Kratom (Mitragyna spp.) is a leafy tree that is native to Thailand and Malaysia. Kratom leaves have been used as an "opium substitute" by people in Southeast Asia for centuries. With the new boom in ethnobotanical vendors, we are now seeing Kratom use increasing across the US.
The active ingredients in Kratom are mitragynine and 7-hydroxymitragynine. Kratom has been made illegal in Thailand and Malaysia among other countries. Synthetically produced mitragynine and 7-hydroxymitragynine are currently schedule 1 in the US, but natural Kratom is unscheduled. Specifically, in Tennessee, Kratom use is legal as long as it is labeled appropriately. It can be found at many smoke and vape shops. It is often marketed alongside CBD products as an "all-natural" pain reliever.
Kratom is a partial agonist at the mu- and delta-opioid receptors. At low doses it produces stimulating effects and at higher doses sedative effects predominate. Kratom has been touted as an opium substitute and has been used to suppress the symptoms of opiate withdrawal.
Kratom comes in many different forms. Dried leaves are sold as powder which can be taken in capsule form or made into tea. Kratom extract is also sold. Dosages vary greatly depending on the freshness of the leaf and the potency of the particular plant. Vague terms are often used to describe the potency such as "super," "premium," and "enhanced." This can further compound users’ ability to predict effects from an administered dose.
There have been no deaths directly attributed to Kratom, but there have been deaths associated with products sold as Kratom that contain other additives or contaminants. Hepatotoxicity has been reported with Kratom extracts but has not been seen with unenhanced dried leaf products. It is highly addictive with evidence showing heavy users develop physical dependence.
Be vigilant for Kratom use in your patients as it is becoming more readily available in our community. Patients may not be aware of the potential harms given the way it is marketed as an all-natural plant-based product.
This question was prepared by: Jeffrey Birnbaum, MD, Pediatric Emergency Medicine Fellow
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Donna Seger, MD
Tennessee Poison Center
Poison Help Hotline: 1-800-222-1222