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Kratom

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Kratom, Mitragyna Speciosa

  • See Also
  1. Opioid Abuse
  • 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
  • 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 (as traditionally used, leaf form)
  4. Opioid effects at high dose (concentrated, marketed forms)
  5. 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)
  • Adverse Effects
  1. Stimulant effects
    1. Sinus Tachycardia
    2. Tremor
  2. Opioid Effects
    1. Drowsiness
    2. Nausea
  3. Opioid Withdrawal
    1. Anxiety
    2. Insomnia
    3. Agitation
  4. High Dose, Toxicity or Overdose
    1. Hepatotoxicity
    2. Seizures
    3. Respiratory Depression
    4. Cardiac Arrest
  • Drug Interactions
  1. Inhibits many Cytochrome P450 metabolism pathways (increases other drug levels)
    1. CYP1A2 Inhibitor
    2. CYP2D6 Inhibitor
    3. CYP3A4 Inhibitor
  • 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
  • References
  1. (2016) Presc Lett 23(11)
  2. (2025) Presc Insights, Issue 3/2025