Kratom

Opioids

Also known as: Mitragyna speciosa, Biak, Thang, Kakuam, Thom, Ketum

Medical Review & Editorial Standards

All content is written, edited, and medically reviewed by licensed professionals with expertise in addiction medicine and behavioral health.

Author

Benjamin Zohar

NCACIP

Nationally Certified Advanced Clinical Intervention Professional and recovery advocate in long-term recovery, specializing in intervention services and treatment coordination.

Editor

Ezra Zohar, M.S.Ed.

Educational Specialist

Educational Specialist with M.S. in Secondary Education, reviewing educational content focused on addiction awareness and recovery.

Medical Reviewer

Brandon McNally

Registered Nurse with specialized training in addiction medicine and behavioral health nursing.

Last Updated

November 2025

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What is Kratom?

Kratom is a tropical tree native to Southeast Asia. Its leaves contain compounds (primarily mitragynine and 7-hydroxymitragynine) that interact with opioid receptors in the brain. Traditionally used in low doses as a stimulant by laborers and in higher doses for pain relief and relaxation. In the United States, kratom is sold as powder, capsules, extracts, or tea, typically marketed as a dietary supplement or herbal remedy. It is promoted for pain relief, opioid withdrawal management, energy, and mood enhancement. Many people view kratom as a safe, natural alternative to prescription opioids. However, kratom acts on the same opioid receptors as morphine and can cause dependence, addiction, and dangerous side effects. The FDA has not approved kratom for any medical use and has issued warnings about its risks. Kratom products vary widely in strength and purity.

Effects

Effects depend heavily on dose. Low doses (1-5g) produce stimulant effects: increased energy, alertness, sociability, reduced appetite, and enhanced focus. Users describe feeling more talkative, motivated, and productive. Moderate to high doses (5-15g) produce opioid-like effects: pain relief, euphoria, sedation, relaxation, and reduced anxiety. Users experience warm contentment, reduced physical and emotional pain, and drowsiness. Physical effects include constricted pupils, dry mouth, increased urination, constipation, nausea (especially at higher doses), and itching.

Risks & Dangers

Regular kratom use leads to physical dependence and addiction. Many people using kratom to quit opioids end up addicted to kratom instead. Withdrawal can be severe, similar to opioid withdrawal. High doses cause nausea, vomiting, severe itching, constipation, dizziness, and sedation. Extremely high doses can cause seizures, liver damage, and respiratory depression, especially when combined with other substances. Kratom products are often contaminated with bacteria, heavy metals, or adulterated with actual opioids. Quality and potency vary dramatically between batches and vendors, making overdose risk unpredictable. Long-term heavy use is associated with weight loss, darkening of facial skin, psychosis, and liver damage. Mixing kratom with other depressants significantly increases overdose risk.

Withdrawal Symptoms

Withdrawal is similar to opioid withdrawal but generally less severe. Symptoms include muscle aches, insomnia, irritability, aggression, emotional instability, runny nose, jerky movements, anxiety, depression, severe cravings, hot flashes, sweating, and nausea. Begins 12-24 hours after last dose, peaks at 2-4 days, gradually improves over 1-2 weeks.

Addiction Potential

Moderate to high. Despite marketing as non-addictive, kratom causes significant physical and psychological dependence with regular use. Many daily users find it extremely difficult to quit. Tolerance develops, requiring progressively higher doses.

Duration

Onset: 10-20 minutes. Peak: 1-2 hours. Duration: Stimulant effects last 2-4 hours at low doses. Opioid effects last 4-6 hours at higher doses.

Legal Status

Legal status varies. Not federally scheduled in the US, but banned in several states (Alabama, Arkansas, Indiana, Rhode Island, Vermont, Wisconsin) and many cities. Some states regulate it as an adult-only product. The DEA has considered scheduling kratom as Schedule I. Legal in most states but heavily debated.

Dosage Information

Doses vary widely based on kratom potency. Low (stimulant): 1-5g. Moderate: 5-10g. High (opioid effects): 10-15g. Very high doses 15g+ increase adverse effects and overdose risk. New users should start with 2g or less. Extracts and enhanced products are much more potent and unpredictable.

Alcohol Interaction Warning

Mixing Kratom with alcohol can be extremely dangerous and potentially life-threatening. Combining substances increases the risk of:

• Respiratory depression and overdose
• Unpredictable effects and loss of consciousness
• Increased toxicity to liver and other organs
• Impaired judgment leading to risky behaviors

Learn more about alcohol use disorder and polysubstance use.

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