Kratom: What You Need to Know

TABLE OF CONTENTS

• What Is Kratom?
  • The History of Kratom
• Is Kratom Legal in 2021?
  • Is It Legal to Travel With Kratom?
  • Is Kratom Legal in Southeast Asia?
  • Does Kratom Show Up on Drug Tests?
• Why Has Kratom Become So Popular in the US?
• How Much Kratom Is Needed to Feel Its Effects?
• What Are the Different Strains of Kratom?
• What Is Kratom Used For?
  • Kratom for Pain
  • Kratom for Addiction Withdrawal
  • Kratom for Anxiety
  • Kratom As a Nootropic
• Potential Risks and Side Effects of Kratom
  • Side Effects of Kratom
  • Combining Kratom With Other Medications
  • Lack of Regulation
  • Kratom Addiction
  • Can You Overdose on Kratom?
• Can You Become Addicted to Kratom?
  • Warning Signs of Kratom Addiction
  • What Can I Do if I Am Addicted to Kratom?
  • What Are Kratom Withdrawal Symptoms?
• Can Kratom Cause Psychological Problems?
• Is It Safe to Use Kratom During Pregnancy?
• The Bottom Line

What Is Kratom? (pron. kray-tum)

Kratom is a substance obtained from the leaves of the kratom tree—a tropical evergreen in the coffee family that is native to Southeast Asia. Its leaves contain many compounds, including mitragynine, a psychotropic (mind-altering) opioid.

Kratom grows naturally in Thailand, Indonesia, Malaysia, Myanmar, and Papua New Guinea, where it is also known as herbal speedball, biak-biak, kakuam, ithang, thom/tom, and ketum. It has been used as herbal medicine since the nineteenth century. Kratom is so deeply rooted in local Southeast Asian cultures that most don’t consider it a drug and will use it for pain relief before considering prescription medication.

The History of Kratom

Kratom is a powerful central nervous system stimulant used to boost both physical and mental energy. A popular herb among manual laborers in Southeast Asia, it has been used to increase work efficiency and relieve fatigue. It has also been used to treat pain, improve mood, increase sexual arousal, and serve as a less-expensive substitute for opium.

In 2016, the Centers for Disease Control and Prevention (CDC) reported an increase in calls to poison control centers involving kratom, and in 2019, the U.S. Food & Drug Administration (FDA) warned consumers to avoid it. As of February 2019, the FDA recommended making kratom’s active compounds, mitragynine and 7-hydroxy mitragynine, a DEA schedule-I drug due to their opioid-like effects, the potential for dependence, and a lack of medical indication.

When states began to ban kratom, advocates fought to prevent the Drug Enforcement Agency (DEA) and the FDA from enforcing them. Despite protests, in August 2016, the DEA added kratom to the list of Schedule-I drugs that produce neurological effects, including LSD, heroin, and cocaine. A few months later, the decision was reversed when kratom advocates launched a full-fledged campaign to defend kratom and keep it legal in the US.

Is Kratom Legal in 2021?

The FDA has not approved kratom for any medical use. In addition, the DEA has listed kratom as a Drug and Chemical of Concern. Kratom is not controlled under the US Controlled Substances Act; its legal status is determined by individual states.

The possession, use, and/or sale of kratom is presently illegal in the following states:

• Alabama
• Arkansas
• Illinois (illegal in Jerseyville, elsewhere legal if sold to those over age of 18)
• Indiana
• Tennessee (legal for those over age 21)
• Vermont
• Rhode Island
• Wisconsin

In the following states, kratom is still legal, although bans have been passed or are being considered:

• California: Kratom is legal in the state of California but has been banned in San Diego
• Florida: Kratom is legal in the state of Florida but is illegal in Sarasota County. If caught with it there, you could face 60 days in jail and a fine of $500.
• Iowa
• Louisiana
• Michigan
• New Hampshire (illegal for those under the age of 18)

Is It Legal to Travel With Kratom?

You can travel with kratom if it is legal in both your departure and destination locations. If the herb is illegal in either place, you should not travel with kratom.

Countries where kratom is illegal include:

• Argentina
• Australia
• Bulgaria
• Croatia
• Denmark
• Estonia
• Finland
• France
• Germany
• Ireland
• Israel
• Italy
• Latvia
• Lithuania
• Luxembourg
• Moldova
• Norway
• Poland
• Portugal
• New Zealand
• Romania
• Singapore
• Slovenia
• Sweden
• Switzerland
• United Arab Emirates
• United Kingdom

Is Kratom Legal in Southeast Asia?

Ironically, kratom is illegal in many of the countries where it is produced, including:

• Indonesia
• Malaysia
• Myanmar
• Thailand (legal for medical use and research only)

Mufti Djusnir, the head of the Narcotics Laboratory Center of the National Narcotics Agency (BNN) in Indonesia, stated that,

“Kratom leaves contain compounds that are harmful to your health… the benefits from the plant are far less than its disadvantages, kratom is 13 times stronger than morphine. Based on research, the therapeutic index value is very small. If it is continuously consumed, kratom will cause symptoms of addiction, respiratory depression, and even death.”

Does Kratom Show Up on Drug Tests?

If kratom is requested on a drug test, it can be found in the bloodstream. Most experts agree that it can take over a week for kratom to clear and two weeks until kratom alkaloids are undetectable in the blood. Kratom is unlikely to trigger a false positive drug test for other opiate medications because the chemical structures of the active ingredients are very different from conventional pharmaceutical or illicit opiates.

In general, most companies, government agencies, or athletic associations ordering drug tests aren’t looking for kratom. The herb is completely legal in most parts of the US, so there would be no reason to look for it unless you currently live in a region where kratom is outlawed.

Why Has Kratom Become So Popular in the US?

Americans have quickly taken to using kratom. Presently, there are approximately 10 to 16 million kratom users in the US. The substance’s popularity can be attributed to its two major psychoactive ingredients: mitragynine and 7-hydroxy mitragynine. These substances cause effects similar to both opioids and stimulants.

In smaller doses, mitragynine interacts with receptor systems in the brain to produce:

• Stimulant effects
• Increased energy
• Sociability
• Alertness

When consumed in larger amounts, both of kratom’s psychoactive ingredients (mitragynine and 7-α-hydroxy mitragynine) interact with opioid receptors in the brain, producing:

• Sedation
• Pleasure
• Decreased sensation of pain

There are multiple ways to consume kratom. The leaves may be chewed, crushed and smoked, brewed as tea, or taken in the form of capsules, powders, liquid extracts, and gum.

How Much Kratom Is Needed to Feel Its Effects?

Kratom is a close relative of the coffee plant and, like coffee, kratom is a powerful central nervous system stimulant. Its effects, however, are unique. Kratom is a complex plant; there are 16 key ingredients in the leaves, each with its own set of effects. The ratios of these compounds can change from one strain to another, giving each one a unique “effect profile.”

The effects of kratom are dose-related. High-dose kratom is a powerful painkiller and provides a euphoric state similar to opiate pain medications. Lower doses offer mild pain relief but activate the central nervous system to make the user feel more alert and energized.

There is no specific dose of kratom that fits everyone. Many variables affect the dosage, including:

• The strain of kratom
• Where the tree was grown (known as the cultivar)
• Freshness of the kratom leaves
• Variations in leaf compounds
• Your weight
• Your desired effects

A safe dose of kratom has not been established. Effect will vary based on the drug, the concentration and the medical and medication history of the person consuming it.

While low doses are stimulating, once the dosage of kratom increases, the effects change completely and become sedating. Users feel relaxed, carefree, and lazy. These doses are most useful for supporting sleep, easing anxiety, and alleviating chronic pain or muscle tension. Kratom can also increase empathy, provide a warming sensation in the body, increase sexual arousal, and improve erectile function.

It is thought that kratom’s effects are noticed within 30 minutes of ingestion, peak at 60 minutes and are usually gone within 3 or 4 hours. This is an estimate and in no way exact.

What Are the Different Strains of Kratom?

There are many different types of kratom, referred to as “strains.” Each strain has a different set of effects: some are powerful sedatives and painkillers, while others are better for boosting mood or energy. In total, there are more than 50 different strains of kratom.

Each strain is differentiated by its geographical location (Thailand, Bali, Borneo, Indonesia, Sumatra, etc.) and vein color (red, white, yellow, green). There are also strains named after the region in which they’re grown (Hulu, Jong Kong, Kali) and strains named after their unique leaf shape (elephant and horn kratom).

Differences in strain effects are a result of the chemical composition of the leaves. The primary active ingredients in kratom are 7-hydroxy mitragynine (7-HMG), mitragynine, paynantheine, and speciociliatine, but there are over a dozen other active alkaloids that contribute to the effects of the individual strains. A strain’s unique combination of these active ingredients and their different chemical ratios account for differences in leaf veins’ colors and effects.

What Is Kratom Used For?

Kratom for Pain

Despite the lack of research, kratom is considered one of the most effective herbal pain relievers, second only to opium. Kratom’s popularity as a natural painkiller has been rapidly increasing in recent years. It’s estimated that 3 to 5 million people in the United States regularly use kratom for pain relief.

Red-vein strains are generally considered to have the strongest pain killing benefits. Green-vein kratom strains offer pain killing effects but with less intensity than red-vein strains. White-vein strains are more stimulating and less useful for managing pain.

Kratom for Addiction Withdrawal

A 2008 case study explored the use of kratom to help a recovering opiate addict lessen his withdrawal symptoms. The patient in this study reported that while the withdrawal period was considerably less intense, it took longer to recover completely. He found kratom to be effective for both preventing withdrawal symptoms and alleviating the chronic pain that prompted him to use painkillers in the first place.

Methadone is a synthetic opiate used to treat opioid addiction. Due to its widespread availability in developing countries, kratom is currently being explored as an alternative to methadone treatment. Kratom and opioids (like methadone) are both opioid-receptor activators. They act at the same sites in the brain, so taking them together would increase the risk of severe adverse effects or death from overdose. Kratom is also found to be effective in battling mild symptoms of alcohol withdrawal, such as restlessness, anxiety, aches, pains, and mood changes.

Kratom for Anxiety

In animal studies, kratom has been shown to have anti-anxiety effects. A study from 2011 demonstrated that when mice were given one of the active ingredients in kratom followed by exposure to a stressful situation, they maintained lower levels of stress hormones in their bloodstream.

Kratom As a Nootropic (pron. new-tropic).

Nootropics are drugs, supplements, or foods that can enhance the way the brain works, whether through improving mental clarity/intelligence, or increasing focus. Some people believe kratom is an effective nootropic for personal growth because it improves mental energy, focus, endurance, and stamina. Its relaxing and euphoric effects promote introspection and deep emotional healing.

The active compounds in kratom bind to the same opioid receptors in the brain and body and have effects like those of morphine or oxycodone.

Potential Risks and Side Effects of Kratom

Side Effects of Kratom

SHORT- TERM	LONG-TERM	WITHDRAWAL
nausea vomiting dizziness increased heart rate itching sweating dry mouth constipation increased urination loss of appetite Low doses: Increased energy, sociability, and alertness High doses: Sedation, euphoria, and decreased pain	lack of appetite weight loss insomnia skin darkening dry mouth frequent urination constipation confusion seizures Long-term use at high doses: hallucinations, psychoses, delusions, seizures, liver damage	muscle aches insomnia hostility aggression emotional changes runny nose jerky movements

Combining Kratom With Other Medications

Combining kratom with most prescription medications is not considered safe. Kratom’s depressant effects on the central nervous system are greatly magnified when taken with:

• Benzodiazepines (Klonopin, Xanax, Valium)
• Barbiturates (phenobarbital)
• Alcohol
• Opioids (Fentanyl, Oxycodone, Morphine Codeine)
• Antidepressants (Paxil, Lexapro, Zoloft)
• Anxiolytics (Xanax, Valium, Ativan)
• Other CNS-active drugs

Lack of Regulation

Since the production of kratom is not regulated, some preparations may contain dangerous contaminants. Samples of kratom have been found to contain prescription pain killers like fentanyl, hydrocodone, or morphine. In Sweden, 9 people died between October 2009 and December 2010 from a “boosted kratom formula” called Krypton. This product contained a combination of kratom, caffeine, and O-desmethyl tramadol. Other kratom products have been found to contain significantly less kratom than advertised on their packaging.

Kratom Addiction

Like caffeine or nicotine, kratom poses a risk for addiction when taken frequently and in higher doses and withdrawal symptoms will occur once kratom is stopped. Studies in rats have shown that:

• Mitragynine by itself does not appear to have abuse potential and may even decrease opioid intake.
• In contrast, 7-hydroxy mitragynine does have a strong abuse potential when administered as a pure compound to rats. The risk of addiction appears to be higher if the extract is used to treat opioid withdrawal or self-treatment of pain.

Withdrawal symptoms are mild compared to opioids and may last from 3 to 10 days following the last dose. Short-term medication therapies can help manage withdrawal symptoms.

Can You Overdose on Kratom?

Although no study has identified a lethal dose of kratom for humans, one 2019 study demonstrated a lethal dose in mice. Mice were injected with a very high dose of kratom extract. These doses are too high to achieve using oral forms of the herb and can only be attained by injection. In humans, kratom produces severe nausea and vomiting long before reaching a toxic dose.

Can You Become Addicted to Kratom?

With long-term use, kratom can result in changes to the opioid receptors, resulting in physical dependence. The longer a person uses kratom and the higher the dose, the more likely they are to become addicted to the drug.

Warning Signs of Kratom Addiction

The following may suggest the development of a dependence on or addiction to kratom:

• Continuing to use kratom despite developing problems in your life.
• Spending unreasonable amounts of money on kratom.
• Repeat failed attempts to stop using kratom.
• Losing interest in regular activities, socializing, etc.
• Difficulty controlling the dosage and how often you take kratom.
• Changes in daily habits such as sleeping or eating.
• The development of tolerance and withdrawal symptoms.
• Lying or keeping secrets regarding kratom use.
• Craving kratom throughout the day or being unable to function or enjoy life without it.

What Can I Do if I Am Addicted to Kratom?

There are several ways to get support and treatment for kratom addiction. Speak to your doctor about the best approach to treating your addiction.

Support Groups

There are many online support groups for people with addiction. Some online communities have entire groups of people dedicated specifically to helping manage kratom addictions.

Drug Rehab Centers

Rehab centers can provide support through therapy sessions, group meetings, and education. Treatment can be on an outpatient or inpatient basis.

Therapy

Working with a therapist to discover the root causes of your addiction may go a long way in solving the problem.

What Are Kratom Withdrawal Symptoms?

• Depression
• Agitation and restlessness
• Anxiety
• Lack of motivation
• Allergy-like symptoms
• Feeling tired and lazy
• Insomnia
• Muscle and bone aches
• Restless leg syndrome (RLS): One of the most irritating kratom withdrawal symptoms. RLS makes people incapable of finding comfort or rest. The sensation of agitation is so intense that people find they must constantly jerk or move their muscles to avoid it.
• Post-acute withdrawal syndrome (PAWS): This syndrome tends to begin after the initial physical withdrawal symptoms have stopped. PAWS symptoms are usually psychological and may include things like depression and anxiety. They are the result of changes in brain chemistry caused by long-term substance abuse. PAWS symptoms go away after some time but working with a therapist can help, as can trying meditation to restore brain function.

Can Kratom Cause Psychological Problems?

There’s some evidence suggesting a link between long-term kratom use and delusional behavior, hallucinations, depression, and anxiety. You should never use kratom or any other psychoactive substance if you or a close family member has a history of psychosis, bipolar disorder, or schizophrenia.

Is It Safe to Use Kratom During Pregnancy?

It is not advisable for kratom to be used in pregnancy.

Babies born to mothers who take kratom in pregnancy experience neonatal abstinence syndrome (NAS), similar to babies born to mothers who take opioids, such as heroin.

Neonatal abstinence syndrome is a withdrawal condition experienced by newborns whose body is withdrawing from opioids.

A 2018 article published in the journal Pediatrics reported on a newborn born to a mother who drank kratom tea throughout her pregnancy. The newborn had signs and symptoms consistent with neonatal abstinence syndrome, including low birth weight, resting tremors, irritability, and a high-pitched cry, as well as tight muscles.

NAS is a treatable condition that newborns experience due to prenatal exposure to certain substances, most often opioids. Symptoms may also include difficulty feeding, respiratory problems, and seizures.

Kratom should not be used in pregnancy.

The Bottom Line

Current estimates suggest that more than 5 million Americans are using kratom for a variety of reasons, including:

• Chronic pain
• Opioid use disorder
• Withdrawal symptoms from a range of prescription and non-prescription drugs.
• Mood disorders
• Insomnia

Kratom is also enjoyed for its:

• Mind-altering properties
• Euphoria
• Energy
• Mental clarity
• Endurance
• Stamina
• Introspective thoughts
• Deeply emotional, psychological healing

Kratom is extracted from tree leaves and has historically been used in Southeast Asia as a stimulant at low doses and for pain relief and sedation at higher doses. Kratom comes in different forms, including leaves that can be chewed or prepared as tea, powders, capsules, liquids, resins, and patches.

There are several strains of kratom available, with varying effects and potencies based on their exact composition. The active compounds in kratom bind to the same opioid receptors in the brain and body and have effects like those of morphine or oxycodone.

Kratom is now listed as a “drug of concern” by the US Drug Enforcement Agency (DEA). Although kratom use is legal at the federal level, at least 6 states have banned it, and more are considering bans.

Kratom’s side effects may include agitation, rapid heart rate, nausea, drowsiness, and hypertension (high blood pressure). Withdrawal symptoms may include muscle spasms, insomnia, watery eyes, runny nose, restlessness, and depression. After long-term use at higher doses, risks include seizures, hallucinations, and even death. Kratom use may increase the risk of addiction, abuse, and dependence.

In a February 2018 statement, then-FDA Commissioner Scott Gottlieb, MD, shared the agency’s view:

“The extensive scientific data we’ve evaluated about kratom provides conclusive evidence that compounds contained in kratom are opioids and are expected to have similar addictive effects as well as risks of abuse, overdose and, in some cases, death.”

Based on growing research showing the risks involved with using kratom, the agency continues to advise consumers against the use of kratom-containing products.

Written by: Lisa Shephard, MD | Editor: Victoria Menard | Reviewed December 10, 2021 | Copyright myObMD Media, LLC, 2021