Kratom Facts
Opioid;
Description
Kratom (Mitragyna speciosa Korth., Rubiaceae) is a tropical tree native to Southeast Asia whose leaves contain over 40 alkaloids. Its dominant constituent, mitragynine, activates both opioid and stimulant pathways in the brain. At low doses this produces alertness and energy; at higher doses, sedation and pain suppression dominate.
Subjective effects include stimulation, mood elevation, pain relief, sedation, and euphoria — shifting from sociable energy at lower doses to opioid-like warmth and cognitive slowing at higher doses.[1] The defining quality is a dose-dependent inversion absent from conventional stimulants or opioids, though preparation type and alkaloid concentration shape the experience considerably.[2]
Prolonged use carries significant opioid-type physical dependence risk, and kratom is a documented cause of drug-induced liver injury.[3][4] The highest-risk pattern is combining kratom with opioids or sedatives — additive opioid signaling can slow breathing to a dangerous or fatal degree.[5][6]
Dose and duration
No dose or duration recorded for any route.
Body and dependence
- Acute toxicity
- Low
- Chronic toxicity
- Moderate
- Physical dependence
- High
- Psychological dependence
- High
- Withdrawal
- Moderate
- Compulsive redosing
- Moderate
Tolerance
- Builds
- Moderate
- Fully resets after
- 10 days
- Carries over to
- opioids
Who shouldn't take it
Combinations65 recorded
Seek help immediately if
- Unresponsive / can't be woken, even to a firm sternal rub
- Slow, shallow, or stopped breathing
- Pinpoint pupils
- Blue/grey lips, fingertips, or skin (cyanosis)
- Limp body; pale, clammy skin
- Choking or gurgling sounds ("death rattle")
- Slow, erratic, or absent pulse
What to do
- Try to wake them — shout their name, firm sternal rub
- Call emergency services immediately
- Administer naloxone if available
- Give rescue breaths (or CPR if there is no pulse)
- Place them in the recovery position
- Stay with them; re-dose naloxone every 2–3 minutes if there is no response
- Reversal agent
- Naloxone (Narcan) — opioid antagonist. May require repeated doses; its effect can wear off before the opioid does.
With prompt naloxone and rescue breathing, reversal is usually rapid. Because naloxone can wear off before the opioid — especially with long-acting opioids (methadone) or high-potency ones (fentanyl) — a period of monitoring is needed even after the person revives.
988 Suicide & Crisis LifelineFireside Project: 62-FIRESIDE
References
- [1]^Smith KE, Rogers JM, Dunn KE, Grundmann O, McCurdy CR, Schriefer D, Epstein DH (2022) Searching for a Signal: Self-Reported Kratom Dose-Effect Relationships Among a Sample of US Adults With Regular Kratom Use Histories — Frontiers in Pharmacology doi:10.3389/fphar.2022.765917
- [2]^Sharma A, Kamble SH, Leon F et al. (2019) Simultaneous quantification of ten key Kratom alkaloids in Mitragyna speciosa leaf extracts and commercial products by ultra-performance liquid chromatography-tandem mass spectrometry — Drug Testing and Analysis doi:10.1002/dta.2604
- [3]^Singh D, Muller CP, Vicknasingam BK (2014) Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users — Drug and Alcohol Dependence doi:10.1016/j.drugalcdep.2014.03.017
- [4]^Schimmel J, Dart RC (2020) Kratom (Mitragyna Speciosa) Liver Injury: A Comprehensive Review — Drugs doi:10.1007/s40265-019-01242-6
- [5]^Shi T, Shea JL (2024) A case of fatal overdose involving both hydromorphone and kratom — Journal of Forensic Sciences doi:10.1111/1556-4029.15394
- [6]^Kronstrand R, Roman M, Thelander G, Eriksson A (2011) Unintentional fatal intoxications with mitragynine and O-desmethyltramadol from the herbal blend Krypton — Journal of Analytical Toxicology PMID:21513619