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Kratom Use: What You Should Know About This Herb’s Effects

This entry was posted in Drug Side Effects on by .
Medically Reviewed

Last Updated on September 17, 2021 by Chris Weatherall


Alternative to Meds Editorial Team
Medically Reviewed by Dr Michael Loes MD

What is kratom? Kratom is a psychoactive plant used in South Asia and parts of Africa as a recreational drug and has a centuries-long history as a traditional medicine. In Thailand, it is used by farm workers to combat fatigue and increase productivity.1-3 Kratom is made from the leaves of a Southeast Asian tree called Mitragyna speciosa (a species in the same family as coffee).

There are numerous psychoactive components in the leaves including mitragynine, 7-hydroxymitragynine, speciogynine, paynantheine, speciociliatine, over 40 other alkaloids and other chemicals that need further study to determine their potential effects or toxicity. These are the substances that create the stimulant effects when used in small doses, or the sedating-narcotic effects when taken in larger doses.

Mitragynina speciosa

Kratom has been marketed to consumers in the West as a novel psychoactive substance for an expanding range of purposes including opiate withdrawal, pain management, depression, and anxiety. The FDA does not advocate kratom for any purpose in Western medicine, and has issued warnings against the drug to the public.4

Research Regarding Kratom

Researchers found the most prominent chemical in the leaves to be mitragynine, ranging from up to 66% purity in leaves in products out of Thailand, to 12% purity in extracts from Malaysia, somewhat complicating the evaluation of kratom’s effects and potential toxicity. Another complexity was found that needs to be researched further — the alkaloids responsible for kratom’s analgesic effects likely bind to a much broader range of receptors than opioids like morphine, including dopamine, serotonin and adrenergic receptors, which might explain the stimulant effects of kratom. Taken at low doses, kratom acts as a mild stimulant. When taken in higher doses, kratom induces opioid-like effects and sedation. Rat studies showed low-doses to be relatively safe, and toxic effects such as enlarged liver, changes to brain tissues, loss of body weight, and other biochemical alterations only at high-dose levels, according to the research of Sabetghadam et al, published in the Journal of Ethnopharmacology in 2013.5

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What Is Kratom Used For?

A report from the EMC (equivalent of FDA in the US) reported that kratom has been traditionally used in Southeast Asia and Africa for relief of work-related pain, for energy, to stimulate appetite and as a sexual enhancer. Medicinal uses in these regions include as an anti-diarrheal, cough suppressant, anti-diabetic treatment, an intestinal deworming agent, as a wound poultice, and to wean addicts off heroin.7 There are no approved medicinal uses in Western medicine, though the drug has been popularized for getting off heroin, and for recreational effects such as euphoria and as a substitute for opioids.

Kratom Use For Pain Management

Kratom Use For Pain Management

Pain is a devilish overlord. It may be true that prescription drugs alleviate pain, but it may also be that big pharma has taken advantage of the vulnerability of the suffering to line their own pockets through the careless saturation of the market with the most highly addictive drugs ever known to man or beast.

After the fiasco of Oxycontin ©, many turned to heroin or other alternatives for pain management. Kratom has been popularized as such an alternative. Users experiencing chronic pain claim that kratom is an effective and gentle substance for chronic pain management. However, long-term use of kratom, notably at high dose levels, can induce significant side effects.8 Holistic measures can help discover and treat the root causes of pain, both physical and psychological, so that numbing agents are no longer a necessity.

Kratom Use For Withdrawal

According to research published in the 2013 Addiction Journal, 40 million Americans suffer from chronic pain. Some of this population has found their prescription opioids have stopped working over time, yet produce wretched withdrawals when attempting to stop. Kratom has been found useful for those who are seeking to self-manage their pain as well as the withdrawals from prescribed opioids.9

The researchers found that as effective as kratom was in attenuating harsh opiate withdrawals, the person would likely continue taking it well after opioid cessation was completed. As with treating addiction to any substance, there is a fear that, rather than break the addiction and return to abstinence, the initial addictive substance will instead be replaced with another addictive drug. Adverse effects of kratom are described in the next section, below.

What are the Side Effects of Kratom Use?

Kratom side effects include invigorating euphoria, alertness, pain relief, respiratory suppression, sedation, dream-like state, constipation, injury to kidneys, liver, heart, lungs and thyroid. Also reported are weight loss, nausea and vomiting, increased sociability, increased energy and capacity to work, sexual arousal, cocaine-like stimulation, profuse sweating, and flushing of the cheeks.7

Kratom Dependence

A clinical study involving 263 kratom users found more than half developed severe dependency after more than 6 months of using, and the higher the dose, the more cravings would be experienced. The withdrawals were also found to be more severe the longer the period of use.10

Physical kratom withdrawal symptoms were reported as muscle spasms, tremors, nausea and vomiting, chills, body aches, profuse sweating, muscle aches, pain, watery eyes, runny nose, cravings, insomnia, fever, hot flashes, no appetite, and diarrhea. Psychological withdrawals included restlessness, tension, anger, sadness, anxiety, and nervousness. Infants born to mothers addicted to kratom can experience post-natal withdrawal syndrome.11

Kratom Withdrawal

Is Kratom Hard on the Liver?

Yes. Though the mechanism is poorly understood, kratom is known to cause liver damage. Kratom can also damage the heart, the lungs, and the kidneys. Kratom is processed in the body as a toxin. Some of the alkaloids in Kratom are cardio-toxic. Toxicity reactions should receive emergency medical care to avoid brain injury or other severe consequences. The symptoms of kratom toxicity include heart failure, respiratory failure, brain tissue damage (hypoxia), hallucinations, coma, and rarely, death.12

Traditional Use of Kratom

Kratom Use

Regional names for kratom products include Biak, Ketum, Ithang, Thom, and Kauam. The leaves of the mitragyna tree are chopped or dried and ground up to be either smoked, chewed, taken in capsules, or brewed to make tea.

Traditionally, kratom was consumed in Thailand and other tropical countries, with the intention of fighting fatigue and improving work productivity. There is also evidence for the appearance of kratom in indigenous religious ceremonies. Local traditions also employ the use of kratom for the mitigation of pain, treatment of diarrhea, treating wounds, and later, as a substitute for opium.1

Kratom Flavor

Those who take kratom orally are met with a bitter, earthy, and herbal flavor that some enjoy, but many find the flavor a bit repulsive until they become accustomed or find a way to improve it. Some mix the kratom into milk or yogurt in attempts to neutralize the taste, and may even add sweeteners like honey. Others choose to dissolve powdered kratom into liquids including fruit juices that can mask the taste.1

Is Kratom Considered a Controlled Substance?

Different countries and regions have different regulations in place about the use or the sale of kratom. In some areas it is a controlled substance, and in others it is legal, without restrictions on use. Drug regulators can change drug laws without much notice to consumers and for kratom, this happens frequently.

Does Kratom Use Cause Depression?

Small doses of kratom produce a mildly invigorating euphoria. But, as use becomes habitual, tolerance builds, dosage increases, and potential dependence on the substance can take place. As drug dependence worsens, so can depression, anxiety and pain.13

Closing Thoughts

While arguably better in low doses than using opiates, kratom used at high doses can be viciously hard on the kidneys, heart, and other organs and develop a formidable dependence. The withdrawal from kratom is often complicated with similar withdrawal characteristics as opiates. For kratom withdrawal an option to consider may be using low dose naltrexone or other temporary medication, along with holistic treatment that can encourage the body to repair opiate receptor function.13

We recommend abstinence based approaches that include direct neurotransmitter and other support such as the items seen here.

1. Cinosi E, Martinotti G, Simonato P, et al. Following “the Roots” of Kratom (Mitragyna speciosa): The Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries. Biomed Res Int. 2015;2015:968786. doi:10.1155/2015/968786 [cited 2021 Sept 15]

2. Prozialeck WC, Jivan JK, Andurkar SV. Pharmacology of kratom: an emerging botanical agent with stimulant, analgesic and opioid-like effects. J Am Osteopath Assoc. 2012 Dec;112(12):792-9. PMID: 23212430. [cited 2021 Sept 15]

3. Fluyau D, Revadigar N, “Biochemical Benefits, Diagnosis, and Chemical Risks Evaluation of Kratom.” published in Frontiers in Psychiatry [online] April 21 2017 [cited 2021 Sept 15]

4. “FDA Issues Warnings to companies selling illegal, unapproved kratom drug products marketed for opioid cessation, pain treatment, and other medical uses.” June 25, 2019 [cited 2021 Sept 15]

5. Sabetghadam A, Ramanathan S, Sasidharan S, Mansor SM. Subchronic exposure to mitragynine, the principal alkaloid of Mitragyna speciosa, in rats. J Ethnopharmacol. 2013 Apr 19;146(3):815-23. doi: 10.1016/j.jep.2013.02.008. Epub 2013 Feb 17. PMID: 23422336. [cited 2021 Sept 15]

6. Thailand takes kratom off illegal drug list, published by AFP [online] [cited 2021 Sept 15]

7. European Monitoring Center for Drugs and Drug Addiction, “Kratom Drug Profile.” [online [cited 2021 Sept 15]

8. Swogger MT, Hart E, Erowid F, Erowid E, Trabold N, Yee K, Parkhurst KA, Priddy BM, Walsh Z. Experiences of Kratom Users: A Qualitative Analysis. J Psychoactive Drugs. 2015 Nov-Dec;47(5):360-7. doi: 10.1080/02791072.2015.1096434. Epub 2015 Nov 23. PMID: 26595229.[cited 2021 Sept 15]

9. Boyer EW, Babu KM, Adkins JE, McCurdy CR, Halpern JH. Self-treatment of opioid withdrawal using kratom (Mitragynia speciosa korth). Addiction. 2008;103(6):1048-1050. doi:10.1111/j.1360-0443.2008.02209.x [cited 2021 Sept 15]

10. Singh D, Müller CP, Vicknasingam BK. Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug Alcohol Depend. 2014 Jun 1;139:132-7. doi: 10.1016/j.drugalcdep.2014.03.017. Epub 2014 Mar 22. PMID: 24698080.[cited 2021 Sept 15]

11. Eastlack SC, Cornett EM, Kaye AD. Kratom-Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review. Pain Ther. 2020;9(1):55-69. doi:10.1007/s40122-020-00151-x[cited 2021 Sept 15]

12. Aggarwal G, Robertson E, McKinlay J, Walter E. Death from Kratom toxicity and the possible role of intralipid. J Intensive Care Soc. 2018;19(1):61-63. doi:10.1177/1751143717712652 [cited 2021 Sept 15]

13. Bowe A, Kerr PL. A Complex Case of Kratom Dependence, Depression, and Chronic Pain in Opioid Use Disorder: Effects of Buprenorphine in Clinical Management. J Psychoactive Drugs. 2020 Nov-Dec;52(5):447-452. doi: 10.1080/02791072.2020.1773586. Epub 2020 Jun 17. PMID: 32546067.[cited 2021 Sept 15]

Originally Published by Lyle Murphy

This content has been reviewed and approved by a licensed physician.

Dr. Michael Loes, M.D.


Dr. Michael Loes is board-certified in Internal Medicine, Pain Management and Addiction Medicine. He holds a dual license in Homeopathic and Integrative Medicine. He obtained his medical doctorate at the University of Minnesota, Minneapolis, MN, 1978. Dr. Loes performed an externship at the National Institute of Health for Psychopharmacology. Additionally, he is a well-published author including Arthritis: The Doctor’s Cure, The Aspirin Alternative, The Healing Response, and Spirit Driven Health: The Psalmist’s Guide for Recovery. He has been awarded the Minnesota Medical Foundation’s “Excellence in Research” Award.

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Kratom Use: What You Should Know About This Herb’s Effects
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