Kratom: Dangers, Side Effects, and Overdose

What is Kratom?

Kratom refers to the tropical trees native to Southeast Asia trees, known as Mitragyna speciosa, as well as to products that are derived from its leaves, which are sold as herbal supplements.¹

Typically taken orally, kratom is legally sold online and in stores in different forms, including capsules, powders, and liquid extracts. Individuals may swallow the raw plant material in capsules or powders, mix the powder into food or drinks, or brew tea using kratom leaves.¹

Studies suggest that individuals use kratom for a variety of reasons, including the increased energy and relaxation but also to alleviate pain, to address the symptoms associated with mental health conditions like anxiety and depression, to reduce opioid or other substance use, and to manage the opioid and other drug withdrawal symptoms.¹

While it’s legal to sell and use in much of the United States, kratom is not approved by the U.S. Food and Drug Administration (FDA) for any medical purposes. That’s due, in large part, to the fact that researchers do not fully understand the myriad ways kratom affects individuals—including the short- and long-term health effects associated with its use.¹

Like other substances, kratom effects may depend on the concentration, formulation, method of ingestion, other substances present in the body, underlying medical conditions, and dosage. At low doses, kratom appears to have stimulant effects—such as increased energy, alertness, and rapid heart rate. At higher doses, kratom produces effects similar to opioids or sedatives. However, studies have not clearly established if effects are determined by dose.¹

Kratom contains two main compounds that give the substance its psychoactive properties.³ These include mitragynine and 7-hydroxymitragynine.^1,3 This compound appears to activate opioid receptors in the brain and is thought to influence kratom’s opioid-like effects.¹ Some research also suggests that mitragynine may bind to adrenergic, serotonin, and dopamine receptors in the brain, which may contribute to some of the arousing effects individuals have reported feeling.¹

Adverse Side Effects of Kratom

Kratom research is relatively new compared to other substances, so there is little evidence to show how kratom may affect an individual over time. However, studies and case reports indicate that some people experience rare adverse effects from kratom use.¹

Similarly, without robust literature on the topic, the short-term effects are not well understood and come from anecdotal evidence and self-reports. These effects vary widely, but some of the more commonly reported adverse effects include:¹

•   Nausea and vomiting.
•   Constipation.
•   Dizziness.
•   Drowsiness.

Case reports indicate that some individuals experience other rare but serious adverse effects from kratom use, including:^1,5

•   Confusion.
•   Tremors.
•   Seizures.
•   High blood pressure, increased heart rate (tachycardia), and other heart-related effects.
•   Slow breathing.
•   Liver problems.

Additionally, a very small number of deaths have been linked to kratom products—nearly all of which involved other drugs or harmful contaminants.¹ In fact, the FDA has issued public warnings when kratom products were found to contain salmonella and/or dangerous levels of heavy metals, which can put individuals at risk of serious illnesses.⁴

Furthermore, while there is no specific diagnostic criteria for a kratom use disorder outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (DSM-5), some case reports suggest that kratom may have addiction potential. That’s because some individuals have reported signs of compulsive use despite negative consequences as well as experiencing withdrawal symptoms when use suddenly stops.⁴

Finally, there is very little research available on kratom’s potential effects during pregnancy. One 2021 report suggests that kratom use during pregnancy likely involves other substances so the effects of kratom alone—on the baby or pregnant person—are difficult to determine. That being said, this same report did indicate that a small number of women, who used kratom but not opioids during pregnancy, had infants with opioid-like neonatal abstinence syndrome, in which the newborns showed signs of withdrawal, including jitteriness, irritability, and muscle stiffness.^1,4

Lack of Regulation and Research on Kratom

Kratom remains unrecognized as a controlled substance in the United States by the Drug Enforcement Administration (DEA), therefore, is not subject to regulation under the Controlled Substances Act.⁷

Additionally, kratom is not approved or regulated by the FDA. In fact, the FDA warns consumers not to take kratom or products containing kratom because of its toxicity potential in multiple organ systems and the risks of misuse, physical dependence, and addiction.⁷

Regardless of the warnings—and as previously noted—kratom is currently legal and accessible in the U.S.¹ However, some states and municipalities banned its sale and use.⁶

Mixing Kratom and Other Substances

As previously mentioned, research suggests that individuals who use kratom often also use other substances. Few case reports indicate that kratom used in combination with other drugs can potentially lead to adverse effects, though more research is needed to understand the impact of kratom in combination with other substances.¹ Additionally, the FDA reports that, while rare, most kratom-involved deaths usually involved other substances, too, so the role kratom played is unclear.⁴

Symptoms of Kratom Overdose

There have been very few deaths reported from a kratom overdose, and most reported fatalities involved contaminated products or other drugs.^1,8 In fact, a 2019 report found that there were 11 deaths associated with kratom exposure in the United States between 2011 and 2017. Two of these deaths were due to kratom alone.¹

If you suspect someone has overdosed on kratom or another substance, call 911 right away.

Most reports of kratom overdoses are anecdotal. One case report suggests that kratom overdose symptoms may mimic those associated with opioid overdose and include:⁹

•   Unresponsiveness.
•   Apnea (stopped breathing).
•   Cyanosis (blue or purplish skin).
•   Altered mental status.
•   Constricted pupils.

Symptoms of Kratom Withdrawal

There’s not yet enough evidence to say for sure whether people can experience kratom withdrawal; however, some evidence suggests that withdrawal may be possible, especially after prolonged use.¹

Reports indicate that kratom withdrawal symptoms may include:^5,9

•   Anger.
•   Nervousness.
•   Restlessness.
•   Depression.
•   Anxiety.
•   Muscle spasms.
•   Pain.
•   Insomnia.
•   Runny nose.
•   Fever.
•   Loss of appetite.
•   Diarrhea.

Misusing Kratom to Manage Addiction

People commonly report using kratom to self-treat and manage symptoms associated with opioid addiction and withdrawal as well as withdrawal from other substances. However, as previously mentioned, kratom has not been proven to be safe or effective for any medical condition, including opioid or other substance withdrawal.¹

According to the National Institute on Drug Abuse (NIDA), early evidence suggests that kratom and kratom compounds should be more extensively studied as experimental treatments for substance use disorders, especially OUD.

It’s important to note that safe, effective, and FDA-approved medications exist to help individuals manage opioid withdrawal and OUD.^1,10

Kratom and Drug Addiction Treatment

If you or a loved one struggle with kratom use, you should know that help is available. Some facilities, including American Addiction Centers (AAC), offer kratom detox from high doses, as case reports suggest that withdrawal from kratom can mimic opioid withdrawal.¹¹ Treatment also allows you to receive support and participate in different forms of therapy to help you remain substance free and avoid relapse.¹²

Following detox, which may be the first step in a more comprehensive, individualized plan, treatment may take place in an inpatient or outpatient setting, depending on your unique needs.

Treatment for OUD can help you stop using opioids and start the path to long-term recovery.¹² This typically involves the use of medications to treat withdrawal to help prevent cravings and associated symptoms, as well as behavioral therapies to help you make positive life changes and develop healthy coping skills to change your thoughts, emotions, and behaviors so you can identify triggers, manage stressors, and prevent relapse.¹⁰

Prior to entering treatment at AAC, you’ll receive a thorough assessment from a team of addiction professionals, who can help determine the appropriate level of care for your needs. Sustained recovery from opioid addiction is possible, and proper, evidence-based treatment has been shown to help people stop substance use and cultivate a drug-free lifestyle.¹²