An herbal substance, kratom has both stimulant and opioid-like effects. There are no FDA-approved uses for kratom in the United States, but the substance is legal to possess and consume in some states. There is no current federal regulation of the drug.
Kratom comes from the tropical tree found in Southeast Asia, the Mitragyna speciosa. Leaves are dried, chewed, and made into teas or powders for stimulant effects in low doses and opioid-like euphoria and sedation in higher doses.
The FDA warns against using kratom, as use comes with a variety of negative effects, including drug dependence, withdrawal symptoms, addiction, and even the potential for life-threatening overdose.
What Is Kratom?
Kratom is an herbal substance that is used for its stimulant and sedative-narcotic effects. It is typically brewed into a tea as dried leaves, or the fresh leaves are chewed. The dried leaves can also be crushed and smoked. In addition, kratom comes in a pill form that can be swallowed.
Kratom has no approved medical uses in the United States, but people do report using it to manage opioid drug withdrawal symptoms and cravings, for pain management, to address mental health concerns, and to combat fatigue.
Some people may take kratom in smaller doses to stay awake, alert, and more social. In higher doses, it is often taken to get a “high” similar to that associated with an opioid drug. It can produce a calming sense of euphoria, which also makes it an addictive substance with a high potential for drug dependence.
In low doses, kratom can make a person more talkative. It can also increase energy and alertness — therefore, acting as a stimulant substance. In higher doses, kratom can cause sedation and opioid-like effects.
Side effects of kratom use may include the following:
- Mental confusion
- Dry mouth
- Loss of appetite
- Increased urination
Kratom is potentially addictive. It can cause physical dependence and withdrawal symptoms, including cravings, sleep disturbances, anxiety, restlessness, lethargy, tremors, muscle pain, and nausea. Long-term use of kratom can also lead to unhealthy weight loss, anorexia, and insomnia.
Stats on Kratom Use & Abuse
Just under 1% of people over the age of 12 in the United States used kratom in 2020, which equates to 2.1 million people. Kratom abuse is most common in adults, ages 26 and older, with 1.8 million adults using kratom in 2020 compared to 286,000 young adults and teens between the ages of 18 and 25, and 48,000 adolescents between the ages of 12 and 17.
Signs of kratom use may include the following:
- High energy
- Heightened sexual desire
In higher doses, it can have opposite effects. These are signs of use at higher doses:
- Euphoria or a dreamlike state
- Loss of motor coordination
Kratom is more commonly used in the Asia Pacific region of the world than in the United States. There are even several countries that classify kratom as a medical herbal substance with some therapeutic properties, particularly in traditional Eastern medicine.
In Southeast Asia, kratom is used to wean people off heroin. It is also used as an antidiabetic, intestinal deworming agent, antidiarrheal, cough suppressant, and wound poultice.
There are anecdotal reports of using kratom to self-regulate pain and as an opioid replacement. There are no known medical uses for kratom in modern medicine, however. Use of the substance, at least in the USA, is typically considered to be for recreational and nonmedical purposes.
Kratom Overdose Death Statistics
There were nearly 30,000 drug overdose deaths between July 2016 and December 2017. Of these, 152 tested positive for kratom postmortem. Typically, kratom overdose deaths involve another substance. In the same period, these substances were listed as follows:
- Fentanyl: 65.1%
- Heroin: 32.9%
- Benzodiazepines: 22.4%
- Prescription opioids: 19.7%
- Cocaine: 18.4%
In nearly 60% of these overdose fatalities, kratom was listed as the cause of death. In seven of these deaths, kratom was the only substance found. Thus it is possible to overdose and die from Kratom alone although the risks are much higher when combined with other sedating substances.
A kratom overdose often appears like an opioid overdose, including significant drowsiness or loss of consciousness, difficulty breathing, nausea and vomiting, mental confusion, hallucinations, and loss of coordination and balance.
A kratom overdose is a medical emergency, especially when the substance is combined with other drugs.
Is Kratom Legal in My State?
Kratom is not currently listed as a controlled substance by the DEA, although it is considered a “drug of concern.” Because of this, it is not federally regulated. This means that it is technically legal at the federal level. Different states have varying regulations on the possession and consumption of kratom.
Here is information on the possession, growth, sale, use, or regulation of kratom in each state as it currently stands:
- Alabama: Kratom is illegal to buy, possess, use, or sell.
- Alaska: Kratom is legal.
- Arizona: The Kratom Consumer Protection Act (KCPA) has passed. Kratom is legal, but requirements such as a minimum age can be set by regulators.
- Arkansas: Kratom is illegal to buy, possess, use, or sell.
- California: Kratom is legal everywhere except in San Diego, where it is banned.
- Colorado: Kratom is legal everywhere with exception of Denver where it is banned for human consumption although it is legal to sell it there. It is illegal to sell kratom in Parker Town and Monument Town.
- Connecticut: Kratom is legal.
- Delaware: Kratom is legal.
- Florida: Kratom is legal except in Sarasota County where it has been banned.
- Georgia: The KCPA has been passed.
- Hawaii: Kratom is legal, but legislation is pending to potentially ban the substance.
- Idaho: Kratom is legal.
- Illinois: Kratom is legal to use and possess for people ages 18 and older except in the city of Jerseyville where it is banned.
- Indiana: Kratom is illegal to buy, possess, use, or sell.
- Iowa: Kratom is legal.
- Kansas: Kratom is legal. There was a bill to criminalize the substance that was removed, and currently, the KCPA is being reviewed.
- Kentucky: Kratom is legal.
- Louisiana: Kratom is legal, but if the DEA places kratom on the controlled substances list, there is a bill in place to criminalize its use and sale.
- Maine: Kratom is legal.
- Maryland: Kratom is legal.
- Massachusetts: Kratom is legal.
- Michigan: Kratom is legal, but legislation is pending to classify kratom as a Schedule II controlled substance.
- Minnesota: Kratom is legal.
- Mississippi: Kratom is legal except in Union County where the substance is banned.
- Missouri: Kratom is legal, but the KCPA is under review, and some counties are considering a ban.
- Montana: Kratom is legal.
- Nebraska: Kratom is legal.
- Nevada: The KCPA has been passed.
- New Hampshire: Kratom is legal for possession and use for people ages 18 and older, except in Franklin where it is banned.
- New Jersey: Kratom is legal.
- New Mexico: Kratom is legal.
- New York: Kratom is legal.
- North Carolina: Kratom is legal to possess and use for people ages 18 and older.
- North Dakota: Kratom is legal.
- Ohio: Kratom is legal, but the state is considering kratom regulation.
- Oklahoma: Kratom is legal, but there is a pending bill to regulate the substance.
- Oregon: Kratom is legal to possess and use for individuals ages 21 and older. Manufacturers or retailers of kratom must disclose the drug as an ingredient when selling kratom products.
- Pennsylvania: Kratom is legal.
- Rhode Island: Kratom is illegal to buy, possess, use, or sell, but there is a pending bill that may reverse the ban and enact regulations instead.
- South Carolina: Kratom is legal.
- South Dakota: Kratom is legal to possess and use for people ages 21 and older.
- Tennessee: Kratom is legal for possession and use for people ages 21 and older. There is a bill pending that would regulate kratom sales by retailers to packets between 5 and 7 ounces.
- Texas: Kratom is legal, but there is a pending bill to regulate the substance.
- Utah: The KCPA has been passed, and retailers are required to test the substance before selling it.
- Vermont: Kratom is illegal to buy, possess, use, or sell, but there is a pending bill to reverse the ban.
- Virginia: Kratom is legal.
- Washington: Kratom is legal.
- West Virginia: Kratom is legal.
- Wisconsin: Kratom is illegal to buy, possess, use, or sell, but the ban may potentially be reversed, and the KCPA passed instead.
- Wyoming: Kratom is legal.
Where Is Kratom Banned?
Several states, counties, and cities have banned kratom completely from being used, sold, or possessed. Kratom is also illegal in several countries, including these:
- South Korea
- South Korea
- New Zealand without a medical prescription
Kratom is not widely recognized in many countries throughout the world, which can impact its controlled and legal status. Different cities and provinces may have laws concerning kratom, and its status is rapidly shifting as the drug becomes more commonly known.
Why isn’t Kratom Legal Everywhere?
Kratom is widely recognized as an addictive drug with serious potential side effects.
While it is not currently controlled in the United States, kratom was listed as a “drug of concern” by the DEA in June 2020. It has the potential to be placed on the Controlled Substances list. The FDA has thus far found kratom to have no potential therapeutic benefits.
Kratom can cause some significant symptoms when used for an extended period. These symptoms include drug dependence and withdrawal along with the potential for addiction and fatal overdose.
When combined with other substances, kratom can be especially dangerous. Long-term kratom use can also lead to weight loss, muscle pain, darkening of skin pigmentation, liver damage, and potential breathing issues.
Kratom is an unregulated substance, which means it can be difficult to know exactly what is in the product you are buying or using. Because it is unregulated, this increases the potential risks of using kratom.
Traveling With Kratom
There are no federal regulations on kratom within the United States, so if you are traveling inside the country (even on a plane), the substance is technically legal, and you can carry it with you. If you are traveling outside of the country to a place where it is currently banned, you cannot bring it with you or carry it onto a plane.
It is important to research the area where you are traveling and know the legality of kratom there before bringing it with you. Even though kratom is not federally regulated in the United States, there are several states, counties, and cities where the substance is banned. You could face legal consequences if you bring it into a place where it is locally restricted.
By Elena Hill, MD, MPH
Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where ... Read More
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