Is Kratom Safe? Exploring Kratom’s Effects on Brain, Traditional Uses & Side Effects

Kratom products have been increasing in popularity and availability across the United States in recent years, prompting questions about how safe kratom really is. About 1.7 million Americans aged 12 and older reported using kratom in the most recent national drug survey in 2021, and the higher end of estimates reached about 10 million current users in 2019. 

Many people report therapeutic benefits associated with the herbal drug, but other reports from medical authorities such as the US FDA, CDC, and the Mayo Clinic caution against using kratom products. 

Here, we provide a balanced evaluation of the benefits and safety risks associated with using kratom and explore the effects of kratom on the body’s biochemistry. 

What is Kratom?

Kratom refers most generally to the Mitragyna speciosa tree, indigenous to Southeast Asia. This tree belongs to the coffee family, and products made from its leaves have been used for therapeutic applications and socioreligious ceremonies in its native regions for centuries. 

Kratom use in the United States is comparatively new and did not become widespread until around 2015. Today, you can find various kratom products — which include loose leaf, powder, capsules, and concentrates — legally available for purchase through online retailers, smoke shops, convenience stores, and supplement purveyors across 46 states. Age restrictions may apply in some states, so always double-check your local laws. 

The leaves of the kratom tree contain over 40 alkaloids, with mitragynine and 7-hydroxymitragynine being the most pharmacologically significant. These compounds interact with mu-opioid receptors on nerve cells, inducing diverse effects that range from pain relief and energy stimulation to anxiety reduction and sleep improvement. 

Research analyzing self-reports about kratom use in the US indicates that kratom is primarily self-administered for symptoms such as: 

• Anxiety
• Depression
• Pain
• Fatigue
• Withdrawal effects in substance use disorders, particularly in opioid weaning, withdrawal, and cravings

Kratom is currently legal at the federal level and in most states. However, the emergence of poisoning cases involving kratom has aroused safety concerns, which have led the FDA and the Drug Enforcement Administration (DEA) to issue multiple warnings identifying kratom as a “drug of concern.” The CDC and DEA have even explicitly warned that kratom may cause psychosis or death.

Kratom and Health Benefits: Popular Uses and Scientific Evidence

People take Kratom to relieve a variety of symptoms. With limited scientific research available to verify the effectiveness of Kratom for therapeutic uses, the benefits of kratom use are largely supplied by anecdotal reports from individual users. Some users take kratom to self-treat:

• Symptoms related to drug withdrawal, particularly from opioids
• Fatigue
• Pain 
• Insomnia
• Muscle cramps
• Depressed mood
• Low physical stamina and energy

However, these beneficial effects associated with kratom are yet to be legitimized by significant evidence from modern scientific studies. So, there is a level of caution that must be exercised when considering whether to give kratom a try, given that research on the effectiveness of kratom is still unfolding and the potential risks are significant. 

Potential Risks Associated with Kratom

Because of the limited scientific research on kratom’s benefits and side effects, it is unclear whether kratom will produce the desired effects it is reputed to provide — especially on the individual level. One must consider if the potential risks outweigh the possible benefits.

Kratom may interact with certain medications in ways that have not yet been studied, and people with certain conditions may not respond well to taking kratom. Therefore, it is recommended that consumers consult with a physician regarding their personal medical history before approaching kratom as a potential treatment option, and never self-diagnose or self-treat.

Adverse Effects

The adverse effects of kratom may not be worth the benefits associated with its use and can even be severe. Preclinical studies on the physiological effects produced by kratom’s most prominent alkaloid, mitragynine, have yielded some concerning results. For example, studies using mice and rats have pointed to the possibility that there may be a risk of addiction with kratom use, as well as cognitive impairment. 

There are also case studies that indicate the possibility that a range of organ systems may be susceptible to kratom-related damage. Examples include kidney injury, cardiotoxicity, thyroid damage, and hypothyroidism. Liver injury in particular appears to be an especially common reaction. 

Other adverse effects associated with kratom ingestion include:

• Agitation
• Tachycardia (increased heart rate)
• Hypertension (high blood pressure)
• Drowsiness
• Vomiting
• Aching muscles or joints

It is important, however, to note that many of these negative outcomes are the result of chronic use or high doses of kratom. Additionally, more severe effects such as seizures, respiratory arrest, and death occurred in the presence of other drugs in the person’s system and with incredibly high doses of kratom. 

Since kratom acts on mu-opioid receptors, the potential for harm, dependence, and withdrawal is still there. Like most drugs, kratom’s side effects are dose-dependent. So far, it seems low doses of 1-5 grams cause stimulant effects, while higher doses of 5-15 grams give stronger opioid-like effects. The safety of any kratom doses, frequency, and routes are unknown.

Thus, it’s important to do more research into the toxicity profile, dosing, and potential therapeutic effectiveness – if any – for low to moderate doses of kratom. We need to understand the extent to which kratom might be harmful altogether, or just in cases of abuse. 

Lack of Regulatory Oversight

Kratom’s health applications are yet to be legitimized by the scientific community, so the FDA has not approved Kratom as a drug or supplement. This means that Kratom products are unregulated and are not held to any comprehensive, enforced standards. 

So, like in the case of non-prescription CBD and hemp products, there is a level of caution consumers must exercise when selecting a particular brand or purveyor of kratom. With the lack of regulatory framework or enforcement in place, there can be kratom products that are falsely advertised, ineffective, or even unsafe. For example, in 2018, the FDA issued a mandatory recall due to Salmonella contamination in kratom products. 

Moreover, the DEA has placed kratom on its Drugs and Chemicals of Concern list, although kratom is not yet considered to be a controlled substance.

The lack of control makes it difficult to ensure that consumers are receiving reliable information regarding their product’s processing, dosing, or labeling, which adds further uncertainty regarding the health risks associated with consuming kratom products. Unfortunately, certain manufacturers may be adding much more kratom or adulterants to products than naturally available in the plant, increasing the risk of side effects.

Kratom is widely available online, in supplement stores, and even in gas stations and smoke shops across most of the US, except in states and cities where it is banned. Online retailers must often market kratom products as being “for soap-making and aromatherapy” to circumvent the 2014 FDA ban on the importation of kratom for use as a dietary supplement. 

Therefore, it’s important to seek out trustworthy brands and vendors (i.e. GMP certified) when purchasing kratom to be more confident that you are not receiving contaminated or falsely advertised products.

So, Is Kratom Safe?

Although kratom has been used for hundreds of years, there is still little modern scientific evidence supporting its touted benefits. Conversely, many studies are illuminating the possible toxic and adverse effects associated with kratom use, but most of these studies were done with animals and involved testing the effects of high doses of kratom or chronic kratom use. Since the absence of evidence does not necessarily indicate evidence of absence, kratom may provide desirable outcomes that have not been thoroughly researched yet, especially for those recovering from opioid addiction or individuals with chronic pain.

Overall, the case for kratom is still under development, so it is recommended that consumers proceed with caution. Always consult a physician regarding choices that will affect your current healthcare plan, and research particular kratom brands and retailers carefully before making your kratom purchases. Remember that without clinical research, third-party testing, and regulations, none of these products can be guaranteed to be fully safe or pure.