What Is Kratom—And Is It Safe?

By | August 21st, 2023

Some people are experimenting with an herbal extract called kratom as a brain-boosting supplement. Here's what we know about what it does to the brain.

About 1.7 million Americans have taken up use of a substance called kratom — an herbal extract from the leaves of a tropical tree grown in Southeast Asia — to boost energy or treat various conditions, including chronic pain and opioid withdrawal. A spate of wrongful death lawsuits spurred concerns over the safety and legality of kratom following the death of a Florida woman, Krystal Talavera, who died in 2021 after taking kratom supplements. Now, scientists are keeping a close eye on its negative cognitive effects, including forgetfulness and other cognitive problems.  

Talavera’s family won $11 million in damages from the supplement’s distributors through a wrongful death suit. The coroner in Talavera’s case determined that the death resulted from intoxication by a chemical extract called mitragynine — is one of the two main chemical extracts found in kratom. How does kratom work? And what does it do to the brain? Here’s what we know so far.

What’s the science behind kratom?

Leaves from the kratom tree have two main chemical components — mitragynine and 7-hydroxymitragynine — responsible for their effects on the body and brain.

While scientists have run many experiments on animals and Petri dishes, few clinical trials have studied the effects of kratom.

That means it is tough to determine its safety and effectiveness across different conditions like chronic pain or depression. 

Kratom as an off-label treatment for opioid addiction and withdrawal symptoms

People with opioid dependence still face stigma when it comes to seeking help in addressing their addiction. Some might turn to kratom supplements, which is sometimes used by people struggling with addiction to treat opioid dependence and withdrawal. 

“Some people, particularly if they have a history of substance use, may have had previous negative experiences with the medical system,” Dr. Stephanie Weiss, a research physician at the Translational Addiction Medicine Branch at the National Institute on Drug Abuse told Being Patient. “They may feel more comfortable taking something like kratom because there’s more privacy and maybe less stigma compared to going into the medical system and feeling judged by it.”

As a result of this desire to avoid stigma, doctors have raised concerns that patients end up self-medicating themselves instead of seeking professional, medical help for their opioid use.

Is kratom safe? At what dosage?

At a low dose (one to five grams), kratom boosts arousal and awareness — though experts note a cup of coffee may be a safer alternative.

At higher doses (five to 15 grams), kratom has effects similar to drugs called opioids (which include Oxycontin) — it may provide pain relief and treat symptoms of anxiety and depression. 

According to Weiss, the lack of existing, gold-standard research on kratom’s effects on humans makes it hard to tell how well kratom works — or whether it works at all — for any of these indications.

What are its side effects?

Meanwhile, kratom may cause side effects like:

  • Anxiety
  • Irritability or aggression
  • Constipation
  • Difficulty breathing
  • Vomiting

Heavy prolonged use can cause more severe side effects, including seizures, tremors, and addiction. Can using kratom literally kill you? That’s also unclear.

“Unfortunately, we don’t know,” Weiss said of the question of whether kratom could be fatal. Many people take kratom along with other drugs, treatments, and supplements. The interactions between these different substances might also be responsible, she noted. 

Is kratom regulated?

Only six states — Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin — outright banned the buying, selling, and possessing kratom. In August 2016, the Drug Enforcement Agency imposed strict federal restrictions. But the agency later rescinded the restrictions after a significant public backlash the following year.

Elsewhere, it cannot be marketed legally as a drug or dietary supplement. 

The FDA has warned consumers about kratom’s possible safety and addiction risks. The agency does, however, support more research toward understanding the effects of kratom. But finding a website, vape shop, or gas station selling kratom is still very easy. 

Safety and purity of kratom  

Pieter Cohen, a neurologist at the Cambridge Health Alliance, has made a career of testing different types of supplements to see if their labels were accurate and the products were safe. 

His research suggests widespread mislabelling of supplements — including brain-boosting pills, dopa mucuna extracts, melatonin gummies, and fitness supplements. In some cases, the supplements don’t contain what’s advertised on the label, while in other cases, the supplements contain illegal and dangerous unlisted ingredients

Do over-the-counter kratom products even contain kratom?

“One of the big risks of using a product like Kratom is that you don’t necessarily know what you’re getting in the package,” Weiss said.  

Scientists behind a 2016 study took samples of 15 kratom products sold online. After laboratory testing, they found that the products only contained one of the chemical components of kratom mitragynine but not 7-hydroxymitragynine. A 2019 FDA analysis also found many kratom products were contaminated with high levels of lead and nickel.  

A 2023 study pointed to several products containing kratom with dangerous undeclared ingredients like morphine, phenylethylamine, and hydrocodone. In other cases, the products were contaminated with heavy metals and Salmonella.

Should you use kratom?

Kratom is also often advertised as natural — but that’s not necessarily the case, scientists say.

“Sometimes people use these [natural supplements] hoping to receive the benefits of something more wholesome and natural,” Cohen told Being Patient in a previous conversation about supplements. “At other times, consumers are drawn to them because they are worried about side effects from pharmaceutical drugs.” 

Since the labels on kratom products may be inaccurate, it is even harder for the average person and their doctor to judge the actual benefits and risks. In addition, the medications that someone is taking might interact with kratom supplements, leading to additional side effects. 

Weiss believes it’s important to evaluate the potential risks and benefits before deciding to take kratom — and in terms of risks, it is hard to tell how exactly kratom will react with other drugs or supplements, whether some people are predisposed to liver problems as a result of kratom, and whether the product they’re buying is contaminated. For some people, the benefit of avoiding medical stigma will outweigh these risks. For others, that won’t be the case. In all cases, being informed about the science behind a supplement is crucial to making a balanced decision.

UPDATE, 23 August 2023, 12:32 P.M. ET: Typos were corrected; the title of Dr. Weiss’s affiliation, was corrected. It is the National Institute on Drug Abuse, not the National Institute of Drug Addiction.

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