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Kratom is a substance made from the leaves of a tree native to Southeast Asia. It produces a range of effects that vary depending on the dose, including stimulant effects and sedative (or opioid-like) effects. Although it is currently legal in the United States, its legal status is under question and evaluation. This article will provide an overview of kratom, its traditional and recent uses, its potential risks, and its current legal standing.
- Kratom is used as a healing and medicinal herb, with potential benefits in treating pain, diarrhea, and opioid dependence and withdrawal.
- Kratom may cause adverse side effects, negative long-term impacts, drug interactions, and addiction.
- People who abuse kratom may require professional support to manage or reduce their drug use.
What is kratom?
Kratom is a substance derived from Mitragyna speciosa, a tree native to Southeast Asia whose leaves are used for therapeutic purposes. The leaves can be chewed; dried and made into a powder to be swallowed as a capsule, brewed in tea, or mixed into food or drink; or made into a liquid extract. [1] Street names for kratom include thang, thom, ketum, biak, and kakuam.
Kratom contains bioactive alkaloids, which are chemicals that create both stimulant and sedative effects. In higher doses, it is reported to cause similar effects to opioids. Effects begin quickly, within 10 minutes of ingestion, and they may last several hours. [2]
Kratom has been used in traditional medicine for hundreds of years, predominantly for its healing and therapeutic effects. [3] It has become increasingly used in the West as a therapeutic or recreational drug. Kratom can cause serious adverse effects, and the full scope of its effects is not completely understood. [4]
Common uses of kratom
Traditionally, kratom has been used for its medicinal effects in Southeast Asia for many centuries. It was reported to be used in low doses to improve productivity and energy in people doing strenuous work. [3]
At higher dosages, it was used traditionally as a medicinal and healing substance, for its analgesic, muscle relaxant, and antidiarrheal effects. It was also used historically to treat morphine dependence and as a substitute for opioids. Many countries in Southeast Asia continue to use kratom for its medicinal properties, particularly Thailand. [5]
In recent years, kratom has increased in popularity in Europe and the United States, used for similar purposes and also as a recreational drug. Reported medicinal uses of kratom include in treating coughs, pain, anxiety, depression, diarrhea, opioid addiction, and opioid withdrawal. [4][6]
How does kratom work?
Kratom contains psychoactive alkaloid compounds, of which mitragynine and 7-hydroxymitragynine are the most prevalent. These compounds are partial agonists on opioid receptors, similar to other opioids such as morphine and heroin. This contributes to the opioid-like effect of kratom. [7]
However, mitragynine has a unique mechanism of action that differs from opioids. Certain pathways that are activated by opioid actions are not activated by kratom. These pathways are linked to some of the adverse opioid effects, such as respiratory depression and constipation, which are less likely to be produced by kratom. [5][7]
Additionally, mitragynine has been found to be less likely to cause physical dependence than opioids and can potentially reduce the desire to use opioids in addicted individuals. This can contribute to the reported benefits seen when using kratom to treat opioid addiction and withdrawal. The addictive properties of 7-hydroxymitragynine, however, may differ. [5][7]
Is kratom safe?
The safety of kratom use is not certain, and the evidence of its benefits and risks varies—some reports suggest that kratom can produce benefits with little or no side effects. However, there have been many reports of physical and mental harm associated with kratom use. [2][8][9]
Kratom-related deaths have been reported in Europe and the US, where they are mostly associated with multiple drug use. [10] According to a study of 2312 kratom exposures, serious effects, such as seizures, respiratory depression, hallucinations, and coma, are reported in 2.3% to 6.1% of cases. [11]
Fewer kratom-related incidents and deaths are reported in Southeast Asia than in Europe and the US, which may be associated with an underreporting of effects, differences in concurrent drug use, and the purity or preparation of the products used. It may be more likely for those in Asia to be using fresh and unadulterated kratom. [3]
Because of these risks, kratom may be considered unsafe, particularly when bought online, used in conjunction with other substances, or used by people with health issues. People who wish to use kratom may benefit from learning about harm reduction and safer drug use techniques to reduce their risks.
Precaution: Dangers of kratom
Drug interactions
Kratom might interact with other substances, creating increased risks. For example, using kratom with antidepressants and other serotonergic substances may increase the risk of serotonin syndrome. Additionally, combining kratom with central nervous system depressants, such as opioids, benzodiazepines, and alcohol, may increase the risk of oversedation and breathing problems. [12]
Contaminated kratom
As the sale of kratom is not regulated, people buying kratom products cannot be certain of the contents. Some people might buy and use kratom containing additional substances and harmful contaminants. [13]
Pregnancy and breast-feeding
Using kratom while pregnant or breastfeeding may cause harm to the fetus or infant. If exposed to kratom during pregnancy, some babies may experience withdrawal symptoms when they are born, similar to neonatal abstinence syndrome. [1][17]
Physical health issues
People with pre-existing health conditions may be at increased risk of harm from kratom use, such as heart, lung, and seizure conditions. [1]
Mental health issues
Kratom may increase the risk of new or worsening mental health issues, like depression or psychosis. [1][2]
Side effects of kratom
The effects of kratom differ significantly depending on the dose. At low doses, it creates a stimulant effect, causing side effects such as: [3]
- Increased alertness
- Talkativeness
- Increased energy
With higher doses, kratom creates a sedative effect and side effects such as: [2][5]
- Drowsiness
- Nausea
- Itching
- Dry mouth
- Sweating
- Loss of appetite
- Constipation
- Increased urination
- Changes in heart rate
- Psychotic symptoms, such as hallucinations and delusions
- Confusion
Long-term use of kratom may be linked to effects such as: [2][9]
- Severe weight loss
- Insomnia
- Anorexia
- Seizures
- Liver damage
- Addiction and dependence
- Withdrawal symptoms
Is kratom addictive?
The addiction potential of kratom is currently unclear, as research and evidence vary. Some research, including self-reported experiences, indicates mild to moderate withdrawal symptoms after stopping kratom use, with some symptoms of addiction. Studies suggest that, with the increase in kratom use, more people are presenting with withdrawal symptoms on cessation. [5]
The chemical compounds, mitragynine and 7-hydroxymitragynine, partially activate opioid receptors that are known to be associated with the potential for addiction, suggesting that kratom has addictive properties. However, research may indicate that these compounds produce far less potential for addiction than those found in opioids. Further research is needed to clarify the addictive potential of kratom. [5][7]
Kratom withdrawal
Reports of kratom withdrawal suggest a similar presentation to that seen in opioid withdrawal, including symptoms such as: [5][9]
- Weight loss
- Decreased appetite
- Sleep disturbances and insomnia
- Decreased libido
- Spasms and pain in the muscles
- Jerky limb movements
- Fever and hot flashes
- Diarrhea
- Runny nose and watery eyes
- Agitation
- Aggression
- Low mood
- Restlessness
- Nervousness
- Psychotic symptoms
Kratom overdose
Kratom use may cause overdose, which can produce similar symptoms to an opioid overdose, such as: [7][14]
- Pinpoint pupils
- Respiratory depression
- Loss of consciousness
- Skin becoming pale or blue
- Changes in heart rate
- Seizures
According to one case study, kratom overdose can also respond to naloxone administration, which may confuse the diagnosis. [14]
Severe symptoms of kratom overdose can rebound within 12-24 hours, during which time the individual may be at risk of severe harm. If a kratom overdose is suspected, call 911 for immediate medical assistance. The individual should be monitored for at least 24 hours. [14]
The risk of overdose is likely to be increased in people who have not used the substance before, if a large dose is used, or if the product is adulterated with other substances.
Is kratom legal?
In the US, kratom is not regulated by the Controlled Substances Act (CSA) and is not approved for any medicinal use by the Food and Drug Administration (FDA). It is not illegal and can be purchased online and in stores. However, in many states, kratom is banned, and governmental agencies, such as the FDA and Drug Enforcement Administration (DEA), warn against its use. [2][6]
Traditional and current medicinal and therapeutic uses of kratom, along with reports of kratom-related harm, have caused recent discussions about its legal status. At present, research into its therapeutic effects is limited, highlighting a need for additional controlled studies to determine the benefits and risks. [1][7]
In 2016, the DEA reported their intention to add kratom to the CSA, as a Schedule I substance, due to reports of severe harm and death. However, evidence for these cases suggested that kratom was not the sole agent or cause of harm. As such, the DEA proposal was withdrawn. [15]
The legality of kratom varies throughout the world. It is illegal in 40 countries, including Argentina, Australia, Russia, and Poland. It is legal in 17 countries, including Ukraine, Spain, and Brazil. It is a controlled substance in Portugal and Finland. Other countries do not specifically mention kratom in legislation to determine its legality. [16]
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