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Kratom (Mitragyna speciosa) is a tropical plant in the coffee family (Rubiaceae), native to Southeast Asia. [1][2] The leaves contain the active ingredient mitragynine, which acts on opioid receptors in the brain. [1] Valued for centuries in Southeast Asian cultures for alleviating pain and fighting fatigue, kratom’s popularity is now growing in the West as an alternative medicine for pain relief, mood enhancement, and managing opioid withdrawal symptoms and opioid use disorder. [2]
However, as its use increases, concerns are rising over potential health risks, such as dependence, addiction, and toxicity, especially as kratom remains largely unregulated. [1][2] Understanding its side effects is crucial for informed choices and risk reduction.
- Common side effects of kratom include nausea, vomiting, headaches, dizziness, constipation, drowsiness, sweating, itching, and dry mouth.
- Long-term severe side effects may include confusion, seizures, high blood pressure, respiratory depression, acute liver injury, tremors, insomnia, cognitive impairment, psychosis, dependence, and tolerance.
- Treatment options for kratom abuse are limited; however, some approaches include medical detox with symptom management, behavioral therapies, and supportive care.
What is kratom?
The leaves of the kratom tree contain a compound called mitragynine.[1][3] Mitragynine is the primary active ingredient in kratom, and it acts on opioid receptors in the brain.[1][3] However, the way kratom works within the body is not fully understood.[2][4] It has both stimulant and opioid-like effects, depending on the dosage.[2][3][4]
What is kratom used for?
Kratom’s effects are dose-dependent.[1][2][3][4] At lower doses, it acts as a stimulant, enhancing energy and alertness, making it popular among users seeking a natural boost. [2][4] In higher doses, kratom takes on sedative and pain-relieving properties, similar to opioids. [4]
Because of this versatility, people use kratom for:[1]
- Pain relief
- Mood enhancement
- Stimulant effects
- Support with opioid withdrawal symptoms
- Anxiety and depression
Some animal studies suggest kratom may have antidepressant and appetite-suppressing properties; however, more research is needed to confirm these effects in humans.[1]
Common side effects of kratom
Research on kratom is only in its early stages compared to other substances. However, there are published studies and case reports that indicate some people experience rare side effects from kratom. [5] The most reported side effects include: [1][2][5]
- Nausea and vomiting
- Headaches
- Dizziness
- Constipation
- Drowsiness
- Sweating
- Itching
- Dry mouth
Side effects are dependent on various factors and can affect the body in different ways depending on these factors: [1]
- The concentration and strength of the active ingredient in kratom: The amount of mitragynine and other alkaloids present in the kratom product can influence the intensity of side effects.
- Formulation: Different forms of kratom (powder, capsules, extracts) may have varying absorption rates and effects.
- Method of consumption: Swallowing, chewing, applying to the skin, or smoking kratom can influence how the body processes and reacts to it.
- Use of other drugs: Interactions with other substances, including both prescribed and illicit drugs, can alter kratom's effects and increase the risk of adverse reactions.
- Pre-existing medical conditions: Underlying health issues can make individuals susceptible to specific side effects.
- Previous experiences and mood: Individual responses to kratom can vary based on prior use and mental state.
Severe and long-term kratom side effects
The long-term effects of kratom use are not fully understood due to limited research. However, case reports and preliminary studies suggest that serious side effects can develop with prolonged or high-dose use, though more comprehensive studies are needed to determine these risks accurately.
Rare but serious side effects that have been reported include:[1][2][5][6]
- Confusion
- Seizures
- High blood pressure
- Increased heart rate (more than 100 bpm)
- Respiratory depression (slow, shallow breathing)
- Acute liver injury (liver toxicity)
- Tremor
- Chronic insomnia
- Cognitive impairment
- Psychosis
- Anorexia/weight loss
- Darkening of the skin on the face
- Hair loss
- Urinary changes (increased urgency or frequency)
- Tolerance (as well as cross-tolerance to opioids)
- Dependence
- Addiction and withdrawal symptoms
Risks of kratom use for specific populations
People with certain medical conditions must pay special attention to possible adverse effects when taking kratom: [5][6]
- Women who breastfeed: Nothing substantial has been concluded, but it is best to avoid kratom during this period.
- Pregnant women: Although there is little research available on kratom’s potential effects during pregnancy, a 2021 report suggests that kratom use during pregnancy likely involves polysubstance use, so the effects of kratom alone on both the fetus/newborn and pregnant person are difficult to determine. The same report does, however, indicate that a small number of women who used kratom but not opioids during pregnancy gave birth to infants with opioid-like neonatal abstinence syndrome. This causes a newborn to show signs of withdrawal, including jitteriness, irritability, and muscle stiffness.
- People with epilepsy: Kratom use may cause an increased risk of seizures.
- People with alcohol use disorder: Kratom plus alcohol use increases the risk of suicide.
- People with mental health disorders: People who have mental health disorders and also use kratom may have an increased risk of suicide.
- People with heart disease: Kratom may worsen existing heart conditions.
Kratom overdose
While more research is needed, fatal overdose from kratom use alone is extremely rare. A 2019 report shows that there were 11 deaths between 2011 and 2017 in the US associated with kratom exposure, including two deaths related to kratom exposure alone.[6][7]
However, it must be noted that kratom use may be underreported due to its legal status in the US, lack of routine testing for it, or lack of awareness among healthcare providers and medical examiners. This can result in incomplete data and potential underestimation of kratom-related risks and/or death.
Why do people abuse kratom?
People may misuse or abuse kratom due to its unique, dose-dependent effects:[1][2][4][9]
- Stimulant Properties: At low doses, kratom acts as a stimulant, making users feel more alert, energized, and sociable. It’s appealing to people looking for a natural “upper” to improve focus, productivity, or confidence in social settings.
- Sedative Effects: In higher doses, kratom produces sedative effects, which, according to anecdotal reports, reduce pain, alleviate anxiety, and bring about a sense of relaxation. In essence, it may be used recreationally to relax or unwind.
- Management of opioid withdrawal symptoms: Because kratom acts on opioid receptors, it provides some relief from cravings and withdrawal discomforts. Since kratom is more accessible to obtain than prescription medications, many turn to it as an accessible alternative.
Misconceptions about kratom's safety also contribute to its abuse.[4] Many believe that its natural origin makes it safe to use.[4] However, the inconsistent potency of kratom products, unclear dosing information, and the addition of extra active ingredients by some sellers make accurate dosing difficult, leading to unintentional overuse and increased dependence risk.
Alternatives to kratom for pain management and opioid withdrawal
While some people use kratom for pain relief and managing opioid withdrawal, it’s important to note that it’s not FDA-approved for these purposes, and its use carries risks.
A tailored approach is ideal for pain management. Depending on individual needs and pain levels, alternatives can include non-pharmaceutical options, like physical therapy, acupuncture, mindfulness practices, and over-the-counter medications. Consulting a healthcare provider can help determine the safest and most effective combination.
For opioid withdrawal, FDA-approved options, such as methadone and buprenorphine, are considered the gold standard, which should be administered under medical supervision to manage withdrawal symptoms.
Treatment for kratom abuse
Currently, there are no FDA-approved medical treatments specifically for kratom abuse. However, a 2020 literature review suggests potential treatment options for addressing kratom withdrawal and substance use disorder symptoms. [8]
Potential treatment approaches:
- Sublingual buprenorphine-naloxone (Suboxone): This medication shows promise for detoxification and maintenance replacement therapy for kratom-dependent users.
- Symptomatic management during inpatient detoxification using:
- Intravenous clonidine: This medication can reduce anxiety, agitation, muscle aches, and sweating.
- Oral dihydrocodeine and lofexidine: This combination can help manage pain and discomfort during withdrawal.
