Kratom is an opioid-like substance obtained from the leaves of a tree (Mitragyna speciosa) that is is found in Southeast Asia and Africa. The drug has a long history of medicinal use in areas where it naturally grows. In the United States, kratom often comes as capsules, in a powder, or as leaves that are chewed or ingested in another form, such as brewed into a tea. Since kratom is typically considered a “natural supplement,” and is often minimally regulated, many people think that kratom is harmless to consume.
But is kratom safe? In fact, kratom's side effects can be significantly harmful, and its use has even resulted in death in severe cases. Read on to better understand myths surrounding kratom use, to get the truth about the drug—and be better prepared to avoid serious side effects for yourself and your loved ones.
Myth 1: Kratom is not addictive.
According to Mayo Clinic, kratom is typically used for a wide range of purposes, including recreation, attempted detox from opioids or other drugs, and pain relief. Its legality varies by jurisdiction but it is generally not particularly difficult to access. In fact, its accessibility is one reason why many people believe the drug is not addictive, or even relatively mild.
But kratom actually has a high potential for addiction. When you take kratom, the drug produces effects similar to both opioids and stimulants, according to the National Institute on Drug Abuse (NIDA). Chemicals found in kratom—most potently, mitragynine and 7-hydroxymytragynine—interact with opioid receptors in your brain and produce feelings of pleasure, reduced pain, sedation, sociability, and excitement.
"When acting as an opioid, Kratom functions similarly to buprenorphine, working as a mu opioid agonist and a kappa and delta competitive antagonist," Josiah Teng, MHC-LP and Mental Health Clinician at Vivid World Psychology, PLLC, tells WebMD Connect to Care. "Its two particularly significant alkaloid compounds, mitragynine and 7-α-hydroxy mitragynine, possess potency levels similar to codeine and 10-20x that of morphine, respectively. This means Kratom is highly efficacious in creating strong stimulating and sedative effects comparable to other opioids when taken more frequently or in large doses."
Because it has opioid-like effects, “Kratom can be addictive and can cause withdrawal symptoms,” Monty Ghosh, MD and addiction specialist at the University of Alberta Hospital in Edmonton, tells WebMD Connect to Care. Indeed, regular use of kratom can lead to dependence on, increased tolerance to, and persistent cravings for the drug.
“As such, people need to be careful when taking kratom, and it can lead to concerns of dependence and misuse,” Ghosh says.
Myth 2: You can safely use kratom in medication assisted treatment for opioid addiction.
Some people who want to stop taking opioids may consider using kratom powder or kratom capsules as an herbal alternative to pharmaceutically-based medication assisted treatment. The rationale is that kratom's similarity to opioids, and "natural" origins, will safely prevent unpleasant opioid withdrawal symptoms.
However, since kratom also has opioid-like properties, it carries many of the same risks as opioids, including dependence and uncomfortable side effects, reports NIDA.
“Kratom can be just as dangerous as opioids, and the most common way to treat kratom disorder is by using medications which we use to treat opioid use disorder like buprenorphine/naloxone,” Ghosh says. In other words, kratom addiction may ultimately require the same sort of detox treatment that conventional opioid substance abuse disorder requires.
NIDA also concurs that there is no scientific evidence proving that kratom can be effectively used within medication assisted treatment for opioid addiction or opioid withdrawal symptoms.
Myth 3: There is no risk of overdose with kratom.
“People can still overdose with kratom, usually when mixed with other substances,” Ghosh says. “It can act as a depressant and as such can lead to overdoses.”
According to NIDA, there have been multiple reports of death following kratom use. In 2017, the FDA reported nearly 44 deaths associated with kratom use, with one case involving the use of pure kratom. However, most of these kratom-related deaths involved the intake of kratom and other substances like alcohol, opioids, and benzodiazepines.
NIDA also notes that many of these fatalities appear to have resulted from the use of adulterated kratom products. For example, there are reports of some kratom products labeled as dietary supplements being laced with dangerous substances that have caused death when ingested. In fact, according to a Mayo Clinic report in 2018, over 130 people had been sickened with salmonella bacteria that had contaminated kratom products. In some cases, salmonella poisoning can be fatal
Myth 4: There are no kratom side effects, because it is a supplement.
Kratom may be obtained from plants, but that does not mean it is entirely safe, reports Cleveland Clinic. In fact, kratom can cause serious side effects, including the following:
- Heart attack and abnormal heartbeat
- Brain disease
- Liver damage
- Kidney damage
- Respiratory depression
This list may be inexhaustive. "Kratom use may cause nausea, vomiting, diarrhea, tremors, agitation, and even psychosis in some individuals," Kelly Johnson-Arbor, MD and Medical Toxicologist and Co-Medical Director at the National Capital Poison Center tells WebMD Connect to Care. "Increased skin pigmentation is an odd side effect associated with kratom use. Both addiction and withdrawal have been reported to occur in kratom users. Signs and symptoms of kratom withdrawal include nausea, vomiting... diarrhea, and body aches."
People sometimes mistake the legality and accessibility of kratom as an endorsement for its safety. But as with other unregulated products, the fact that it is easy to access does not necessarily mean that it is safe.
“Supplements actually are not regulated by the FDA. Therefore, there is no guarantee that a supplement will actually contain the ingredients listed on the label. Also, there are no requirements for scientific studies to assess its efficacy. Lastly, side effects are still a possibility,” Julian Lagoy, MD and psychiatrist with Community Psychiatry + MindPath Care Centers, tells WebMD Connect to Care.
Indeed, due precisely to a lack of regulation, the strength and purity of kratom sold in any given product can be difficult to ascertain, and may contain harmful byproducts. "Because kratom is a plant that grows in soil, it is also susceptible to contamination with heavy metals," says Johnson-Arbor.
Myth 5: Kratom is completely legal.
As of this writing, kratom remains legal on the federal level. It is also widely accessible, and can be ordered online with relative ease. However, its legal status is actually more complicated than it may appear, and will likely continue to evolve in the future.
Numerous states—as of this writing, Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin—have made kratom illegal. Several other states place a variety of regulations on its use. For instance, kratom is illegal in certain jurisdictions in California, Colorado, Florida, Illinois, and Mississippi. Other states have placed age restrictions on its use.
Finally, despite being formally unregulated federally at the present moment, it is quite possible this will change. In 2019, the Food and Drug Administration (FDA) put out a warning encouraging Americans not to use kratom, noting that the drug "appears to have properties that expose users to the risks of addiction, abuse, and dependence."
The Drug Enforcement Administration (DEA) has taken a similar approach to kratom. "Because of its psychoactive properties, in 2016 the United States Drug Enforcement Agency (DEA) considered listing kratom as a Schedule I drug (meaning that it has no accepted medical use and a high potential for abuse)," Johnson-Arbor says. "However, public outcry led to abandonment of this initiative."
Despite the 2016 decision not to classify kratom as a Schedule I drug, the DEA currently warns that kratom use can lead to addiction, and has classified it as a "Drug and Chemical of Concern."
More research is needed to fully understand the addictiveness and circumstances of kratom use. But regardless of its legal status, the evidence is clear that the drug can be addictive in some cases, and oftentimes dangerous. Fortunately, like similar substances (including opioids), kratom dependence is treatable. Medically-assisted detox programs can be highly effective in treating addiction.
In part due to the increasing prevalence of kratom addiction, more medical professionals who work with those dealing with substance abuse disorder are gaining experience with kratom abuse treatment.
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