Kratom does not typically cause hallucinations. It is not a hallucinogen, and its primary active compounds work on opioid receptors in the brain, not the serotonin pathways responsible for the visual and perceptual distortions caused by drugs like LSD or psilocybin. That said, there are specific circumstances where kratom use has been linked to psychotic symptoms, including paranoia, delusions, and confusion, which some people may describe as hallucinations.
Why Kratom Isn’t a Hallucinogen
Classic hallucinogens like psilocybin and LSD produce their effects by strongly activating a specific serotonin receptor called 5-HT2A. Kratom’s main alkaloid, mitragynine, does bind to this receptor, but only weakly. Lab testing published in the Journal of Medicinal Chemistry found that mitragynine’s binding affinity at the 5-HT2A receptor is roughly 5,000 nM, which in pharmacological terms is very low. For comparison, actual hallucinogens bind at concentrations hundreds of times smaller. The other key kratom compound, 7-hydroxymitragynine, showed essentially zero activity at this receptor, displacing less than 4% of the test compound even at high concentrations.
Instead, both mitragynine and 7-hydroxymitragynine primarily act as partial agonists at the brain’s mu-opioid receptor. This is the same receptor targeted by morphine and other opioids. At low doses, kratom produces stimulant-like effects (increased energy, alertness). At higher doses, it acts more like a sedative. Neither profile involves the kind of sensory distortion associated with hallucinogens.
When Kratom Can Cause Psychotic Symptoms
While kratom won’t produce a “trip,” escalating use has been linked to psychiatric episodes in case reports. One published case described a patient who developed paranoid delusions after weeks of increasingly heavy kratom consumption. Researchers speculated the stimulant effects of kratom contributed to a psychiatric decompensation, though no clinical trials have established a specific dose threshold where this becomes likely.
Confusion is one of the more commonly reported effects of kratom toxicity, appearing in about 8% of documented poisoning cases. Other frequent symptoms include agitation (18.6%), rapid heart rate (16.9%), and drowsiness (13.6%). In severe cases, kratom toxicity has caused acute liver injury, and when the liver can no longer filter toxins from the blood, that can lead to a state of mental confusion and altered consciousness that might feel like hallucinating but has a completely different cause.
One extreme case involved a patient who developed posterior reversible encephalopathy syndrome, a condition involving brain swelling, after days of kratom-related complications. Symptoms included sudden altered mental status, headache, and dangerously high blood pressure. This kind of severe neurological event is rare but illustrates that heavy kratom use can affect the brain in ways that go well beyond its intended effects.
The Serotonin Syndrome Risk
If you take kratom alongside antidepressants or other medications that raise serotonin levels, the combination can push serotonin dangerously high. Kratom inhibits several liver enzymes responsible for breaking down common psychiatric medications, meaning those drugs stay in your system longer and at higher concentrations than expected. One published case report described a patient taking multiple serotonergic medications (for anxiety and depression) alongside kratom who developed signs of serotonin syndrome.
Serotonin syndrome can cause agitation, confusion, muscle twitching, rapid heartbeat, and in severe cases, altered perception that could be mistaken for hallucinations. The risk isn’t from kratom alone but from the way it interferes with your body’s ability to metabolize other drugs. This is especially relevant for anyone taking SSRIs, SNRIs, or similar medications.
Adulterated Products Add Unknown Risks
Not all kratom products contain only what’s on the label. Lab analysis of commercially available kratom has found products spiked with artificially elevated levels of 7-hydroxymitragynine, the more potent and addictive of kratom’s two main compounds. This increases the risk of opioid-like side effects, including sedation and confusion, beyond what a user would expect from natural kratom leaf.
More alarming, kratom products sold in Sweden were found to be adulterated with O-desmethyltramadol, a powerful synthetic opioid. At least nine people died after consuming those products. While adulteration with substances that directly cause hallucinations (like synthetic cannabinoids) hasn’t been widely documented in kratom specifically, the lack of regulatory oversight means any given product could contain unexpected compounds with unpredictable psychiatric effects. If someone reports hallucinations after using a commercial kratom product, the adulterant may be the actual cause rather than kratom itself.
What the Confusion and Agitation Actually Feel Like
Most people who report strange mental effects from kratom are not experiencing true hallucinations in the clinical sense, meaning they’re not seeing things that aren’t there or hearing voices. What they typically describe is a foggy, disoriented state, sometimes with paranoia or a sense that something is very wrong. At high doses, the sedative opioid effects can produce a dreamlike state where the boundary between waking and sleeping blurs, which some users interpret as a hallucinatory experience.
The distinction matters because true hallucinations would suggest activity at the 5-HT2A receptor that kratom’s alkaloids simply don’t produce at meaningful levels. What people experience instead are the downstream effects of opioid receptor activation, liver stress, or drug interactions, all of which can alter your mental state without involving the hallucinogenic pathway at all.