Kratom: Understanding Its Effects, Risks, and Emerging Public Health Concerns
Kratom (Mitragyna speciosa) is a tropical tree native to Southeast Asia whose leaves have traditionally been used for their stimulant and opioid-like effects. In recent years, kratom products have become increasingly available internationally in forms such as powders, capsules, teas, extracts, and concentrated liquids. Some individuals use kratom to manage pain, fatigue, anxiety, or symptoms associated with opioid withdrawal. However, growing evidence and regulatory concerns indicate that kratom is not risk-free and can lead to dependence, withdrawal, and other serious adverse effects.
What Is Kratom?
Kratom contains numerous naturally occurring alkaloids, with mitragynine and 7-hydroxymitragynine (7-OH) receiving particular scientific attention. These compounds interact with opioid receptors in the brain. Mitragynine is the primary alkaloid in natural kratom leaves, while 7-OH normally occurs only in small amounts but has substantially stronger opioid-receptor activity. The effects of kratom can therefore vary considerably depending on the product, its concentration, and whether it contains enhanced or concentrated 7-OH.
At lower exposures, kratom may produce stimulant-like effects such as increased alertness or energy, whereas higher exposures may produce sedation and opioid-like effects. This variability can make it difficult for consumers to predict how a particular product will affect them.
Why People Use Kratom
People report using kratom for a variety of reasons, including pain, fatigue, anxiety, depression, and attempts to manage opioid withdrawal. Some individuals perceive kratom as a natural alternative to pharmaceutical medications because it originates from a plant. However, being plant-derived does not automatically mean that a substance is safe or medically appropriate.
The U.S. Food and Drug Administration (FDA) states that there are no FDA-approved prescription or over-the-counter drug products containing kratom and warns consumers against using kratom to treat medical conditions because its safety and effectiveness for those purposes have not been established.
Kratom and the Brain
Kratom's effects are primarily associated with interactions involving opioid receptors, although its alkaloids also affect other neurological systems. These pharmacological effects help explain why kratom can produce both stimulant-like and opioid-like experiences.
Repeated exposure can result in tolerance and physical dependence. Some people who use kratom regularly report cravings and withdrawal symptoms after reducing or stopping use. The FDA has documented cases meeting criteria for substance use disorder among some kratom users, including continued use despite negative consequences, increased consumption, cravings, and withdrawal symptoms.
Kratom Dependence and Withdrawal
A significant misconception is that kratom cannot produce dependence because it is a plant. In reality, repeated use can lead to physical dependence in some individuals. Withdrawal may include symptoms such as irritability, restlessness, fatigue, body discomfort, sleep difficulties, and other physical or psychological symptoms.
The severity of withdrawal can vary according to factors such as frequency of use, duration of use, product potency, individual physiology, and whether other substances are involved. People who have developed problematic kratom use may benefit from professional assessment rather than attempting to manage severe dependence without appropriate support.
Health Risks Associated With Kratom
Kratom has been associated with several potential adverse health effects. The FDA identifies serious concerns including liver toxicity, seizures, substance use disorder, and other adverse effects. Reported effects can also include nausea, vomiting, constipation, agitation, sleep disturbances, and, in some circumstances, respiratory depression.
The FDA has also reported concerns about contaminated kratom products. Previous investigations have identified products contaminated with organisms such as Salmonella, while other concerns involve potentially harmful levels of heavy metals. These risks illustrate an additional problem: consumers may not always know precisely what is contained in a commercially marketed product.
The Emerging Concern With 7-Hydroxymitragynine
An important recent development in the kratom discussion involves products containing concentrated or enhanced 7-hydroxymitragynine (7-OH). Although 7-OH naturally occurs in trace amounts in kratom leaves, concentrated products may contain much higher levels.
In July 2025, the FDA announced actions concerning 7-OH products and described concentrated 7-OH as a potent opioid product with significant potential for abuse. The agency warned that products marketed as tablets, gummies, drink mixes, and shots may expose consumers to substantially higher concentrations than naturally occurring kratom leaf.
This distinction is important because natural kratom leaf and concentrated 7-OH products should not automatically be treated as identical substances. Their chemical composition and potency can differ substantially.
Kratom and Addiction
Kratom can become part of a cycle of dependence for some individuals. A person may initially use it to manage pain, emotional distress, fatigue, or withdrawal symptoms. Over time, repeated use may produce tolerance, leading the individual to consume more or seek stronger preparations. Attempts to stop may then produce withdrawal symptoms, encouraging continued use.
This pattern illustrates an important principle in addiction medicine: a substance does not have to be traditionally classified as an illicit drug to create problematic use. Dependence and substance use disorders can develop in connection with a variety of psychoactive substances.
Kratom and Opioid Withdrawal
Kratom is sometimes promoted as a way to manage opioid withdrawal. However, the FDA emphasizes that kratom has not been demonstrated to be safe and effective for treating opioid use disorder or opioid withdrawal. Relying on an unapproved product may also delay access to evidence-based treatment.
Evidence-based treatment for opioid use disorder can include FDA-approved medications such as buprenorphine, methadone, and naltrexone, depending on an individual's clinical circumstances. People experiencing opioid dependence should therefore be evaluated by qualified healthcare professionals rather than assuming that kratom is a safe substitute for established treatment.
The Importance of Product Variability
One of the major public health concerns surrounding kratom is variability between products. A consumer may purchase products labeled with similar names but encounter substantial differences in alkaloid concentrations, extracts, additives, or contaminants.
Concentrated extracts can also produce effects that differ from those associated with traditional preparations of kratom leaf. The FDA's recent import actions demonstrate that regulatory authorities continue to identify concerns involving kratom products entering the U.S. market.
Kratom and Mental Health
Some individuals use kratom in an attempt to cope with anxiety, depression, trauma-related distress, or emotional exhaustion. Although temporary changes in mood may occur, using psychoactive substances to manage untreated mental health symptoms can create additional problems, particularly when tolerance and dependence develop.
A comprehensive approach should address the underlying psychological condition rather than relying solely on an unapproved psychoactive substance. Mental health treatment may include psychotherapy, appropriate medications, behavioral interventions, social support, or combinations of these approaches depending on the individual's needs.
Treatment and Recovery From Problematic Kratom Use
Individuals who develop problematic kratom use should be treated with the same compassion and clinical seriousness applied to other substance-related problems. Assessment should consider the person's pattern of use, physical dependence, withdrawal symptoms, co-occurring substance use, mental health conditions, and social circumstances.
Treatment may involve behavioral therapy, supportive care, addiction counseling, peer recovery resources, and medical supervision when clinically indicated. Individuals should not assume that because kratom is plant-based, withdrawal or dependence cannot require professional attention.
Conclusion
Kratom is a psychoactive botanical substance with a complicated pharmacological profile. Although some individuals use it for pain, energy, emotional symptoms, or opioid withdrawal, scientific and regulatory evidence demonstrates that kratom can produce dependence and is associated with potentially serious health risks, including liver toxicity, seizures, and substance use disorder.
The emergence of concentrated 7-OH products has added another layer of concern because these products can contain much more potent opioid-active compounds than naturally occurring kratom leaf.
A professional understanding of kratom requires moving beyond the assumption that “natural” means safe. Continued research is needed to better understand kratom's pharmacology, long-term effects, dependence potential, and appropriate clinical responses. In the meantime, individuals experiencing problematic kratom use should have access to evidence-based medical and behavioral health care.
References
U.S. Food and Drug Administration. (2024). FDA and kratom. FDA and Kratom
U.S. Food and Drug Administration. (2025). Products containing 7-OH can cause serious harm. Products Containing 7-OH Can Cause Serious Harm
U.S. Food and Drug Administration. (2025). FDA takes steps to restrict 7-OH opioid products threatening American consumers. FDA 7-OH safety announcement
U.S. Food and Drug Administration. (2026). Import Alert 54-15: Dietary supplements and bulk dietary ingredients that are or contain Mitragyna speciosa or kratom. FDA Import Alert 54-15
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