Kratom: The Down and Dirty

First came Spice1, then Bathsalts,2then Krokodil,3and now Kratom.4  All considered designer drugs by the National Institute of Drug Abuse (NIDA) and all with significant risk factors that today’s physicians need to be aware. Emergency room physicians and psychiatrists especially, but all physicians need to be aware as with the earlier designer drugs Spice and Bathsalts, Kratom is increasingly being seen in the clinical setting and with significant clinical problems. The CDC5reported over 150 deaths between 2016-2017 involved Kratom. Considered a drug of abuse:

“Kratom (Mitragyna speciosa), a plant native to Southeast Asia, has been growing in popularity as an herbal supplement. Consuming low doses of it may have stimulant like effects, while higher doses may produce opioid-like effects, the report’s author’s note.”

US Drug Enforcement Administration (DEA) calls it a “drug of concern6” and is being considered for DEA classification of schedule 1. There have also been reports of both salmonella and heavy metals in Kratom products. According to the DEA,7Kratom 

  • At low doses, increased alertness, physical energy, and talkativeness
  • At high doses, sedation
  • Addictive: causes hallucinations, delusion, and confusion
  • Nausea, itching, sweating, dry mouth, constipation, increased urination, and loss of appetite
  • Long-term use can cause anorexia, weight loss, and insomnia

The National Institute of Health8reported:

“studies in experimental animals suggest that high doses of kratom may be less likely than high doses of opioids to be fatal. However, some deaths in people have been linked to kratom. Typically, they have involved the use of kratom in combination with opioids or various prescription or over-the-counter drugs.”

Reported side effects include anxiety, irritability, and increased aggression, which may be related to the drug’s stimulant effects; and sedation, nausea, constipation, and itching, which may be related to its opioid-like effects. Increased pigmentation of the cheeks, tremor, loss of appetite, weight loss, and psychosis have been seen in long-term kratom users. Seizures have been reported in users of high doses of kratom.8 

If you are a doctor then Kratom should be a “drug of concern” for you too.


  4. Kuehn B. Kratom-Related Deaths. JAMA. 2019;321(20):1966. doi:10.1001/jama.2019.6339