What is kratom? Risks, side effects and what to know about the controversial supplement

The herbal supplement is often marketed for pain relief and energy, but health officials warn it can be addictive and may cause serious side effects.

Kratom, an herbal product derived from a tree native to Southeast Asia, has grown increasingly popular in the United States as a supplement marketed for pain relief, energy and mood enhancement. But health officials continue to warn consumers about its potential risks.

The supplement is typically sold as capsules, powders, extracts or beverages and can be purchased online, at smoke shops, gas stations and other retailers. While kratom is not federally banned, it is not approved by the U.S. Food and Drug Administration for any medical use.

How does kratom work?

Kratom comes from the leaves of the Mitragyna speciosa tree. It contains two primary psychoactive compounds, mitragynine and 7-hydroxymitragynine, which interact with receptors in the brain.

According to the Drug Enforcement Administration, kratom can act as a stimulant at lower doses, increasing alertness and energy. At higher doses, it may produce sedative effects similar to opioids and, in some cases, can lead to psychotic symptoms.

Some manufacturers and users promote kratom as a way to manage pain or reduce dependence on opioid medications. However, medical experts caution that kratom itself can be habit-forming.

Is kratom legal?

Kratom is not classified as a controlled substance under federal law. However, the DEA lists it as a "Drug and Chemical of Concern."

Several states and local governments have restricted or banned kratom sales and possession such as Connecticut, Indiana and Tennessee.

The FDA says kratom is not lawfully marketed in the United States as a drug product, dietary supplement or food additive. As a result, there are currently no FDA-approved prescription or over-the-counter drugs containing kratom.

What are the risks?

The FDA has repeatedly warned consumers not to use kratom because of reports of serious adverse health effects, including:

• Liver toxicity
• Seizures
• Substance use disorder
• Psychiatric complications
• Cardiovascular problems
• Gastrointestinal issues
• Respiratory depression

Federal health officials say people can develop dependence on kratom and experience withdrawal symptoms when they stop using it. Reported symptoms include cravings, tolerance and continued use despite harmful physical or personal consequences.

Health officials have also reported cases of neonatal abstinence syndrome, in which babies exposed to kratom during pregnancy experienced withdrawal symptoms such as irritability, jitteriness and muscle stiffness after birth.

In addition, the FDA has issued warnings about kratom products contaminated with Salmonella or elevated levels of heavy metals.

Can you overdose on kratom?

Although considered uncommon, overdoses involving kratom have been reported.

The FDA says some deaths have been associated with kratom use, though many cases involved the use of additional substances, making it difficult to determine kratom's exact role.

The Mayo Clinic similarly notes that most reported deaths involving kratom also included other drugs or substances.

How many people use kratom?

An estimated 1.7 million Americans age 12 and older used kratom in 2021, according to the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health.

The supplement has received renewed attention following several high-profile death investigations in which kratom was found at the scene. On Sept. 21, packaged kratom was recovered during separate investigations into the deaths of two University of Mississippi students, though authorities said they have not determined whether the substance contributed to either death.

In another widely publicized case, 23-year-old Georgia resident Ethan Pope died in 2021 after using kratom. His parents later filed a wrongful death lawsuit against companies involved in the product's manufacture and sale.

Why is kratom controversial?

Federal regulators have scrutinized kratom for more than a decade amid reports of addiction, injury and overdose.

Supporters argue the product may offer a safer alternative to opioid painkillers and could help some people manage chronic pain or opioid withdrawal. Critics, including many health officials, say the supplement lacks sufficient scientific evidence to support those claims and poses significant health risks.

As debate over the product continues, the FDA maintains that consumers should avoid kratom because of the potential for serious adverse effects and the lack of approved medical uses.

If you or someone you know is struggling with drug addiction, call the national hotline for drug abuse at 1-888-633-3239 to receive information regarding treatment and recovery.