Kratom is a tropical tree native to Southeast Asia whose leaves produce stimulant effects at low doses and sedative, pain-relieving effects at higher doses. It belongs to the same plant family as coffee, but its active compounds interact with opioid receptors in the brain, making it far more potent and controversial than its botanical cousin. Kratom is legal at the federal level in the United States but banned in several states, and it has not been approved by the FDA for any medical use.
What Kratom Is and Where It Comes From
Kratom (Mitragyna speciosa) is a tree indigenous to Thailand, Malaysia, Myanmar, and surrounding parts of Southeast Asia. It can grow up to 50 feet tall with a canopy spreading over 15 feet. For centuries, workers in these regions chewed the raw leaves or brewed them into tea for energy and pain relief. Today, kratom is typically sold in the U.S. as a dried powder, capsule, or liquid extract.
The plant produces more than 40 structurally related alkaloids, but two do most of the heavy lifting. Mitragynine is the most abundant, and 7-hydroxymitragynine is less prevalent but considerably more potent. Both compounds bind to the same brain receptors that opioid drugs target, functioning as partial activators of those receptors. Unlike full opioids such as morphine or fentanyl, these alkaloids show a preference for one specific signaling pathway inside the cell, which some researchers believe could mean a different side-effect profile. That distinction, however, has not been confirmed through clinical trials in humans.
How Kratom Affects the Body
Kratom’s effects shift depending on how much you take. At low doses, roughly 1 to 5 grams of dried leaf powder, users typically report increased energy, alertness, and sociability. At higher doses of 5 to 15 grams, the experience tilts toward pain relief, relaxation, and sedation. Doses above 15 grams can produce effects that closely resemble an opioid overdose, including dangerous slowing of breathing.
Interestingly, a study of 63 long-term kratom users in Malaysia found that both stimulant and sedative effects occurred regardless of the amount consumed, and the differences between low-dose and high-dose users were not statistically significant. This suggests individual biology and tolerance play a large role in how kratom feels, and the neat “low dose equals stimulant, high dose equals sedative” framework is more of a general pattern than a reliable rule.
Why People Use It
In a large online survey of kratom users, pain relief was the most common reason for use, cited by 48% of respondents. About 22% used it for anxiety, PTSD, or depression. Ten percent took it primarily for energy or focus, and another 10% used it specifically to reduce opioid use or manage withdrawal symptoms. Over 90% of those who used kratom as a substitute for opioids said it helped relieve pain, reduce their opioid consumption, and ease withdrawal.
These self-reported numbers are notable, but they come with a major caveat: kratom has not been tested in the kind of rigorous, controlled clinical trials required for medical approval. What users perceive as effective may carry risks that only show up in larger, longer-term studies.
Side Effects and Serious Risks
Common side effects include agitation, irritability, fast heart rate, and elevated blood pressure. At higher doses, the risks escalate significantly. An analysis of single-substance kratom exposures reported to poison control centers found that nearly 52% resulted in serious medical outcomes, including seizures, respiratory depression, slowed heart rate, liver damage, coma, and cardiac arrest.
Kratom also interferes with the liver enzymes your body uses to process many common medications. Its primary alkaloid, mitragynine, strongly inhibits two key enzyme systems (known in pharmacology as CYP2D6 and CYP3A). In practical terms, this means kratom can cause other drugs to build up in your bloodstream to potentially dangerous levels. Modeling studies predict that a single 2-gram dose of kratom could increase blood levels of certain sedatives by nearly sixfold and some psychiatric medications by roughly 2.5-fold. For one anti-anxiety medication, the predicted increase was 14-fold. If you take any prescription medications, combining them with kratom is a serious concern.
Contamination in Commercial Products
Because kratom is sold as an unregulated supplement rather than an approved drug, product quality varies wildly. The FDA tested 30 commercial kratom products and found significant levels of lead and nickel that exceeded safe daily exposure limits for oral intake. Some products contained nickel concentrations above 20,000 nanograms per gram, and lead levels in several products ranged from 300 to over 900 nanograms per gram. Heavy users, who consume kratom multiple times daily, may be exposed to levels many times greater than what is considered safe. Past FDA investigations have also linked kratom products to salmonella outbreaks.
Dependence and Withdrawal
Regular kratom use can lead to physical dependence. In a study of people who used kratom more than four times per week, the most commonly reported withdrawal symptoms after stopping for a day or longer were anxiety (33%), irritability (33%), low energy (29%), restlessness (23%), difficulty sleeping (23%), nausea (22%), and body aches (22%). Some users also reported depressed mood, hot and cold flashes, runny nose, and restless legs.
The overall severity was described as mild to moderate by most respondents, and the symptom profile closely resembles opioid withdrawal. Intense cravings were less common (reported by about 5% of regular users) but rated as the most severe symptom by those who experienced them. About 29% of regular users reported wanting to use another substance to relieve their kratom withdrawal, which points to real dependency potential even if the withdrawal is less intense than what occurs with prescription opioids or heroin.
Legal Status in the United States
Kratom is not a controlled substance under federal law. The DEA lists it as a “Drug and Chemical of Concern” but has not placed it on a scheduling list. In 2016, the DEA announced its intent to emergency-schedule kratom’s two main alkaloids as Schedule I substances, which would have criminalized possession. That proposal was withdrawn after significant public backlash and congressional pushback.
Six states have banned kratom outright: Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin. Tennessee enacted its own ban in 2013. In states where kratom remains legal, it is sold in smoke shops, gas stations, and online retailers with no standardized testing or labeling requirements. Several states have passed or are considering versions of a “Kratom Consumer Protection Act,” which would regulate the product rather than ban it, setting standards for purity, labeling, and age restrictions.