For Andy, kratom produces a similar effect to the opioids he was once addicted to, giving him enough energy to get through the day and reducing some of the pain he feels from working in physically demanding jobs in fast food and factories. Kratom, a plant from Southeast Asia with stimulant and opioid-like effects that is commercially available across most of the U.S., also helped him stop drinking and quit opioids. Yet Andy is now completely dependent on kratom instead.
“It’s been kind of a blessing and a curse for me,” Andy, who requested using only his first name for privacy, told Salon in a phone interview. “I was able to quit alcohol and I don’t do opiates anymore, but I do take quite a bit of kratom now and I am addicted to kratom.”
The kratom tree (Mitragyna speciosa) is a member of the coffee family, but the similarities end there. Its leaves are dried up and ground to be sold in smoke shops, online or sometimes even cafes. Chemical compounds within the plant, especially mitragynine and 7-hydroxymitragynine, bind to the opioid receptors in the body, acting as a stimulant in lower doses and behaving more closely to an opioid at higher doses. Importantly, the alkaloids in kratom are considered "atypical opioids" so a one-to-one comparison to something like morphine isn't entirely accurate.
At higher doses, kratom has been associated with side effects like liver injury and slowed breathing, with other drugs or medications potentially affecting a person’s susceptibility to some of these adverse outcomes. Unlike opioids though, the National Institute of Health reports that kratom fatal overdoses are “extremely rare,” and the drug has actually been used by many as a tool to cope with opioid withdrawal symptoms or quit drugs like fentanyl entirely.
As a commercially available product that is relatively affordable, many have turned to kratom when they do not have access to other treatments for conditions such as chronic pain, depression and anxiety, or substance use disorder. People with all of these conditions notoriously suffer from treatment disparities, with 94% of people with substance use disorder going untreated in 2021. Additionally, there are few available treatments for people with chronic pain, and far too few resources for the millions of Americans who experience anxiety and depression.
According to the Centers for Disease Control and Prevention (CDC), 80% of people who experienced a kratom overdose between July 2016 and 2017 had a history of substance use and 90% were untreated for pain.
Like cannabis and other medicinal plants, kratom doesn't consist of just one drug but multiple. As mentioned, some of these alkaloids work on the central nervous system’s opioid receptors, binding to them as partial agonists. However, they don’t cause the same strong effect as something like heroin would, but they do provide similar effects as morphine or other opioids in regards to pain relief, often with less adverse or toxic effects, said Dr. Oliver Grundmann, who studies the effects of herbal products on the central nervous system at the University of Florida.
“Many of the alkaloids also bind to other receptors that are not opioid receptors as well, and that might explain why we see this kind of relief of depression and anxiety with the use of kratom,” Grundmann told Salon in a phone interview.
An estimated 1.7 million Americans used kratom in 2021, but it hasn’t been studied extensively, with a 2022 review concluding the research on its health effects was “still in its infancy.” The Food and Drug Administration (FDA) recommends against its use, citing its “risk of serious adverse events.”
It is also labeled a "drug and chemical of concern” by the Drug Enforcement Agency (DEA). In fact, the DEA tried to ban kratom in 2016, but received such backlash, including from a bipartisan coalition in Congress, that the agency backed off from its emergency scheduling — a move that was unprecedented in American drug policy. Still, some states like Alabama and Vermont have introduced their own bans, while other states have swung the complete opposite direction, passing laws that enshrine access in places like Kentucky, Texas and Oregon. Kratom use spans the political spectrum and some believe the associated risks are overblown by some in media and government, but its true risks are not black and white.
“There are people who say it is very bad, and there are people who have said it has changed my life,” said Dr. Abhisheak Sharma, the co-director of the Translational Drug Development Core and assistant professor at University of Florida. “As a scientist, we see the good and the bad side of it, and I believe everything depends on the dose.”
In kratom’s natural leaf form, the body is not efficient enough at metabolizing the drugs to easily overdose, Sharma said. However, many products like liquids or capsules that contain kratom extract are much more potent, which can lead to some of its negative effects, including overdose. Many kratom-derived products also include isolated or chemically-synthesized components of kratom, which are sometimes more potent and have not been studied in humans.
For example, mitragynine naturally comprises 3% of the kratom plant, but has been detected in concentrations of up to 60% in extracts, Grundmann said. Most of the pain-relieving effects of kratom don't come from mitragynine, however, but what it breaks down into: 7-hydroxymitragynine, which is 13 times more potent than morphine. This metabolite does occur naturally in kratom leaves but at nearly undetectable levels. However, some kratom companies have isolated the drug and are now selling it as a nearly pure substance.
These extracts and isolate products are increasing in prevalence among what is sold in the market, Grundmann said. Although the kratom plant itself is relatively safe, that may not be reflected in the same products hitting shelves in some areas.
“Based on the current market situation, I one hundred percent agree with [the FDA] because I don’t want a young kid taking a semi-synthetic alkaloid, considering it as an herbal supplement,” Sharma told Salon in a phone interview. He clarified that kratom can be useful to people struggling with substance use getting off other drugs, and that he would like to see increased regulations to ensure leaf-based, pure products are in the market.
Anecdotal experiences with kratom cover all ends of the spectrum, with some saying it saved their life and others blaming it for the deaths of loved ones. Yet some deaths involving kratom may have occurred when a person consumed one of its derivatives, were on other medications that could have influenced their tolerance, or when kratom was mixed with other drugs. Without more research, some of the effects of these possibilities are still unknown.
Still, the rate of fatal kratom overdoses pales in comparison to those lost to opioids or even alcohol. Eleven deaths between 2011 and 2017 were associated with kratom, according to a 2019 report using poison control center data. In comparison, more than 200,000 people died by death from an opioid overdose during the same time period, according to NIH data.
For Andy, buying kratom takes priority over buying food sometimes. When he doesn’t have it, he starts to experience withdrawals that he says are similar to opioid withdrawal. But for him, that is far better than the alternative.
“Without it, I would probably be doped out,” he said. “I would probably be dead by now.”
