Kratom: Beneficial Botanical or Dangerous Drug?
Depends on who you speak with…
Many of you may have encountered "kratom" at gas stations, convenience stores, smoke shops, and even at natural health or vitamin shops. It comes packaged as capsules, powders, drinks, or energy shots. It is touted to help many conditions ranging from pain relief to elevation of mood and focus. Legions of people rely upon it for opioid withdrawal symptoms. Its growing prominence and visibility in these retail spaces has sparked both curiosity and excitement as well as concern among healthcare providers.
Depending on what you read, who you listen to, and which experts you defer to, you can get a remarkably different idea about the benefits or potential harmfulness of kratom. Millions of people believe that kratom is an accessible pathway out of undertreated chronic pain and opiate withdrawal, which can safely improve mood and focus. Many experts believe that kratom is a dangerous, unregulated, addictive drug with little medical utility and potentially severe side effects, including addiction and overdose. How can millions of regular kratom users, the US Drug Enforcement Agency (DEA) and medical professionals have such divergent views of the same plant? Is either vantage point fully accurate? How do we factor in that it is difficult to come up with a sensible opinion on any drug in a culture that’s been assaulted by a half century’s War on Drugs, which tends to shift the dialogue toward distorting facts and exaggerating harms?
What is kratom?
Kratom (Mitragyna Speciosa) is a tropical tree related to the coffee family native to Southeast Asia, with properties that range from stimulant-like, energizing and uplifting, to opioid-like, causing drowsiness, constipation, and euphoria. Kratom has dozens of active components and stimulates numerous different receptor systems in our brain. All of this makes kratom difficult to characterize as one particular type of drug such as a "stimulant" or an "opiate."
The two main chemicals, mitragynine and 7-hydroxymitragynine, have strong activity at the main opioid receptor, the "mu" receptor, which is the same one stimulated by narcotics such as heroin and oxycodone. Kratom is commonly consumed orally, such as made into a tea, with added sweetener to overcome its utterly disgusting bitterness (in my opinion…) or swallowed as a pill. There are now available extremely potent concentrates such as 7-hydroxymitragynine which appear to be even more addictive and toxic. The variety of kratom related products are proliferating.
Side effects of kratom that have been cited include agitation, tachycardia, drowsiness, vomiting, and confusion. There are also said to be grave side effects such as seizures, as well as respiratory and cardiac arrest. Deaths have been reported from kratom though, as discussed below, this has not truly been established.
Kratom can be found in gas stations, smoke shops, natural medicine and botanical shops, and paraphernalia shops in most parts of the US, except in the handful of states and cities that have banned it. Many people purchase kratom over the Internet, where it typically is sold "for soap-making and aromatherapy" to avoid the fact that in 2014 the FDA made it illegal to import or manufacture kratom as a dietary supplement. The sites essentially say, ‘not for human consumption, wink wink, nod nod.’
What are some of the problems with kratom?
There is little to no reliable information on the growth, processing, importing, packaging, or labeling of the kratom sold in the US, which adds to the already considerable uncertainty of its health risks. No adults are regulating this industry. This means that there is no guarantee that any kratom that you buy will be safe and unadulterated. In 2018 the FDA instituted a mandatory recall over concerns about Salmonella contamination of kratom-containing products. The DEA has recently placed kratom on its Drugs and Chemicals of Concern list but has not yet labeled it as a controlled substance.
Kratom can be addictive due to its opioid-like qualities, and a small minority of users end up requiring addiction treatment. This is called Kratom Use Disorder, and is often characterized by tolerance, withdrawal, and cravings. There are case reports of doctors needing to use Suboxone (buprenorphine), a treatment for fentanyl and oxycodone addiction, to get people off of kratom. The CDC claims that between 2016 and 2017, there were 91 deaths due to kratom, but this claim must be greeted with skepticism, as all but seven of these casualties had other drugs in their system at the time of death, making it impossible to uniquely implicate kratom.
Why do people use kratom?
The DEA, who tend to be one of the least reliable resource on any drugs in my humble opinion, maintains that kratom has no medical uses or benefits. However, in Asia kratom has been used for hundreds of years to treat cough, diarrhea, opiate withdrawal, depression, and chronic pain, and to boost energy and sexual desire.
More recently, in the US there has been an uptick in the use of kratom by people who are self-treating chronic pain and acute withdrawal from opiates. People are desperately seeking alternatives to prescription medications as pressure is put onto doctors not to prescribe these pills. This pressure, as well as a lack of available providers, results in an increase in overdoses, as people are thus forced to buy street drugs tainted with fentanyl, and suicides.
There is very limited research suggesting that kratom is effective and safe. A 2024 study, ‘Ecological Momentary Assessment of Self-Reported Kratom Use, Effects, and Motivations Among U.S. Adults’, which assessed 357 current kratom users, found that,
Most reported using kratom daily to relieve pain, improve mood, or increase productivity, and some used it as an opioid substitute. Most participants reported improvements in daily living and productivity; more frequent use was associated with tolerance, withdrawal, and craving but not with social or functional impairment.
Kratom has an extremely vocal community of supporters, and, while there are countless anecdotal testimonials of effectiveness, these treatment practices and outcomes using kratom have not been as rigorously studied as they need to be. I look forward to seeing more studies, hopefully in the near future, so we can confirm kratom’s safety and efficacy.
A patient wishing to use kratom for pain or to mitigate withdrawal symptoms would encounter several problems, not all of which have to do with the intrinsic properties of kratom itself.
First of all, the DEA has threatened to make it a Schedule 1 controlled substance (i..e., no medical utility, high misuse liability), which is in the same category as heroin or psilocybin. Paradoxically, both of these drugs have robust medical usefulness – did I mention that the DEA doesn’t know what it is doing?. This would make it difficult for desperate patients to access and would likely make the supply, as a whole, even more dangerous. It is always the case that making drugs illegal makes them more hazardous for everyone.
Secondly, the complete lack of oversight or quality control in the production and sale of kratom makes its use potentially dangerous. There is no ‘adult in the room’ regulating kratom and naked capitalism, on its own, can make for extremely unsafe products.
Thirdly, kratom has not been well studied for any of the uses its proponents claim, though as the saying goes, "absence of evidence of benefit isn't evidence of absence of benefit." The harms haven’t been adequately studied either.
A final problem is that kratom doesn't show up on drug screens. One can argue that the wider adaptation of another potentially addictive opioid-like substance in the midst of an opioid epidemic, which has killed more than one hundred thousand people per year over the last several years, is the last thing we need.
Is there a sensible path forward with kratom?
I'm not sure that anyone has the answer to this question. At bare minimum, safety could be improved with:
Regulation: it would be safer if people knew the exact dosages they were consuming and that it was free of contamination from things such as pesticides and heavy metals.
Education: educated consumers, who know the dangers and potential benefits, are far less vulnerable to misleading claims and able to pick safer products.
Research: if it does have benefits for either addiction or chronic pain, as its advocates claim, we need to know. It is also critical that we better define the risks of using kratom, so that people are more accurately informed, and can practice harm reduction. Kudos to Kirsten Smith at John Hopkins who is studying all this stuff.
Keep from criminalizing kratom. As with all other drugs throughout history, this would make everything about its use more dangerous.
If the above suggestions could somehow be accomplished, by scientists and public health specialists, without overdue distortion from corporate interests, antidrug ideology, and romanticism by kratom enthusiasts, we could then have enough clarity to answer the question: is kratom harmful or helpful?
My guess: more helpful than harmful, but…coherent regulation is essential.
I've used kratom for several years and find multiple health benefits. It's critical that the vendor has 3rd party analysis to avoid funkyv and potentially dangerous filllers.legalize and regulate. I would never by from a gas station or smoke shop. Happy Hippo is the brand I use , predominately for energy and mental focus.
Its needs to be prescribed. Has nothing to do with fillers, etc. My son had pure mitragrynine in his system, nothing else, 2 labs tested. It’s like selling OxyContin at a gas station. By the way, my very healthy 30 year old son died from it.