Kratom is a plant that grows in Southeast Asia. Its leaves have been chewed by locals for centuries for their stimulant and analgesic properties. It is one of many psychoactive substances that have entered the US market.
It became popular in the western world in the late 1990’s via specialized shops and online vendors. Now, it can even be found in convenience stores. In its commercialized form, it is available in a more highly concentrated form of gummies, liquid shots, powders, and pills.
The main active ingredient is a psychoactive alkaloid known as Mitragynine (MG). Psychoactive alkaloids are naturally occurring nitrogen-containing compounds produced by plants that affect the central nervous system, altering mood, perception, cognition, and consciousness. MG has both stimulant properties at lower dosages and opioid-like effects at higher doses.
Kratom also contains a small amount (2%) of 7-Hydroxymitragynine (7-OH), which is up to 46 times stronger than morphine. Kratom also contains many other alkaloids. Kratom is legal in the US, but is considered a “drug of concern” by the DEA. There has been some consideration to classify it as a Class 1 drug due to its dangers of use and risk of addiction.
Similar to the way hemp and marijuana components have been isolated, concentrated, and sold commercially, individual alkaloids of Katom, such as 7-OH, have been sold in very concentrated forms. When the plant is processed into concentrated forms or specific alkaloids are synthesized, the risk for addiction and death is magnified.
The general public may not realize the serious addictive potential of this compound or its toxic effects, as it is easily available at the local smoke shop or online. It is too easy to pull out a credit card and buy it compared to buying drugs from a dealer or trying to obtain prescription opioids.
While sold as a natural supplement, it has very dangerous risks. Side effects are variable and include the opioid-like effects of nausea, vomiting, constipation, itching, dizziness, and drowsiness with respiratory depression; adrenergic effects of tachycardia, hypertension, and dilated pupils; and serotonin effects of agitation and confusion. Other serious consequences include liver damage, tremors, seizures, and addiction.
Kratom in lower dosages is a stimulant, whereas high doses have opioid-like effects, causing sedation and respiratory depression. High doses are associated with constricted pupils and nystagmus, “Kratom Wobbles” (involuntary eye movements).
A Kratom overdose consisting of the typical opioid overdose signs like pinpoint pupils, inadequate respiratory drive, and unresponsiveness may or may not respond to Naloxone. The relative concentration of MG vs 7-OH may dictate response, as well as any other CNS depressants the patient has on board. In many instances, more than one drug was ingested. However, a patient presenting with these signs should be treated with naloxone. If the naloxone is not effective, supportive care will be required with intubation and ventilation until the effects wear off, which may take a couple of days.
Kratom withdrawal is similar to opioid withdrawal. Suboxone (Buprenorphine and Naloxone) has been used to help manage cravings and withdrawal, just like in the case of opioid addiction. This medication should be combined with an effective treatment program that includes counseling, behavioral therapy, and ongoing monitoring.
Sources & More Information:
David Peran, Michael Stern, Petr Cernohorsky, Roman Sykora, Stanislav Popela, Frantisek Duska, Mitragyna speciosa (Kratom) poisoning: Findings from ten cases,
Toxicon, Volume 225, 2023 Available at https://www.sciencedirect.com/science/article/abs/pii/S0041010123000405
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Overbeek DL, Abraham J, Munzer BW. Kratom (Mitragynine) Ingestion Requiring Naloxone Reversal. Clin Pract Cases Emerg Med. 2019 Jan 4;3(1):24-26. doi: 10.5811/cpcem.2018
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Weiss, S.T. and Douglas, H.E. (2021) ‘Treatment of kratom withdrawal and dependence with buprenorphine/naloxone: A case series and systematic literature review’, Journal of Addiction Medicine, 15(2), pp. 167–172. Available at https://calhospitalcompare.org/wp-content/uploads/2025/03/treatment_of_kratom_withdrawal_and_dependence_with.15.pdf
