someone you know, that is reason enough to talk to a clinician.
You can call or message Salus for a confidential conversation, and the person does not need to know at this stage. Our guide to talking to someone you love about getting help covers the conversation itself, and the what we help with page lists the other dependencies we treat at Salus.
Ketum dependence can be treated, just like alcohol or other drug dependence.
