Kratom is marketed and sold as an energy booster, mood enhancer, pain reliever, and herbal remedy for opioid withdrawal. Kratom and kratom-based products are currently legal and widely accessible in the US, although the FDA has not approved the substance for any medical use.
Rare but serious effects of kratom use have been reported, including psychiatric, cardiovascular, gastrointestinal, and respiratory problems. In addition, according to the DEA, Kratom can result in psychological and physiological dependence and is a drug of chemical concern.
The Origin of Kratom
Kratom comes from a tropical tree called Mitragyna speciosa, which is native to Southeast Asia. It has been used for centuries in traditional medicinal purposes in areas where it grows naturally and has been marketed as a multi-purpose remedy to increase alertness and energy while a person is working or attending social gatherings. More recently, products derived from its leaves have been produced and marketed as herbal supplements in the United States.
How Is Kratom Consumed?
Kratom is normally bought as a capsule filled with a powdered form of the leaf material, although it is also available as a chopped form of the leaf that can be brewed for tea or smoked.
Because the substance is not approved by the FDA for medical use, there is no official recommended dose. However, the duration and nature of the effects of kratom vary substantially based on the quantity that is consumed. Generally, though, the effects of kratom are felt relatively quickly and last between five and seven hours. These effects can increase when higher doses are consumed.
What are the Effects of Kratom
At low doses, kratom acts like a stimulant, with users reporting increased alertness, energy, and talkativeness. However, at higher doses, it’s like an opioid, producing sedative effects. According to online research on the subjective experience of the effects of kratom, low doses cause heightened mental and physical alertness and sexual arousal. Some report an increased ability to do physical work, and users described “entactogenic” effects such as euphoria and empathy. However, other users found the effects at lower doses to be “edgy” rather than pleasant.  Higher doses were said to cause general feelings of sedation, decreased sensitivity to pain, and “comfortable pleasure” – effects similar to opioid drugs.
More research is needed on the side effects of kratom, but current findings show short- and long-term negative effects associated with its consumption.
The effects of kratom use appear to vary widely, with some people experiencing little to no side effects and others reporting side effects ranging from mild to severe.
Mild side effects of Kratom include:
- Temporary erectile dysfunction
Severe effects of kratom include:
- Mental and neurological symptoms (confusion, tremors and seizures)
- Heart and lung problems (high blood pressure and slow breathing)
- Gastrointestinal problems (nausea and vomiting)
- Liver problems
- Tremors and seizures
- Weight loss
While kratom can alleviate and even prevent withdrawal symptoms from opioids, it can also induce its own withdrawal symptoms when taken for an extended period.
Kratom has demonstrated parasympathetic-blocking effects, which are reversible with the use of naloxone. This suggests that the effects of kratom are mediated by opioid-agonist actions.  However, there is limited research on how kratom may interact with other medications, further demonstrating the lack of scientific evidence for safe consumption.
A lot remains unknown about the chemical compounds related to kratom, in addition to the short- and long-term health and safety effects of kratom use. Although, NIDA is currently conducting research on kratom and its potential therapeutic uses.
Concerns for Kratom Use
Kratom does not appear in regular urine drug screens and may be undetected during routine screening for acute drug intoxication. There is concern that it may be used by those in drug treatment programs or those required to complete court-ordered drug testing as a way of avoiding detection for the consumption of opioids. There have been concerns that individuals who are abusing illicit substances may swap drugs such as heroin for kratom during the days before a drug test to avoid both detection and uncomfortable withdrawal symptoms.
Additionally, there have been unverified anecdotal reports of kratom causing false positive results of drugs like oxycodone, suboxone, and fentanyl on 10-panel drug tests, providing significant cause for concern in those completing pre-employment drug checks or court-ordered drug testing.
There are growing concerns about kratom in the medical community. Its ease of availability paints a false picture of the safety of the drug. While there may be medical benefits for kratom, these have not yet been confirmed nor has there been an adequate investigation of the substance’s long-term effects or how it interacts with other substances. Research has shown that surveyed adults who use kratom are more likely to disclose monthly use of substances, such as cannabis, cocaine, ecstasy, heroin, methamphetamine, or nicotine, compared to respondents who never used kratom. Further study is needed, although there have been several reports of kratom-related fatalities when the substance is consumed in combination with other drugs. A fatal reaction has been reported that is associated with mixing kratom with propylhexedrine – an amphetamine-like stimulant that is used in decongestant inhalers. An additional case of fatality occurred when kratom was combined with over-the-counter cold medications and benzodiazepines.
Further, despite the need for wider-ranging conclusive evidence, research suggests that kratom is addictive. Studies show that prolonged kratom use is associated with physical and psychological dependence in which long-term users experience withdrawal symptoms when decreasing use or engaging in abstinence. Evidence suggests that kratom withdrawal symptoms are similar to opioid withdrawal symptoms, which are widely known to be a significant barrier to abstinence. Further research on and public knowledge about the potential dangers of kratom are needed to ensure safe, evidence-based use of a relatively unknown, under-studied product that is not yet fully understood.
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 U.S. Department of Health and Human Services. (2023, January 23). Kratom. National Institutes of Health. Retrieved February 14, 2023, from https://nida.nih.gov/research-topics/kratom
 DEA Drug fact sheet: Kratom – dea.gov. (n.d.). Retrieved February 14, 2023, from https://admin.dea.gov/sites/default/files/2020-06/Kratom-2020.pdf
 Prozialeck, W. C., Jivan, J. K., & Andurkar, S. V. (2012). Pharmacology of kratom: an emerging botanical agent with stimulant, analgesic and opioid-like effects. The Journal of the American Osteopathic Association, 112(12), 792–799.
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