Kratom has been in the news a lot lately because it has been touted as a possible remedy in the opioid crisis. Advocates have spoken of the medicine’s herbal and natural origins, but health experts have raised warning flags about the possibility of abuse. This has left many people wondering if it is possible to overdose on kratom.
What Is Kratom?
Kratom has been used for several centuries in Southeast Asian countries as an herbal remedy. The leaves are harvested from the Mitragyna speciosa tree and chewed, smoked, or ground up and consumed as tea. Historically, they have been used for their mild stimulant effects, which laborers have used to get them through long working days in harsh conditions. At higher doses, kratom demonstrates a narcotic-like effect, enhancing mood and offering simple pain relief, like a mild opioid. This is because the mitragynine alkaloid, the main chemical component in kratom, binds to the same opioid receptors in the brain and central nervous system as other opioids do.
US News & World Report explains that kratom is currently unregulated and untested in the United States. While the drug has a long history in places like Thailand, Indonesia, Malaysia, and New Guinea, it is relatively new to the West, and there have been precious few clinical studies done on the safety of the drug and whether it could be useful against opioid abuse. However, because it is not fully illegal (for now), kratom is sold in tobacco or vape shops as well as gas stations, convenience stores, and various online marketplaces. It is sold as crushed leaves, tablets, powders, capsules, or even as gum.
Dr. Alicia Lydecker, a medical toxicologist and emergency physician at Albany Medical Center, told US News & World Report that kratom is not dissimilar to coffee when it consumed at low doses, but when people take more of it, they experience effects that are reminiscent to those of opioids. This duality is why people in Southeast Asia use kratom as much as they do.
Regardless of dosage, however, kratom has side effects. Users report dry mouth, nausea, itching, and sweating in addition to more serious reactions like anxiety, irritability, increased urination, loss of appetite, and constipation, some of which will be familiar as side effects of opioid use. In cases of severe kratom use, people have reported seizures and liver injuries, but doctors and researchers do not have enough information to know if the health problems are directly caused by the kratom or if other factors are at play. Dr. Lydecker at Albany Medical Center told US News & World Report that the people who call poison control centers or who call 911 because of kratom have mild to moderate symptoms; that is, no one has (yet) reported life-threatening problems because of their kratom use.
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The Dangers of Kratom
The real danger is in the kratom products that are sold online. Since mitragynine is unregulated, there are no quality assurances or controls to ensure that the people distributing the product are selling pure, clean, legitimate kratom. These people could easily contaminate their batches with other substances to cut costs, and users will be none the wiser about the substances they are putting in their body.
“Anybody could be adding things to those capsules or powders,” Lydecker warns, adding that users often assume that because kratom is from a plant, or because it has long been used in traditional medicine, it is either relatively safer than pharmaceutical-based drugs or completely safe. However, Lydecker compares kratom to heroin itself since the opium compounds in heroin are also found in plants.
Higher, more concentrated doses of the mitragynine alkaloid in kratom can cause serious side effects in a very short time, so much so that even people who have developed a tolerance for opioids can accidentally overdose on the plant. The lack of regulation is a factor in users not being able to properly dose their consumption.
Can You Overdose on Kratom?
As with most other kinds of drugs, it is possible to overdose on kratom, especially when other substances are involved. However, because not much research has been done on kratom (since it is not regulated, which in turn is because it cannot be researched), the exact dynamics of a kratom overdose are not fully understood. It is unknown how much of the mitragynine alkaloid has to be consumed before the classic overdose scenario plays out. Vice magazine explains that when a person overdoses on opioids, the opioid receptors in the brain and central nervous system are overwhelmed with the molecules from the drug in the span of a single heartbeat.
While this causes the euphoric rush that is immediately evident to users, people on the path to an overdose are unaware of what happens behind the scenes. Opioid drugs (whether illegal or legal, synthesized, natural, or anywhere in between) go to work on the brain systems that control sleep and breathing. When an overdose is in effect, the parts of the brain responsible for breathing are put under severe strain by the opioids, culminating in a complete stop.
With the slowdown, heart rate also decreases. The opioid molecules are shutting down a number of neurological signals. As oxygen levels drop, the heart starts pumping irregularly, meaning that the parts of the body that need oxygenated blood (like the brain) are not getting the nourishments they need. Cardiac arrest is likely at this point.
If a user takes enough of an opioid, the brain does not receive and cannot send the necessary signals to regulate breathing. At this point, the heart and lungs are barely functioning. Without oxygenated blood, the brain starts to suffer. It only takes four minutes of oxygen deprivation for the brain to experience brain damage. If a user does not receive CPR or other emergency medical treatment in this time, the damage could be irreversible.
Opioid overdoses can include fluid leaking into the air spaces in the lungs, a problem known as a noncardiogenic pulmonary edema; this manifests as foam coming out of the user’s mouth, which is a telltale sign of an opioid overdose. Additionally, the body’s natural gag reflex is suppressed because of what the opioid molecules have done to the respiratory center of the brain. As the user loses consciousness, the natural secretions located at the back of the throat are not swallowed or expelled through the mouth, making it possible for a user undergoing overdose to choke to death on their own vomit.
Kratom as a Public Health Threat
While Vice’s breakdown of an opioid overdose is based on the long-recognized signs of heroin or prescription opioid abuse, there is a bit of a question mark over kratom. The Food and Drug Administration has stated that kratom compounds are similar enough to recognized opioids that there is functionally no difference, and they cited 44 deaths related to kratom consumption as proof that the potential for abuse and harm is prohibitively high. But since the plant is has not been studied or tested, there are no official parameters for what a kratom overdose looks like.
There are, however, anecdotal stories of people calling poison control and 911, going to hospital because they took too much kratom (or kratom mixed with another substance) and suffering effects similar to those of an opioid overdose. In quoting the Centers for Disease Control as saying that kratom is emerging as an “emerging public health threat,” Forbes magazine noted unverified reports of people saying they experienced elevated blood pressure, rapid heartbeat, seizures, and psychosis following kratom consumption. Since the mitragynine alkaloid compounds do not activate and overwhelm the opioid receptors in the same way that heroin molecules do, the overdose symptoms are similar but not as life-threatening. However, the main danger is if users smoke a batch of impure kratom or if they combine their kratom with other substances, including actual opioids (whether legal, medicinal, or outright illegal).
The overall danger of too much kratom consumption, and the possibility of kratom overdose, is that there is still so much about it and its interactions that is not known. Additionally, the unregulated status of the drug means that making safe purchases is still a matter of chance.
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The Drug Enforcement Administration has cautioned that it is possible for kratom to induce withdrawal symptoms. If a user has been smoking kratom for a while and then attempts to stop using it, there will be recognizable psychological and physical symptoms of distress as the opioid receptors struggle to regulate communication between the brain, the central nervous system, and the rest of the body. These symptoms include:
- Mood swings
- Muscle and bone pain
- Nausea and vomiting
- Flu-like symptoms
- Periods of depression and anxiety
- Hallucinations and delusions (if the kratom use was chronic)
Withdrawal effects are painful and distressing, and they often make users go back on the substances they were using, sometimes to the point of taking even more of the drug. One of the key symptoms of withdrawal is drug craving, a psychological urge to go back to the original substance under the belief that by being under its effects, the withdrawal symptoms will be gone. Using the drug again will provide initially soothing effects, but such will be the dependence on their relief that addicts often take even more than they did before the withdrawal, thereby deepening their psychological need.
This could be the case with kratom, and it could be the precursor to a kratom overdose. If a heavy kratom user goes for a period of time without their opioid receptors being activated by the mitragynine alkaloid, the withdrawal effects might be distressing enough to cause a relapse, which might in turn be strong enough to set an overdose into effect.
There is much that is not known about kratom, but what is known is that it is indeed possible to overdose on kratom. The effects are not deadly, but they are harmful enough to put a user in danger to the point of requiring medical treatment. Since discontinuing kratom use carries the risk of withdrawal, users should not attempt to do this on their own. It is best if they taper down their use of kratom under medical supervision, so a doctor can administer appropriate medication to keep the worst of the withdrawal symptoms at bay.
Kratom users will likely need therapy and counseling to address the psychological causes and effects of their dependence. This should be followed by peer-led aftercare support to help them maintain their sobriety when formalized treatment is complete.