Kratom

Herbal stimulant at low dose and with Opioid effects at higher dose
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

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

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

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