Kratom

Aka: Kratom, Mitragyna Speciosa

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II. Background

  1. Herbal stimulant at low dose and with Opioid effects at higher dose
  2. Currently legal in U.S. to purchase at gas stations and smoke shops
    1. U.S. sales are >1 Billion/year (as of 2025)
    2. Marketed in capsule, liquid and powder form
    3. Not yet categorized as controlled substance
    4. FDA has had concerns regarding serious adverse effects including death

III. Mechanism

  1. Extracted from leaves of tropical tree (Mitragyna Speciosa) within coffee family, grown in Southeast Asia
  2. Leaves have traditionally been chewed or brewed as a tea
  3. Stimulant effects at low dose (2-3 grams, as traditionally used, leaf form)
  4. Opioid effects at high dose (5-8 grams, concentrated, marketed forms, capsules)
  5. Also acts at Serotonin and Dopamine receptors
  6. Active ingredients and active metabolites
    1. Mitragynine (most abundant in leaves, 0.25 MME or Morphine Equivalents)
    2. 7-Hydroxymitragynine (10-13 MME or Morphine Equivalents)
  7. Intoxicated presentations are often mixes of Kratom with other substances
    1. Kratom laced with other intoxicants
    2. Coingestion of other intoxicants

IV. Pharmacokinetics

  1. Onset: 10-15 min
  2. Duration: 4-6 hours

V. Adverse Effects

  1. Stimulant effects
    1. Palpitations
    2. Sinus Tachycardia
    3. Hypertension
    4. Tremor
  2. Opioid Effects
    1. Drowsiness
    2. Nausea
    3. Confusion
    4. Constipation
  3. Opioid Withdrawal (onset 12-24 hours after last dose, duration 3-7 days)
    1. Anxiety
    2. Insomnia
    3. Agitation
    4. Flushing or sweating
  4. High Dose, Toxicity or Overdose
    1. Hepatotoxicity (cholestatic hepatitis)
    2. Seizures
    3. Respiratory Depression (rare without coingestion)
    4. Cardiac Arrest (rare without coingestion)
  5. Chronic Use
    1. Weight loss or Anorexia
    2. Dependence
    3. Hyperpigmentation
    4. Constipation
    5. Psychiatric effects

VI. Management

  1. Symptomatic management
  2. Kratom Withdrawal
    1. Treat in similar fashion to Opioid Withdrawal

VII. Drug Interactions

  1. Inhibits many Cytochrome P450 metabolism pathways (increases other drug levels)
    1. CYP1A2 Inhibitor
    2. CYP2D6 Inhibitor
    3. CYP3A4 Inhibitor

VIII. Resources

  1. Kratom (FDA)
    1. https://www.fda.gov/news-events/public-health-focus/fda-and-kratom
  2. Kratom (DEA)
    1. https://www.dea.gov/sites/default/files/2020-06/Kratom-2020_0.pdf

IX. References

  1. (2016) Presc Lett 23(11)
  2. (2025) Presc Insights, Issue 3/2025
  3. Morrison and Nordt (2026) Kratom, EM:Rap, 1/26/2026

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