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Can You Overdose on Kratom?

Kratom has gained a reputation in some circles as a natural way to self-treat pain and as an alternative to highly-regulated medications for managing opioid withdrawal symptoms.1 Advocates have spoken of the medicine’s natural, herbal origins, but health experts have raised warning flags about the possibility of abuse and addiction.2The National Institute on Drug Abuse also states that there is no scientific evidence that kratom is either safe or effective for managing cravings and other symptoms of opioid withdrawal (or any other substance withdrawal syndrome).3 The U.S. Food and Drug Administration (FDA) has also issued warnings regarding deaths associated with kratom use.3

What Is Kratom?

Kratom has been used for many years in Southeast Asia. The substance is extracted from the leaves of Mitragyna speciosa trees native to the area. Once the leaves are harvested, they may be chewed or may be crushed up and consumed as tea, or made into a capsule, tablet, or extract. The drug has reportedly been used for many years in Southeast Asia as a substitute for opium. At low doses, the drug elicits mild stimulant effects (including talkativeness and increased energy). At higher doses, sedative effects may begin to be felt.2,4

In recent years, use of this substance has grown in the U.S., gaining the attention of organizations such as the FDA and Drug Enforcement Administration (DEA). The FDA released a statement in 2018 outlining evidence of the opioid properties of kratom compounds and warning of the potential for abuse.4 The FDA also advised that kratom not be used for any medical purpose.5

The FDA has also taken steps to keep the drug from entering the U.S. illegally.5 However, because the drug is not illegal in the U.S. (for now), it is often sold in tobacco or vape shops as well as some gas stations, convenience stores, and various online marketplaces, although a handful of states have banned the drug.6

The Dangers of Kratom

Kratom may be deemed safe by its proponents; however, as with many drugs, its use is associated with several side effects and risks. Potential kratom side effects include:2

  • Insomnia.
  • Drowsiness.
  • Nausea.
  • Vomiting.
  • Constipation.
  • Dry mouth.
  • Appetite loss/anorexia.
  • Liver toxicity.
  • Increased urination.
  • Itching.
  • Sweating.
  • Confusion.
  • Seizure.

According to the DEA, kratom use may also result in the onset of psychotic symptoms, such as hallucinations and delusions.2

Users often assume that because kratom is botanically-derived, or because it has long been used in traditional medicine, it is a safe or, at least, more-benign option than pharmaceutical drugs or illicit drugs. However, in their statement, the FDA cautioned against making this assumption, stating that its plant-based nature doesn’t equate to safety. They point to the fact that heroin, an exceptionally dangerous and addictive drug, is made from morphine—a naturally-occurring plant alkaloid derived from the seed pod of the opium poppy.5

Can You Overdose on Kratom?

There is little information on overdose from isolated use of pure kratom. Although there have been a number of deaths linked to the use of kratom, the real danger seems to be associated with the use of adulterated kratom or polysubstance use involving kratom.3

Adulterated kratom refers to kratom that has been mixed with any number of other substances. Buyers of the drug may believe they are getting a pure form of the drug but actually receive a very dangerous drug combination.

Kratom is widely available in many forms including liquids, tablets, and even gums or resins, and is relatively easy to obtain from a variety of online sellers. Users may be completely unaware of what exactly they are purchasing and consuming. The DEA states, “Because the identity, purity levels, and quantity of these substances are uncertain and inconsistent, they pose significant adverse health risks to users.”7 In fact, there have been some deaths linked to “dietary supplements” sold online containing kratom laced with other compounds.3

Since kratom is unregulated, there are no quality assurances or controls in place that guarantee the purity of kratom products being sold. For example, there have been reports of kratom being adulterated with other opioids such as hydrocodone.5

Serious harm or death may also result from intentionally taking kratom simultaneously with alcohol and other drugs like opioids, benzodiazepines (Xanax, Valium), or gabapentin.3

Kratom as a Public Health Threat?

There is an ongoing debate about kratom, with some pointing to its benefits in treating not only opioid dependence, withdrawal, and addiction but in managing pain, posttraumatic stress disorder, and alcohol cravings. And while research evidence supporting these purported benefits is lacking, the risks of using kratom remain.3,4

In a 5-year period, 660 kratom-related calls were made to poison control centers in the U.S. Of these, nearly 50 involved major life-threatening signs or symptoms.8

A primary concern about kratom is that there is so much about it that is still unknown. The FDA has stated its intention to continue studying this substance to determine the extent of its risks and potential benefits.5 While these are still unclear, it is still risky to take kratom, especially when the unregulated drug could contain unknown substances and harmful impurities.

Kratom Withdrawal

The Drug Enforcement Administration has cautioned that it is possible for kratom users to develop dependence on the drug and experience withdrawal symptoms upon quitting, such as:

  • Runny nose.
  • Muscle and bone aches.
  • Jerky movements of the arms and legs.
  • Mood swings.
  • Aggression.

With the risks of abuse, dependence, and withdrawal, kratom may not be as harmless as many who endorse the use of this controversial substance would want the public to believe. If you are using kratom in hopes of self-treating an opioid withdrawal syndrome or addiction, you may be much safer entering a medical detox staffed with qualified treatment professionals followed by a rehab program that uses evidence-based techniques to treat addiction.

Sources:

  1. Boyer, E. W., Babu, K. M., Adkins, J. E., McCurdy, C. R., & Halpern, J. H. (2008). Self-treatment of opioid withdrawal using kratom (Mitragynia speciosa korth)Addiction (Abingdon, England), 103(6), 1048-50.
  2. U.S. Drug Enforcement Administration. (2017). Drugs of Abuse: A DEA Resource Guide.
  3. National Institute on Drug Abuse. (2018). What is kratom?
  4. National Center for Complementary and Integrative Health. (2018). In the News: Kratom (MItragyna speciosa).
  5. U.S. Food & Drug Administration. (2018). Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency’s scientific evidence on the presence of opioid compounds in kratom, underscoring its potential for abuse.
  6. Bryan, Max. (2018). States Divided on Opioid-Withdrawal Alternative. USNews & World Report.
  7. United States Drug Enforcement Administration (2016). DEA Announces Intent to Schedule Kratom.
  8. Anwar M, Law R, Schier J. Notes from the Field. Kratom (Mitragyna speciosa) Exposures Reported to Poison Centers — United States, 2010–2015. MMWR Morb Mortal Wkly Rep 2016;65:748–749.
  9. U.S. Drug Enforcement Administration. (2013). Kratom (Mitragyna speciose korth).