Kratom

Medically reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD — GMJ Editorial Board

What is Kratom?

Kratom (Mitragyna speciosa) is a tropical tree native to Southeast Asia, particularly Thailand, Malaysia, Indonesia, and Papua New Guinea. The leaves of this plant have been used traditionally for centuries by local populations as a folk remedy and stimulant. Kratom belongs to the coffee family (Rubiaceae) and contains numerous alkaloids, with mitragynine and 7-hydroxymitragynine being the primary psychoactive compounds.

In the United States and many other countries, kratom is available as a dietary supplement in various forms including dried leaves, powders, capsules, and extracts. However, its legal status varies significantly across different jurisdictions, with some countries and U.S. states having banned or regulated its sale and possession.

Health benefits & uses

Pain management (Limited evidence): Some preliminary studies suggest kratom may have analgesic properties, with users reporting pain relief. However, controlled clinical trials are lacking, and most evidence comes from animal studies and user reports.

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Opioid withdrawal support (Limited evidence): Anecdotal reports and small observational studies suggest some individuals use kratom to manage opioid withdrawal symptoms. However, this use is not medically endorsed and lacks robust clinical evidence.

Mood and energy effects (Limited evidence): Traditional use and user reports suggest kratom may affect mood and energy levels, with lower doses potentially providing stimulant-like effects and higher doses producing sedative effects. Scientific validation of these effects remains limited.

It’s important to note that the FDA has not approved kratom for any medical use, and the agency has expressed concerns about its safety and potential for abuse.

How it works

Kratom’s effects are primarily attributed to its alkaloid content, particularly mitragynine and 7-hydroxymitragynine. These compounds interact with opioid receptors in the brain, though their mechanism differs from traditional opioids. Mitragynine acts as a partial agonist at mu-opioid receptors while also affecting other neurotransmitter systems including adrenergic, serotonergic, and dopaminergic pathways.

The dose-dependent effects of kratom are thought to result from different alkaloids becoming predominant at various concentrations. Lower doses may primarily affect adrenergic and dopaminergic systems, producing stimulant-like effects, while higher doses may more strongly activate opioid receptors, leading to sedative and analgesic effects.

Dosage

There is no established recommended daily allowance (RDA) or upper limit (UL) for kratom, as it is not recognized as an essential nutrient. Dosing information comes primarily from traditional use and user reports rather than clinical studies.

Reported typical ranges include:

• Low dose (stimulant effects): 1-5 grams of dried leaf powder
• Moderate dose: 5-15 grams
• High dose (sedative effects): 15+ grams

Due to significant safety concerns and lack of standardization in kratom products, any use should be discussed with a healthcare provider. Potency can vary dramatically between products and sources.

Food sources

Kratom is not found in conventional food sources. The only natural source is the leaves of the Mitragyna speciosa tree. Commercial kratom products are derived exclusively from these leaves, which are typically dried and ground into powder or processed into extracts.

Traditional preparation methods in Southeast Asia include chewing fresh leaves, brewing dried leaves into tea, or smoking the dried material. Modern commercial forms include capsules, tablets, powders, and concentrated extracts.

Safety & side effects

Kratom use has been associated with numerous adverse effects and safety concerns. Common side effects may include nausea, constipation, dry mouth, loss of appetite, drowsiness, and dizziness. More serious concerns include:

• Potential for dependence and withdrawal symptoms
• Liver toxicity (hepatotoxicity)
• Respiratory depression at high doses
• Seizures
• Psychosis and hallucinations

The FDA has linked kratom to multiple deaths, though many cases involved other substances. Quality control issues with kratom products, including contamination with heavy metals, bacteria, and other drugs, pose additional risks.

Interactions

Kratom may interact with various medications due to its effects on multiple neurotransmitter systems and potential impact on liver enzymes. Particular caution is advised with:

• Opioid medications (increased risk of respiratory depression)
• Sedatives and alcohol (enhanced depressant effects)
• Antidepressants (potential serotonin syndrome)
• Blood pressure medications
• Medications metabolized by liver enzymes

Limited research exists on specific drug interactions, making it difficult to predict all potential interactions.

Who should be cautious

Several groups should avoid kratom use:

• Pregnant and breastfeeding women
• Individuals with liver disease
• People with a history of substance abuse
• Those taking medications for mental health conditions
• Individuals with heart conditions
• Anyone under 18 years of age

Given the lack of safety data and potential for serious adverse effects, most healthcare providers advise against kratom use.

Frequently asked questions

Is kratom legal in the United States?

Kratom’s legal status varies by state. While it remains federally unregulated as a controlled substance, several states have banned its sale and possession. The DEA has considered scheduling kratom as a controlled substance but has not yet done so.

Can kratom help with opioid addiction?

While some users report using kratom for opioid withdrawal, this is not medically recommended. Kratom itself has potential for dependence, and FDA-approved medications for opioid addiction are safer and more effective options.

How long do kratom effects last?

Reported effects typically last 2-5 hours, depending on the dose and individual factors. However, detection in the body may persist longer, and regular use can lead to accumulation.

Is kratom safer than prescription opioids?

This cannot be definitively answered due to limited safety research on kratom. While some users perceive it as safer, kratom has been linked to deaths and serious adverse events, and its unregulated status means product quality and potency are inconsistent.

What should I do if I experience side effects from kratom?

Discontinue use immediately and consult a healthcare provider. For severe symptoms like difficulty breathing, chest pain, or altered mental status, seek emergency medical care.