Kratom: Dangers, Side Effects, and Overdose

Kratom is a botanical supplement derived from the leaves of the Southeast Asian tree Mitragyna speciosa. It is available in various forms, including capsules, powders, and teas, and is marketed as a natural stimulant, mood enhancer, and pain reliever. Some individuals use kratom to alleviate opioid withdrawal symptoms, hoping it will ease discomfort [1][2]. 

However, physicians caution that kratom is not approved by the FDA and lacks proven safety or efficacy. The FDA and CDC advise caution due to its potential to harm multiple organs and cause dependence.

This article explains kratom’s effects on the body, its documented side effects, and the risk of overdose in clear, clinical terms.

What is kratom and where does it come from?

Kratom is a leaf extract from the Mitragyna speciosa plant, used as an herbal remedy. Native to Southeast Asia, this plant contains active alkaloids in its dried leaves that affect brain chemistry [2]. 

Historically, kratom leaves were chewed or brewed into tea for pain relief and energy stimulation. In Western countries, kratom is typically sold as a dietary supplement in powder or capsule form[3]. As it is not regulated in the U.S., the strength and purity of kratom products vary significantly.

When consumed orally, kratom’s active compounds, primarily mitragynine and 7-hydroxymitragynine, enter the bloodstream and take effect within minutes. The effects, which typically last 2–5 hours, can be stimulating or sedative depending on the dose (described below). Although kratom is plant-based, many people mistakenly assume it is harmless; however, doctors warn that it carries significant risks.

How does kratom work in the body?

Kratom’s alkaloids act on opioid receptors and other brain mechanisms. Mitragynine, a key compound in kratom leaves, binds to mu-opioid receptors, similar to morphine-like drugs, while also affecting adrenergic and serotonin systems. 

At low doses, kratom stimulates the body, resembling the effects of caffeine or other mild stimulants. 

At higher doses, it produces opioid-like effects, including pain relief, sedation, and euphoria. For example, it is noted that “at low doses (1–5 grams), kratom increases alertness and physical energy, while at high doses (5–15 grams), it creates euphoria and opioid effects, such as reduced pain sensation”.

Unlike traditional opioids, kratom also influences other neurotransmitters, making its effects less predictable. However, because it binds to opioid receptors, kratom overdose symptoms can often be reversed with naloxone, an opioid antidote, in emergencies [3]. Medical case reports have documented kratom overdose patients receiving naloxone to counteract respiratory depression.

What are kratom’s effects?

Kratom’s effects vary depending on the dose, producing distinct outcomes at low and high amounts:

• Low Doses (1–5 g): Stimulant-like effects. Kratom increases alertness, energy, and talkativeness. Some users report experiencing an improved mood or mild euphoria. These effects typically begin 10–30 minutes after consumption and last several hours.

• High Doses (>5 g): Sedative and opioid-like effects. Higher doses lead to deep relaxation, pain relief, and feelings of euphoria or tranquility, resembling opioid effects. Users may experience drowsiness or feel warm. Physical side effects are more pronounced, including constipation, nausea, dry mouth, dizziness, and itchiness [1][3]. Blood pressure and heart rate may initially rise, but very high doses can cause tachycardia, hypotension, or dizziness.

Physiological Effects

At high doses, kratom causes pupil constriction and slowed breathing, similar to opioids. Gastrointestinal issues, such as nausea and constipation, are common at any significant dose. Some users may also experience chills or sweating.

Psychological Effects

Kratom alters perception and mood. At low doses, users often feel more sociable or alert. In contrast, high doses can lead to heavy sedation or, in rare cases, mild hallucinations. Anxiety or confusion may occur, particularly with excessive doses or when combined with other substances. In rare instances, users report lucid dreams or a sense of detachment, similar to psychedelic effects.

Why do people use kratom?

People use kratom for its stimulant, mood-enhancing, and pain-relieving effects. It is marketed as a natural way to boost energy and concentration, similar to a stimulant, or to “take the edge off” and alleviate discomfort. 

Sellers often promote kratom for its “energy boost,” “mood-lifting,” and “pain-relieving” benefits. Historically, in Southeast Asia, kratom leaves have been consumed to relieve pain and fatigue [2]. Due to its analgesic properties, some individuals use kratom to self-treat chronic pain or manage opioid withdrawal symptoms.

However, these uses are not medically established, and the FDA has not approved kratom for any medical purpose. Limited research exists on kratom’s effectiveness. While some users report relief from withdrawal symptoms or pain, experts emphasize that any potential benefits are poorly documented and overshadowed by significant safety concerns. The FDA and DEA strongly warn against using kratom for these purposes.

What are the side effects of kratom?

Kratom has many side effects that range from mild to severe. According to the FDA, kratom damages the body’s organs and brain [1]. Common physical side effects are:

Kratom can cause a range of side effects, from mild to severe. According to the FDA, kratom may damage the body’s organs and brain. Common physical side effects include:

• Gastrointestinal: Constipation, nausea, vomiting, and weight loss. These are common, especially at high doses or with chronic use.

• Neurological: Headaches, dizziness, drowsiness, and impaired concentration. Some users report irritability or difficulty sleeping.

• Cardiovascular: Elevated blood pressure and heart rate have been reported in some users. Rare cases of extremely high blood pressure have been reported.

• Liver: Though rare, kratom has been linked to liver damage (cholestatic liver injury).

• Other Symptoms: Dry mouth, loss of appetite, and muscle or joint pain.

Kratom also affects mental health and mood. Nervous system side effects may include:

• Hallucinations or Delusions: Users may experience sensory distortions (hearing or seeing things that are not there) or irrational beliefs.

• Mood Changes: Anxiety, agitation, confusion, or depression may occur. Some users feel hyperenergetic initially, followed by sudden fatigue.

• Respiratory Effects: Shortness of breath, particularly when kratom is combined with other sedating substances.

• Seizures and Tremors: Though rare, extreme kratom toxicity can cause seizures, tremors, or muscle spasms [4].

A review of kratom-related poison control calls identified thousands of cases, some involving elevated blood pressure, confusion, and seizures. 

Is it possible to overdose on kratom?

Yes, a kratom overdose is possible, though fatalities caused by kratom alone are extremely rare. In an overdose, kratom acts like an opioid, causing symptoms such as deep sedation and slowed breathing (respiratory depression). A reported case involved a patient who became unresponsive with blue lips due to oxygen deprivation, but their breathing was restored with naloxone, highlighting kratom’s opioid-like effects.

Symptoms of a kratom overdose may include:

• Severe Sedation or Stupor: The person may be excessively sleepy or unresponsive.

• Difficulty Breathing: Shallow or slow breathing, or even respiratory arrest (cessation of breathing), may occur [3].

• Cardiac Complications: Extremely low or irregular heart rate, accompanied by very low blood pressure.

• Neurological Effects: Seizures, tremors, or hallucinations in severe cases [4].

• Other Symptoms: Stomach cramping, vomiting, and kidney issues have been documented. Animal studies and case reports have noted restlessness, tremors, and convulsions before fatal outcomes.

Despite these risks, kratom overdoses are rarely fatal on their own. For example, a study found only 11 deaths involving kratom over seven years, with kratom as the sole cause in just two cases. Most kratom-related fatalities, such as the 152 deaths reported by the CDC from 2016–2017, involved other substances like alcohol, opioids, or benzodiazepines [1]. This suggests that kratom is rarely the sole cause of a fatal overdose.

However, caution is critical. Toxic levels can be reached by using high-potency kratom extracts or consuming large amounts, such as dozens of capsules at once. The concentration of kratom’s active alkaloids varies significantly between products [3], meaning one batch may be much stronger than another. A clinical review warns that modern kratom extracts and isolates significantly increase overdose risk compared to traditional tea [4].

Kratom’s margin of safety is poorly understood. While overdose symptoms can initially be reversed with naloxone, some patients experience rebound respiratory depression hours later [3]. Emergency physicians recommend 24-hour observation after a severe kratom overdose to monitor for this rebound effect [3].

Can kratom lead to withdrawal or addiction?

Yes, kratom can lead to dependence with daily use. Kratom is habit-forming, and although some experts suggest its addiction potential is lower than that of traditional opioids, dependence and withdrawal are still possible. The Mayo Clinic reports that months of kratom use can result in opioid-like withdrawal symptoms [1]. In clinical settings, a small percentage of chronic kratom users experience mild-to-moderate withdrawal syndrome.

Kratom withdrawal symptoms are similar to those of flu and opioid withdrawal. These include cravings, irritability, anxiety, depression, fever, diarrhea, muscle pain, insomnia, and nasal discharge [3]. For example, users have reported flu-like symptoms, such as nausea, sweating, and chills, after abruptly stopping kratom. Long-term use can also alter brain chemistry, leading to cravings and addiction.

What are kratom capsules, and are they safe?

Kratom capsules are a convenient way to consume kratom, but their potency is inconsistent. They typically contain ground kratom leaf or concentrated extract in capsule or tablet form. Because kratom is not regulated in the U.S., the amount of mitragynine in one manufacturer’s capsule may vary significantly from another’s. A hospital report noted that “the strength of kratom-containing products (e.g., capsules, tablets, powders) is highly variable”.

This unpredictability makes accurate dosing challenging. A capsule labeled as containing, for example, 500 mg of “kratom” may have a significantly different potency. Consuming multiple capsules at once to achieve a stronger effect can inadvertently lead to an overdose. New users are particularly at risk of unintentionally overdosing due to these variations in strength [3].

Are different kratom strains (e.g., Red Bali) distinct?

Kratom “strains” (e.g., Red Bali, Green Maeng Da) are marketing labels rather than official categories. Red Bali, a red-vein strain, is often promoted as being particularly strong and sedating, with claims of intense pain relief and calming effects. However, scientific evidence suggests that kratom’s effects depend primarily on dosage and individual tolerance, not the strain name. Alkaloid concentrations in kratom products vary more from batch to batch than by so-called strain [3].

In practical terms, all kratom comes from the same species (Mitragyna speciosa), and any differences between strains, such as Red Bali and others, lack rigorous scientific validation. Some users report subtle differences (e.g., one batch of Red Bali feeling more sedating), but these observations are anecdotal. The medical perspective is that all kratom, regardless of strain, carries the same potential for side effects and overdose risk. Strain names do not guarantee safety. To minimize risks, start with a low dose, monitor your condition, and exercise caution with any kratom product.

Frequently Asked Questions

Is kratom addictive?

Yes, kratom can be addictive for some users. Frequent, heavy use can lead to physical dependence and cravings. Although some research suggests kratom is less addictive than traditional opioids, users may experience withdrawal symptoms, such as nausea, anxiety, and insomnia, upon cessation. The risk of addiction increases with frequent or high-dose use.

What are common kratom side effects?

Kratom can lead to physical and mental side effects. Common physical symptoms include nausea, vomiting, dry mouth, constipation, and loss of appetite. Other effects may be headaches, increased heart rate, and muscle or joint pain. Mental symptoms can include dizziness, anxiety, irritability, and confusion. In severe cases, kratom use may cause seizures and breathing problems.

Can kratom relieve pain?

Kratom is sometimes used for pain relief, but there is no scientific proof that it works. While some people believe it helps with chronic pain or arthritis, no approved studies confirm its safety or effectiveness. The U.S. FDA warns that kratom has not been proven safe for any use. Using kratom carries risks of side effects and addiction, making it an untested option.

Are kratom capsules safe?

Kratom capsules are not always safe, as their potency varies greatly between brands and batches. Users may be unaware of the active compound levels in each capsule, and taking multiple capsules can lead to overdose.

What is Red Bali kratom?

Red Bali is a type of kratom characterized by its distinctive red leaves. It is marketed as a relaxing and strong pain reliever, but there is no scientific standard to support these claims. All kratom comes from the same plant, Mitragyna speciosa, and the strength can vary widely. People may experience Red Bali differently, and it carries risks like addiction, side effects, and overdose. 

Get Support for Kratom and Substance Use

If you need assistance with kratom or any other addiction issue, Alliance Recovery is here to help. Alliance Recovery is an addiction treatment facility that deals with substance abuse and mental health. 

Contact Alliance Recovery today at (844) 287-8506 to learn more about their services and initiate the recovery process.

Sources

[1] https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/kratom/art-20402171

[2] https://kslegislature.gov/li_2024/b2023_24/committees/ctte_h_fed_st_1/documents/testimony/20230201_16.pdf

[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC10408695/

[4] https://link.springer.com/article/10.1007/s40429-022-00464-1