What is kratom?

What is Kratom

Kratom (Mitragyna speciosa) is a botanical substance with opioid-like and stimulant properties that should not be used due to serious health risks including seizures, hepatotoxicity, withdrawal syndrome, and documented deaths—the FDA has issued explicit warnings against its use. 1, 2, 3

Botanical and Chemical Characteristics

• Kratom is a tropical tree native to Southeast Asia (Thailand, Malaysia, Vietnam, Myanmar) that has been used traditionally in those regions for centuries 4, 5
• The primary active alkaloids are mitragynine and 7-hydroxymitragynine, which act as partial agonists at mu-opioid receptors (μ-OR) and antagonists at kappa-opioid receptors (κ-OR) 4, 5
• The plant also affects dopaminergic and serotonergic receptors, contributing to its stimulant effects 4
• Kratom contains hundreds of bioactive compounds beyond these primary alkaloids 5

Pharmacologic Effects

• Dose-dependent biphasic effects: lower doses produce stimulant effects, while higher doses (5-15 g per day or more) produce opioid-like sedation and analgesia 3, 4
• Acts on multiple receptor systems including opioid, dopamine, serotonin, and other central nervous system receptors 4, 5
• Inhibits CYP2D6 and CYP3A4 enzymes, creating high potential for drug interactions 1

Serious Health Risks

The Society for Perioperative Assessment and Quality Improvement (SPAQI) explicitly states: "Discontinue. SPAQI does not recommend use of this supplement." 1

Neurologic Complications

• Chronic use may lead to seizures 1, 2, 3
• Tremor and fatigue have been reported 6

Withdrawal Syndrome

• Occurs particularly in patients taking more than 5-15 g per day 1, 2, 3
• Requires tapering rather than abrupt discontinuation 3
• Physical dependence develops with regular use 1

Hepatotoxicity and Cardiotoxicity

• Associated with liver toxicity 3, 5
• Cardiotoxic effects have been documented 5

Mortality

• Multiple deaths have been reported, though often in the context of polysubstance use 5, 7
• The FDA has issued specific warnings against kratom use due to safety concerns 1, 2, 3

Clinical Context and Abuse Potential

• Kratom has gained popularity in Western countries (especially the United States) for self-treatment of chronic pain, opioid withdrawal, and mental health conditions 5, 8
• The addictive potential appears lower than classical opioids but kratom use disorders do occur, primarily in Western countries 5
• Commercial kratom products in Western countries may have adulterations, contaminations, and higher concentrations of 7-hydroxymitragynine compared to traditional preparations 5

Critical Pitfall

Do not confuse kratom's traditional use in Southeast Asia (where it is not a major public health problem) with its use in Western countries, where higher dosages, polysubstance use, and product contamination have led to significantly more adverse events and deaths. 5