What Is Kratom, and Is It Safe

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Kratom (Mitragyna speciosa) is an herbal supplement that's gaining popularity in the U.S. People claim it's helpful for pain relief and increased energy. Others say it helps with opioid use disorder.

But what exactly is kratom, and how does it work in the body?

What is kratom?

Kratom is the name of a tropical tree that naturally grows in Thailand, Malaysia, and other locations in Southeast Asia. Historically, farm workers chewed kratom leaves to give them energy and relieve pain, allowing them to work harder and longer. In more recent years, kratom products have gained popularity for both its stimulant and sedative effects.

Kratom contains two main active ingredients: mitragynine and 7-hydroxymitragynine. Kratom binds to opioid receptors (binding sites) in the body, which is likely how it helps reduce pain symptoms. But kratom is not an opioid. It's considered an alkaloid - a nitrogen-based compound found in plants.

Kratom is not an FDA-approved medication. This means it doesn't have an approved medical use in the U.S. The FDA also determined that kratom cannot be legally sold as a dietary supplement or added to food products - more on that later.

What are the effects of kratom?

How kratom affects you may depend on how much you consume. Low doses of kratom are associated with uplifting effects, including:

• Increased energy

• Increased sociability and outgoingness

• Higher levels of alertness

Larger amounts of kratom produce an effect similar to that seen with opioids. Symptoms reported with large doses include:

• Sedation (feeling drowsy and sleepy)

• Intense pleasure

• Lower levels of pain

Some people say kratom feels like an energy boost that's similar to coffee. It also helps some people with pain management. But keep in mind that there aren't clinical studies to confirm these effects, and there are no clear guidelines as to what a "low dose" or "large dose" of kratom is. Kratom products can also vary from batch to batch, so it can be hard to know how it might affect you with each use.

What benefits do people report from kratom?

As mentioned, kratom has no official medical uses. But the most common reasons people report taking kratom are boosting energy, relieving pain, and helping with symptoms of anxiety or depression.

Animal studies seem to show some evidence that kratom may have antidepressant and pain-relieving effects. But we don't have clinical studies in humans to know for sure. And more importantly, kratom comes with some serious possible risks that we'll discuss more below.

Can kratom offer an alternative to opioids?

Another reason people are turning to kratom is to stop or reduce opioid use. Some report kratom helps manage withdrawal symptoms and reduce cravings in people with opioid use disorder.

Researchers are actively investigating the potential role kratom could play in helping to end the current opioid crisis. But keep in mind that kratom still comes with its own set of safety concerns and risks to consider.

How do people take kratom?

Kratom is most often taken orally. In recent years, kratom leaves, extracts, and powders have been making their way to the U.S. These kratom products are most often mixed into food and drink or brewed as a tea. Some people prefer to chew the kratom leaves themselves. Smoking kratom isn't common, but some people consume it this way, as well.

Side effects of kratom

In a survey of over 2,500 U.S. adults who take kratom, about two-thirds reported no negative side effects. But for those who do experience side effects, they can be serious. Some of the reported kratom side effects include:

• Nausea and decreased appetite

• Itchiness

• Feeling sweaty

• Dry mouth

• Constipation

• More frequent urination

• Fast heartbeat

• Drowsiness

• Liver damage

• Hallucinations

• Seizures

As mentioned, people often take kratom along with other substances, so it can be hard to tell if side effects are specific to kratom itself. And drug interactions may make side effects more likely. Side effects also seem more likely with high doses of kratom. And since the amount of kratom in products isn't regulated, it can be hard to know how much you're actually taking, which can make it easier to consume more than you intend to.

Is kratom legal?

Whether or not kratom is legal is a complicated topic. There are no recognized medical uses for kratom, and it's not an FDA-approved medication. The FDA also issued a statement that kratom cannot be lawfully marketed as a dietary supplement or food additive. That being said, there currently aren't any federal laws against possessing or using kratom.

However, several individual U.S. states, cities, and counties have made kratom illegal or have restricted how it's sold. So it's best to check the laws in your city and state to know whether kratom is legal where you live.

Outside the U.S., kratom is restricted or illegal in at least 13 other countries, including the United Kingdom, Australia, and Thailand.

Is it safe to take kratom?

We don't know for sure. There isn't a lot of information available on the safety of kratom. But we do know that there are several risks associated with it that you should be aware of, including:

• Kratom products may contain contaminants. Herbal supplements aren't well regulated. So it's possible that products sold as kratom may contain contaminants or other substances altogether. There have been cases of salmonella and heavy metals found in kratom products.

• There may be other medications hidden in kratom products. A popular kratom product called "Krypton" was found to contain a form of tramadol, a prescription opioid mediation. It caused at least nine reported deaths in people who consumed it.

• Taking kratom along with other medications or substances can be harmful.Drug interactions between kratom and other medications or substances can cause serious problems, including liver damage and death. More research is needed to understand what medications, if any, are safe to take with kratom.

That being said, there is a much lower risk of death associated with kratom use or overdose as compared to other substances, such as opioids. The biggest risk seems to be if you're taking kratom along with other medications or substances. Or if the kratom you're taking is contaminated. Until there's a clear way to access well-regulated kratom products and understand its drug interactions, there's no guarantee of its safety.

Is kratom addictive?

It might be, but we don't know for sure. Kratom works on opioid receptors in the brain. Other addictive medications, such as opioids, also affect these receptors. So there's a large concern that kratom could be addictive in a similar way. The FDA is currently funding clinical studies to look at kratom's potential for misuse, but results aren't expected for some time.

That being said, kratom seems to cause less dependence and has a lower risk of overdose than opioids. And the risk may be even lower if you only take kratom once in a while, as opposed to every day.

But there's still a possibility of developing a substance use disorder while taking kratom. It can cause dependence in some people. And you may also experience withdrawal symptoms and cravings if you stop taking it.

Kratom withdrawal

Kratom withdrawal symptoms are more common when you take kratom regularly and then stop. Symptoms of kratom withdrawal can include:

• Depression

• Anxiety

• Irritability

• Body aches

• Watery eyes

• Runny nose

• Insomnia

• Diarrhea

• Tremors

• Itching

• Feeling feverish

Babies whose mothers consumed kratom regularly during pregnancy can also have withdrawal symptoms after their birth. It's not considered safe to take kratom during pregnancy.

If you or someone you know struggles with substance use, help is available. Call SAMHSA's National Helpline at 1-800-662-HELP (4357) to learn about resources in your area.

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