Kratom: Weighing the Benefits and Risks

The plant raises questions about the legality of the 'natural' opioid-like powder

Medically reviewed by Violetta Shamilova, PharmD

Kratom is an herbal product made from the leaves of the kratom tree (Mitragyna speciosa), which is native to Southeast Asia. Kratom is sold as a tea or in capsules and marketed as a natural stimulant. Kratom is said to have opioid-like effects, and kratom benefits reported include helping people cope with withdrawal symptoms and drug-related cravings, pain, fatigue, and mental health challenges. Kratom is not approved by the Food and Drug Administration (FDA). Using kratom comes with some risks, too.

Find out kratom's side effects, the different forms it takes, its legal status, and its alternatives in this article.

Is Kratom Powder an Opioid?

Kratom powder is not an opioid. Kratom powder is said to have opioid-like effects and psychostimulant effects. Kratom works on or activates opioid receptors in nerve cells. The effects are mild compared to those of opioids or heroin. This means the adverse effects of kratom or kratom side effects are also milder in comparison to those of opioids.

The naturally occurring chemical compounds in kratom also bind to receptors affecting various aspects of mental health, including serotonin receptors and dopamine receptors. These plant compounds or kratom alkaloids and receptors are linked to kratom's stimulating or arousing effects.

Related: Types of Opioids Used for Chronic Pain Relief

What Are Kratom's Uses?

Researchers have reported several reasons people give for using kratom today, including:

• Pain relief and management

• Mental health conditions like depression and anxiety

• Coping with the effects of drug withdrawal (especially opioid drug withdrawal)

Researchers say most people who use kratom report using it for more than one reason. The National Institute on Drug Abuse notes that though people use kratom to help cope with certain conditions including substance use disorders, kratom is not approved for safe use in helping someone cope with substance use disorders and that regulated, safe, and effective medications do exist to help people reduce the symptoms of opioid withdrawal.

Traditional Uses for Kratom

Kratom has traditionally served as a method of increasing energy and improving work productivity as well as fighting fatigue among farming populations in Southeast Asia.

Kratom Side Effects

The FDA has issued a general warning against using kratom due to the potential for adverse effects including drug abuse and addiction. Some of this concern stems from the fact that kratom is an unregulated herbal remedy.

Kratom Contamination

Contamination in herbal supplements like kratom includes excess traces of heavy metals and bacteria. The FDA has issued numerous warnings about kratom contamination, including on the risk of developing heavy metal toxicity and exposure to contamination from salmonella.

General side effects of kratom include:

• Nausea

• Constipation

• Dizziness

• Discoloration of the cheeks
  

• Drowsiness

• Dry mouth

• Euphoria

• Sleep disturbances

• Increased sociability

• Nervousness or restlessness (increased energy and excitability)

• Respiratory depression or slowed breathing

• Sweating

• Vomiting
  

• Weight loss over time with repeat or regular use

The U.S. Department of Justice and the U.S. Drug Enforcement Administration (DEA) say low doses of kratom have stimulating effects and higher doses of kratom have more sedating effects.

More serious side effects of kratom include:

• Hallucinations

• Delusions

• Tremors

• Loss of libido

The DEA notes several cases of psychosis or hallucinations have been reported after kratom consumption. Though possible, a research review suggests serious adverse effects from kratom are very rare. The FDA has reported few cases of kratom-related deaths.

Kratom dependence can cause someone to experience withdrawal symptoms such as:

• Hostility or aggression

• Aching of muscles and bones

• Jerky limb movements that can look similar to seizures but are not seizures
  

Warning

The long-term health effects of kratom use, kratom use during pregnancy, and the safety profile of kratom use while operating machinery or while consuming other substances (prescription or recreational) are not well understood. There is some evidence to suggest kratom use during pregnancy can cause withdrawal symptoms in newborns.

Related: Herbal Remedies for Osteoarthritis

Forms of Kratom

Kratom tea and chewing the kratom tree leaves are popular in Southeast Asia. In the U.S., you may find kratom more commonly sold in powder form. People self-report using kratom powder in the following ways:

• Putting kratom powder into capsules and swallowing

• Stirring kratom powder into beverages

• Using the “toss and wash” method or consuming a spoon full of powder and washing it down with water or juice

Kratom can also be found as an extract in tincture or resin form.

Kratom Dosing

Dosing for kratom can be hard to determine because dosing and effects for kratom have not been well documented. However, data from literature reviews suggest a typical dose range for consumers in the U.S. may be less than a single gram and up to 7 grams based on data from self-reporting study participants. The average dose for nearly half of the participants was reported between 1 and 3 grams per consumption or each time, with most participants reporting daily kratom use.

Related: What to Know About Adaptogens

Where Does the United States Stand on Kratom Legality?

Kratom is legal in the United States and is available for sale online and in some shops in some counties. Kratom is not listed under the U.S. schedule of controlled substances. However, kratom may seem to be in a legal gray area because several state regulations or prohibitions against the possession and use of kratom exist.

States with bans against kratom according to data from 2017 include:

• Alabama

• Arkansas

• Florida

• Indiana

• Tennessee

• Wisconsin

It’s best to check with your local laws because restrictions, regulations, and bans can be updated at any time.

Many countries have banned kratom use or made kratom illegal. These include:

• Argentina

• Australia

• Belarus

• Bulgaria (unless you have a prescription)

• Croatia

• Denmark

• Estonia

• Finland

• France

• Germany

• Ireland

• Israel

• Japan

• Latvia

• Lithuania

• Myanmar

• Malaysia

• New Zealand (unless it’s prescribed)

• Poland

• Romania

• Russia

• Singapore

• South Korea

• Sweden

• Switzerland

• Thailand

• Vietnam

Alternatives to Kratom

There is an alternative to kratom called Sakae Naa. The FDA has placed an import alert on this new dietary ingredient similar to the one placed on kratom. The FDA says the import alert is due to “inadequate information to provide reasonable assurance that it does not present a significant or unreasonable risk of illness or injury.”

Related: Is Kratom Addictive?

Summary

Kratom is a herbal substance from Southeast Asia that acts on the body in ways similar to those of opioids. Kratom is not an opioid. Kratom in smaller doses has stimulating effects and in larger doses has sedating effects. It has been traditionally used for increasing energy and worker productivity in farming communities in Southeast Asia but it is now also used in the United States for several reasons.

People report using kratom for pain relief and to help cope with depression and anxiety. Kratom has side effects including nausea and digestive upset. Very rare but serious side effects include psychosis and death. Kratom is legal in the U.S. but is not regulated and is a drug of concern due to its potential for abuse and addiction.