Behind the Hype: The Real Risks of Kratom

By now, many of us have heard of kratom- whether from patients, social media, or seeing it sold in gas stations and smoke shops. While it has grown in popularity, there are significant concerns surrounding its safety, effectiveness, and potential for abuse.

What is Kratom?

It is an herbal extract that comes from the leaves of an evergreen tree, the tree is called Mitragyna speciosa, native to Southeast Asia.  The leaves are known as kratom and have been used in herbal medicine since the 19^th century in Cambodia, Thailand, Indonesia, Papua New Guinea, and Myanmar. Historically, the leaves have been consumed via smoking, chewing, and as a tea. Kratom has opioid-like properties and some stimulant-like effects.

However, as of 2018, the safety and medical effectiveness of kratom remain unproven. In 2019, the U.S. Food and Drug Administration (FDA) concluded that there is no reliable scientific evidence supporting kratom’s efficacy or safety for any medical condition. Nevertheless, some individuals report using kratom to manage opioid withdrawal symptoms or for recreational purposes. Its effects typically begin within 5 to 10 minutes and may last 2 to 5 hours.

Kratom is classified as a controlled substance in 16 countries due to rising concerns about its impact on public health. In some regions, its sales and importation have been restricted, and several public health agencies have issued advisories about its risks.

Reported anecdotal effects by users are increased alertness, sedation, changes in mood, physical energy, pain relief and talkativeness. Common side effects are nausea, constipation, appetite loss, and erectile dysfunction.

Severe side effects include respiratory depression (decreased breathing), psychosis, seizure, trouble sleeping, elevated blood pressure and heart rate, and rarely liver toxicity.

Kratom affects the nervous system and the mind and can cause:

• Drowsiness

• Dizziness

• False beliefs/delusions

• Depression

• Confusion, Seizures, Tremors

• Hallucinations, smells, tastes, sounds or touches that seem real but aren’t. 

Other known side effects include:

• Weight loss

• Dry mouth

• Muscle Pain

According to a 2019 report from the America's Poison Centers (AAPCC), most kratom exposures occur intentionally by adult males in their homes. 32% of these incidents required admission to a health care facility.  The others resulted in serious medical conditions. Multiple-substance exposures were associated with a higher number of hospital admissions. Postmortem toxicology tests detected multiple substances for those who died. Fentanyl and Fentanyl analogs were the most identified co-occurring substances. 

Addiction Risk:

Kratom use carries a risk of addiction, especially with frequent or long-term use. Dependence can develop within as little as three months. Withdrawal symptoms resemble those seen with opioids and may include anxiety, agitation, gastrointestinal distress, and insomnia. Users often report needing higher doses over time to achieve the same effects.

According to research, individuals with a history of other substance use disorders are nearly three times more likely to meet the criteria for kratom addiction. Relapse rates are also high, up to 89% in three months post-cessation. In severe cases, treatment similar to that for opioid addiction may be necessary.

Signs of Kratom Addiction and Withdrawal:

• Escalating dosage requirements

• Loss of appetite

• Anxiety, restlessness, and insomnia when use is stopped

7-OH (Supercharged Kratom Extract):

A growing concern within the realm of kratom use is the recent emergence of 7-hydroxymitragynine (7-OH), a highly concentrated kratom extract. Although 7-OH is a natural alkaloid found in kratom, it is now being isolated and sold in much higher doses, often in gas stations and smoke shops, under names like “7-OH,” “7-Hydro,” or “legal morphine.” Users have described the euphoric effects of 7-OH products as notably more intense than those of traditional kratom, though they noted the effects were more short-lived. These products are also associated with a rapid escalation in dosage, and both tolerance and withdrawal symptoms appear to develop more quickly compared to standard kratom use. This trend has triggered public health warnings, including from the Kentucky Department of Public Health, due to the increased risk of addiction, overdose, respiratory depression, and severe sedation. Because 7-OH is more potent than traditional kratom, its misuse can exacerbate kratom's already significant addiction potential. 

Liver Toxicity:

In rare cases, kratom use has been associated with acute liver injury. Reported symptoms include abdominal discomfort, itching, jaundice, and dark urine. On average, the onset of symptoms occurs approximately 20 days after initial use. While these cases remain uncommon, the exact factors that increase an individual's risk are still unknown.

Death:

Kratom overdose is a concern in many countries due to the rising number of hospitalizations and deaths in which chronic kratom use is a contributing factor. Kratom overdose can cause liver toxicity, seizures, coma and death, especially in cases involving other substances like alcohol or opioids. Between 2011 and 2017, 44 U.S deaths were kratom related. People who have died from kratom typically have underlying health conditions or have taken it in combination with other substances.

In 2016-2017, 152 overdose deaths involving kratom use where reported in the United States. In 7 of these cases, kratom was the only agent detected. In 2010-11, nine deaths in Sweden were related to Krypton, which is a mixture of caffeine, Kratom, and Tramadol.

Symptoms of Kratom Overdose:

Although there have been very few deaths associated with kratom. Here are some symptoms to look for. Kratom overdose symptoms may mimic those associated with opioid overdose and include:

• Apnea (stopped breathing) 

• Constricted pupils

• Alerted mental status   

• Cyanosis (blue or purplish skin)

Kratom and Addiction Treatment:

Help is available for those struggling with kratom use. Some facilities, including American Addiction Centers (AAC) offer kratom detox from high doses, as withdrawal from kratom can mimic opioid withdrawal.

People who take kratom report that it helps them. However, kratom has not been shown to be safe or to treat any medical conditions. The U.S Food and Drug Administration has warned people not to use kratom. The U.S Drug Enforcement Administration refers to Kratom as a drug of concern.

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

In closing, the risks associated with kratom demand deeper investigation and greater public awareness. For more detailed information, I have cited my sources below.

References:

American Addiction Centers. (n.d.). Kratom: Side effects, and overdose. https://americanaddictioncenters.org/kratom/side-effects

Hemby, S. E., McIntosh, S., Leon, F., Cutler, S. J., & McCurdy, C. R. (2019). Abuse liability and therapeutic potential of the Mitragyna speciosa (kratom) alkaloids mitragynine and 7-hydroxymitragynine. Addiction Biology, 24(5), 874–885. https://pubmed.ncbi.nlm.nih.gov/31540608/

Mayo Clinic. (n.d.). Kratom: Unsafe and ineffective. Mayo Foundation for Medical Education and Research. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/kratom/art-20402171

Medical Clinical Research. (n.d.). Kratom, opioids, and addiction recovery: What medical research says. https://medclinres.org/kratom-opiods-and-addiction-recovery-what-medical-research-says