The majority of the time, this occurs when Kratom was combined with other drugs, but there have been a small number of cases where Kratom was the only drug found in the post-mortem toxicology. These effects vary widely from user to user, and can be especially unpredictable during your child’s teen years, when their hormones and brain development are constantly changing. Withdrawal, while probably not as bad as that of heroin, still may include sweating, muscle and bone pain, mood swings, diarrhea or constipation, nausea, fatigue, agitation, hallucinations, and delusions. Withdrawal symptoms such as cravings, anxiety, and depression can indicate a growing problem that requires professional intervention.As of 2025, kratom remains legal at the federal level, though several states—including Alabama, Indiana, and Wisconsin—have banned its sale or use.Taking kratom and Suboxone at the same time is not safe and can lead to serious health consequences.Though most of what we know is based on people’s stories, it makes sense for kratom to cause emotional blunting, irritability, etc.For this reason, many people doubt its character and value.But I have this magical box that I can put stuff in, and it locks it for up to 11 days…it’s like a lockbox that is on a timer.She learned that she preferred kratom in capsules, disliking the taste of raw powder.AKA aims to ensure consumers have legal access to the natural herb and emphasizes its potential benefits while also pushing for responsible regulation and use. Replies to “Kratom Dangers and Health Issues” Emergency roomvisits that list kratom as the chief complaint have more than tripled statewidesince 2017, according to data from the N.C. He’d already quit twice becauseof negative side effects, including nausea, mood swings and exhaustion. He started 12 years ago drawing cartoons, butnow he mainly focuses on acrylic paintings. Together, we can continue to learn, share, and empower each other on our kratom journeys. As the community continues to grow, it will undoubtedly play a pivotal role in shaping the future of kratom education, advocacy, and awareness. Navigating the Risks: How Kratom Can Impact Your Physical and Mental Health If you’re not in an area where you feel like you have self-control—because there’s some people who have very addictive personality-they’re gonna consistently try and get that again. Like, yeah, there are some ways to get recreational (with kratom), but honestly it, in my opinion, falls on same scale close to where more marijuana is. She acknowledged “…some dependency, so that’s why I taper versus take tolerance breaks.” She considered her cannabis dependence “way worse” than kratom dependence. Like, I normally do a mix of at least two types of kratom.” She did not take “tolerance breaks” but rather tapers—periodically lowering her dose. Noteworthy may be the observation of self-management of Morbus Menière symptoms with Kratom. Importantly, certain benefits of the drug may still apply even after a drug instrumentalization progressed to a drug use disorder (Müller, 2020; Müller et al., 2021). Drug instrumentalization can be assumed for many psychoactive drugs when used in a non-addictive way. This is defined as a drug use to achieve a drug-independent goal, which would not or only with much more effort be achievable without the drug. In this case, Kratom was not consumed for any hedonistic purpose, but rather for drug instrumentalization. Importantly, there are no reports of deaths due to kratom use in SE Asia for over a century (Veltri and Grundmann, 2019). For instance, nine deaths were from an herbal mix, Krypton, containing a metabolite of the opioid tramadol (Bäckstrom et al., 2010). However, at the current level of scientific knowledge, several factors make it impossible to determine whether kratom contributed to lethal outcomes. Over the past 2 decades, kratom has gained popularity beyond Asian borders, particularly in North America and Europe (Boyer et al., 2007; Grundmann, 2017). Another area of interest is the diversity of kratom strains and their unique properties. This natural supplement can help promote relaxation and reduce feelings of anxiety, providing a potential alternative for those seeking relief. Red kratom anxiety relief has been shown to be effective for many individuals despite common myths and misconceptions. About seven years ago, he searched for natural products for depression self-management and learned about Kratom herbal preparations from the plant Mitragyna speciosa Korth from internet forums. After alcohol consumption was abandoned, he managed his sleeping-problems in context of major depression with occasional and on-demand medication with 1 mg Lorazepam (every 1–2 weeks) for the last 2 years. After 20 years of alcohol use and AUD, the patient submitted to clinical detoxification. This is part of the reason some folks might feel more energy or less pain. People use it for different reasons, but it’s important to understand where it comes from and how it might work in the brain. Kratom, also known as Mitragyna speciosa, is a tropical tree from Southeast Asia with leaves that can have mind-affecting effects. Tolerance builds fast, pushing users to take more, increasing the risks of long-term health problems, and making it harder to quit. Without proper support or a treatment plan, it’s difficult for many users to quit and stay off Kratom for good successfully. The psychological effects of Kratom withdrawal can be just as challenging as the physical symptoms. This emotional reliance often leads to more frequent use, and as their tolerance grows, users need higher doses to achieve the same effects. “It could be left out by somebody, if it’s tea and nobody knows what’s in it and a child drinks it, we don’t know what the effects would be There have been efforts in Clinton Township and the city of Warren to regulate the use and sale of kratom products. “However, a lot of people may not know the addictive potential of it.” Even though kratom does not cause the dramatic symptoms of alcohol, antidepressants or painkillers, it is not safe to drive under the effects of kratom. Because Suboxone is a treatment for kratom addiction, it is not safe to take the substances together. A recent study evaluating the health risks of kratom identified an increase of serious medical events following kratom use, especially when combined with other substances. Among kratom’s many chemically active compounds is mitragynine, which targets the same pain-reducing receptors that are stimulated by opioids like heroin, morphine, and fentanyl. “When Marek started talking about kratom and just the potential of it being used as an analgesic, as a painkiller, and potentially being used in dealing with opioid addiction. However, all strains have the potential to cause addiction and similar risks, as they all contain the active compounds mitragynine and 7-hydroxymitragynine.Research shows that the majority of adverse effects, hospitalizations, and overdoses related to kratom involve other substances of abuse as well.Other alkaloids are either devoid of known pharmacological activity and/or, like 7-hydroxymitragynine, are present at such low levels as to not be considered factors in kratom effects or toxicity (Adkins et al., 2011; Kruegel & Grundmann, 2018; Takayama et al., 2002; Takayama, 2004).At the psychiatric hospital, she exhibited classic kratom withdrawal symptoms, including vague abdominal pain and restlessness.This brings the lethal dose equivalent of mitragynine to around 55,323 mg (55 grams) per kg of bodyweight.It is vital to thoroughly investigate and understand the possible problems and side effects that may arise from consuming Kratom in order to make informed decisions.They also can reach a broader customer base than brick-and-mortar shops, which means they don’t need to factor spoiled products into their operating costs.Our recent publications about kratom (Smith et al., 2024a) largely illustrated how kratom use appears to benefit many consumers. This cross-sectional study compared ECG findings between regular kratom users who consumed kratom daily and a control group. Additionally, this study also reported that mitragynine had decreased the fully glycosylated (fg) hERG1a protein expression at a lower concentration—but upregulated both core-glycosylated (cg) hERG1a protein expression and hERG1a-Hsp90 complexes at a higher concentration—after the hERG1a/1b-transfected HEK 293 cells had been exposed to mitragynine for 24 h. Next, a second in vitro study of kratom-related cardiotoxicity evaluated the mechanism of mitragynine-induced inhibition of the human ether-a-go-go-related gene 1a/1b (hERG1a/1b) current in stable hERG1a/1b-transfected human embryonic kidney (HEK) 293 cells. Interestingly, the World Health Organization reviewed kratom in 2021 and found it to be relatively safe and that scheduling it as a drug would cause more harm than good. Almost all cases of overdose involving kratom also had high concentrations of other dangerous drugs in the system . In this article, we’ll cover the traditional side effects of kratom and give you some tips and tricks to use your strains safely. Despite its popularity for various purposes, it is essential to acknowledge the potential complications and risks that may arise from Kratom usage. This unpredictability makes kratom particularly dangerous for people taking multiple medications or those with underlying medical or psychiatric conditions. Reports from the CDC have documented instances where kratom interactions with other drugs have led to fatal outcomes. You can get kratom products from the internet, herbal stores, and places where they sell tobacco or smoking items, often called head shops. Farmers dry kratom leaves before transforming them into products such as powders, capsules, tablets, and extracts. The interaction of these substances can lead to potentially dangerous, even life-threatening, situations. This highlights the importance of exercising caution and seeking professional advice before mixing kratom with any other substances. Similarly, combining kratom with opioids or gabapentin can increase the risk of overdose due to the combined effect on the central nervous system. It has both stimulant and opioid-like effects, depending on the dosage. Mitragynine is the primary active ingredient in kratom, and it acts on opioid receptors in the brain. The leaves of the kratom tree contain a compound called mitragynine. The leaves contain the active ingredient mitragynine, which acts on opioid receptors in the brain. More recent reports from the FDA continue to warn consumers about Kratom’s addictive potential and unsafe drug interactions. The online groups I was in pointed out, they went on a rant about how insane it was.” He ultimately wanted kratom to stay legal, but with high industry standards for “safety issues.” He expressed suspicion that government could be complicit in profiteering from kratom. But the claims that media and government were making at certain points--and you know how FDA always jumps in there…one doctor was quoted on there, you know, like news article, ‘kratom is 100x more potent than heroin,’…we jumped all over that. But when you pull away from kratom you, if you don’t taper the same way, you’re gonna go through a similar thing but not depression. Like, I was falling asleep in there, it’s because I didn’t have coffee. Our correspondence with Indonesian kratom growers proves to us that this isn’t actually how this is applied in practice.Here, we delve into the scientific aspects surrounding kratom and its effects on the human body.Emergency medical personnel can provide life-saving treatments to prevent the overdose from becoming fatal.For instance, Thailand, where kratom was deeply rooted in society, banned its use in 1943 due to increasing concerns about its addictive properties.He did try to drink a sanitizer fluid once during his hospital stay due to his severe craving for opioids.This kind of drug interaction can be incredibly dangerous, increasing the risk of overdose, injury, or even death.5Note that Schedule I is the only option in the United States for substances with “high” abuse and risk potential but which are not approved for therapeutic use by the FDA.Understand Risperidone withdrawal with We Level Up California. Kratom is a tropical plant native to Southeast Asia that has gained popularity worldwide for its potential to relieve pain, improve mood, and boost energy. Further, it suggests a possibleexplanation for the seemingly improved safety profile of mitragyninecompared to classical opioid agonists. Wehave found that the opioid pharmacology of mitragynine is complicatedby the important role of an active metabolite, 7-OH, in mediatingits activity. Thus, additional study of metabolic drug–drug interactionsamong kratom compounds will also be necessary. Again, a comparison to codeine is warranted,as the abuse liability of this compound has been found to depend onformation of active metabolites and vary depending on interindividualdifferences in CYP metabolic efficiency.47 There also remains the possibility that mitragynine exerts a bufferingeffect on the opioid agonist activity of its 7-OH metabolite, eitherthrough direct competitive antagonism at MOR or through other as-yet-unknownpharmacological mechanisms. Diverse scientific approaches were employed to profile MG’s abuse potential, finding no evidence of rewarding effects in the IV self-administration and ICSS models, and weak evidence of potential reward in the CPP procedure. Factors 4–6 discuss the public health aspects of kratom use; however, many of the same studies address Factor 1 concerning evidence for abuse and are mentioned here. Other studies of opioid or MG withdrawal suggested that specific brain proteins might serve as more sensitive biomarkers for physiological dependence in rats as compared to behavioral signs (Hassan et al., 2021). When using a pentylenetetrazol (PTZ) discrimination trial to evaluate anxiogenic signs in rats after MG or morphine withdrawal precipitated by naloxone, MG showed no substitution to the PTZ discriminative stimulus, while morphine produced a dose-related PTZ-like stimulus, further supporting MG as a novel pharmacotherapeutic intervention for managing opioid use disorder (Johari et al., 2021). MG treatment also reduced naloxone precipitated withdrawal in animals receiving chronic morphine, consistent with human reports. At the psychiatric hospital, she exhibited classic kratom withdrawal symptoms, including vague abdominal pain and restlessness. It will be a burden of cost to screen kratom users in the emergency services in the U.S. where the majority of people with substance use disorders crash. Its leaves and the teas brewed from them have long been used by people in that region to manage pain and opioid withdrawal and to stave off fatigue. The FDA also warns against using kratom given its potential for harm, including liver toxicity, seizures and substance use disorder. Higher doses, on the other hand, can be sedating and possibly offer relief from intense pain (much like opioid medications). In one case study, 33 hours after birth, the baby began showing symptoms consistent with opioid withdrawal, including sneezing, jitteriness, excessive suck, scratching at the skin around his face, and irritability. These include prohibitions against selling kratom to minors, requirements to prevent adulteration, and clear labeling standards for products.The dangers of kratom have been known by the federal government for quite some time.While kratom is used for various purposes, gastrointestinal issues like stomach cramps and diarrhea can occur as side effects.The most common and potentially least pleasant symptoms mimic that of opioid withdrawal.The concerns around the plant stem from the side effects of Kratom usage.The nasal spray has the power to reverse the effect of opioidsEvaluation of the mitragynine content, levels of toxic metals and the presence of microbes in kratom products purchased in the Western Suburbs of Chicago. Kratom dependence may be formed when the drug is abused regularly for a period of time. Kratom is a “drug of concern” that is not federally controlled by the Drug Enforcement Administration (DEA). Identify common holiday relapse triggers and learn how families can support loved ones in medication-assisted treatment (MAT) by developing a holiday relapse prevention plan. Structure and routine are essential for recovery from substance use disorder. A daily routine in addiction recovery offers stability, lowers stress and prevents relapse. These pills are designed to release slowly, which prevents users from overdosing as easily. The average human is around 80 kg (give or take) — which means the lethal dose of kratom is somewhere in the realm of 4000 grams. This brings the lethal dose equivalent of mitragynine to around 55,323 mg (55 grams) per kg of bodyweight. Kratom has a self-limiting action on its dose, which prevents people from being able to overdose on it. Kratom use during pregnancy can lead to infants showing withdrawal symptoms at birth. These long-term effects can significantly impact an individual’s overall health and quality of life. Prolonged kratom use has been linked to potential liver damage and cognitive decline. Comparative Risk Analysis of Leaf Kratom Brain fog tends to be more pronounced as the kratom wears off. Several factors caused by abuse, such as adrenal fatigue and brain chemical imbalances, can cause chronic brain fog even when you’re not using kratom. Brain fog can also become a persistent and constant problem for some using kratom daily. Indonesia may ban kratom exports. Unintentional fatal intoxications with mitragynine and O-desmethyltramadol from the herbal blend Krypton. Examining the psychoactive differences between kratom strains. Prevalence of kratom use disorder among kratom consumers. We need better estimates of kratom use prevalence. He encouraged other companies who make products with kratom to remove them from the market and have them go through the FDA regulatory process. The discussion about kratom grew louder earlier this year, when Gottlieb announced on Feb. 6 that a computational model produced “stronger evidence of kratom compounds’ opioid properties.” The latter of these concerns culminated in the historical development of April 3, when the FDA issued a mandatory recall for all food products containing powdered kratom manufactured, processed, packed, or held by Triangle Pharmanaturals LLC. The substance has been touted as an alternative approach to pain management. Kratom, a derivative of an Asian evergreen tree, that contains the stimulant mitragynine and narcotic 7-hydroxymitraginine, is used by as many as 5 million people in the United States. NCCIH and the National Institutes of Health (NIH) provide tools to help you understand the basics and terminology of scientific research so you can make well-informed decisions about your health. The Clearinghouse does not provide medical advice, treatment recommendations, or referrals to practitioners. Research on kratom is in its early stages. Traditionally, in Southeast Asia, people have chewed its leaves or made them into a tea that is used to fight fatigue and improve work productivity. Common uses of kratom Rodent studies also demonstrate that prodigious amounts of mitragynine (not ingestible at a human equivalent) may be needed to produce severe and sustained withdrawal effects that rival those produced by classical opioids (Harun et al., 2015; Henningfield et al., 2018). Banning or criminalizing kratom, as six United States have done at the time of this writing, has the potential to create a new illicit market for kratom products, increasing the likelihood of adulteration and the use of dangerous substances as kratom substitutes. Because of its purported analgesic properties, kratom is used to treat pain and, notably, as a means to alleviate opioid withdrawal or as an opioid replacement among people with opioid use disorder (OUD) (Smith and Lawson, 2017; Henningfield et al., 2018; Bath et al., 2020). If you or a loved one suffers from kratom and alcohol abuse, it’s time to consider addiction treatment. Mixing kratom and alcohol can result in adverse mental health effects, addiction, overdose, and even liver damage. Kratom has also been used in SE Asia as a substitute or self-treatment for amphetamines and alcohol (Vicknasingam, et al., 2010; Singh et al., 2021) and in the United States to self-treat alcohol dependence (Smith et al., 2021b). Results of large-scale United States online surveys reveal that pain relief is the most common reason for kratom use (Grundmann, 2017; Pain News Network, 2017; Coe et al., 2019; Garcia-Romeu et al., 2020). While kratom’s longstanding medicinal use in SE Asia applies to a variety of ailments, alleviation of pain is among the most common. Most importantly, ANR is very safe, as it is performed by a team of highly experienced board-certified healthcare professionals in an ICU setting of accredited hospitals. Though the terms “dependence” and “addiction” are often used interchangeably, the main difference between them is that dependence is physical, whereas addiction is largely psychological. Once you develop kratom dependence, you won’t be able to function normally without it. Unfortunately, prolonged alcohol use and abuse may lead to alcohol use disorder (AUD), which can have fatal consequences. Even though alcohol is legal in most countries, it can be very dangerous—especially with excessive or regular consumption. In the case of kava, there have been clinical studies that suggest that kava may be helpful in the treatment of anxiety.No matter the substances, the burdens of substance abuse are great.Doing so could confuse your system and lead to adverse effects.Hope Harbor Wellness, a drug rehab in Atlanta, offers support and assistance 24/7.Taken together, these findings suggest that most use kratom to feel good generally, and not to get “high” (Smith et al., 2024).The lack of regulation and safety standards is a significant factor in determining is kratom dangerous.Kratom use can cause physical dependence, which like with other addictive substances, can also mean increased use over time."By physical dependence, I mean symptoms of tolerance, or using kratom to avoid withdrawal, or experiencing withdrawal if you were to stop taking it," Dr. Smith says. However, research suggests that frequent and regular exposure to the drug can lead to various adverse health impacts that vary in severity. The FDA has also expressed concern about the plant use, saying it’s not just a herb but an opioid, which should be regulated. Due to Kratom legal status in the United States, it’s challenging for many researchers to study the substance. At higher doses, these symptoms are enhanced but may also be accompanied by changes in mental state such as stupor, confusion, and delirium. The Kratom effects on health may differ depending on several important factors. You can take kratom following the toss-and-wash method. Kratom can be made into a drink by mixing the powder form of the plant with water or adding liquid from the kratom plant into a drink. Experts have found that the red type might be stronger than the older form of kratom, which is green. Because of kratom’s potency and lack of research to conclude safe amounts, be sure to consult with your pharmacist or doctor before using it. Because Kratom isn’t a widely regulated or controlled substance, there are no standardized screenings for Kratom use in most medical settings. This allows the addiction to continue unchecked, as both the user and the doctor may be unaware of the real issue. Another reason Kratom addiction is hard to spot is the limited awareness and understanding of Kratom within the medical community. This cycle of reliance, justification, and use can spiral into full-blown addiction without the user even realizing it. However, over time, users can become emotionally dependent on Kratom to get through the day. Other pain conditions people reported treating with kratom included multiple sclerosis, neuropathy, osteoarthritis, inflammatory bowel disease, lupus or other autoimmune diseases, complex regional pain syndrome, Ehlers-Danlos syndrome, trigeminal neuralgia, and cancer.Combining these two substances can also dehydrate you and put stress on your liver, among other unpredictable effects.In lower doses, the kratom plant only offers mild pain relief but activates the central nervous system to make users feel more alert, focused, and energized.In this case as well, however, the authors did not assess the patient’s serum mitragynine or 7-HMG levels.Aside from its potential for abuse, kratom poses numerous others risks to patients, largely a consequence of its status as an unregulated supplement.This doesn’t mean that kratom is entirely without its merits.In case of a suspected kratom overdose, immediate medical intervention is crucial to avert severe health complications. Understanding the balance between kratom’s advantages and its risks is crucial. “Make patients aware that kratom may interfere with their OTC and prescription drugs and that it can be addictive/cause a dependence,” said Grundmann. Increased dosage and frequency of use can escalate health risks, particularly in patients with a prior history of SUDs. FDA has taken steps to limit access and issue warnings, highlighting ongoing health concerns regarding kratom use. In fact, if kratom products were banned from the market, it appears likely that many users would turn to the illicit market that would immediately expand to meet the demand. This does not mean that there actually had been none involving kratom or mitragynines, but certainly the public health signal through this major reporting system was very small and not indicative of a major public health problem. These results can guide regulatory authorities in determining the types of restrictions to access of kratom are justified based on the scientific evidence available; the benefits and risks of allowing continued access to the public; and the types of incentivizing claims and deterring warnings that are appropriate for these products. While these four surveys were convenience surveys, the convergence of findings across the four surveys suggest that together, they all add to our understanding of the effects of kratom and the motivations of its users. Nineteen percent reported experiencing adverse effects resulting from kratom use, though these were mostly mild and were less than 24 h in duration. Safer options that have been medically reviewed exist to address any of the conditions often connected to kratom use, states Dr. Lin. But as of yet, NIDA says researchers haven’t found kratom to be “safe and effective.” On the flip side, there also has been movement in the U.S. to “protect access to kratom” through several bills introduced into Congress. This distinct spectrum of effects, including attenuated euphoria and abuse potential, is supported by two recent preclinical studies, which found that mitragynine is not self-administered by rats (Hemby, McIntosh, Leon, Cutler, & McCurdy, 2018; Yue, Kopajtic, & Katz, 2018). Kratom (or compounds derived therefrom) may, in fact, have even greater therapeutic potential, especially in light of evidence suggesting that it lacks the severe overdose risk of classical opioid drugs, including methadone (Singh et al., 2014, 2015; Singh et al., 2016; Toce et al., 2018). In this context, kratom is analogous to agents such as methadone and buprenorphine, which are widely used as replacement therapies in the treatment of OUD despite the fact that the treatment agents themselves may have significant potential for abuse (Eibl, Morin-Taus, & Marsh, 2016; HHS, 2016; Toce et al., 2018). Another piece of evidence suggesting that kratom may have significant therapeutic potential is that US patents have been issued for companies and individuals who are interested in developing kratom-based drugs (Heyworth, 1964; Takayama, Kitajima, Matsumoto, & Horie, 2008). “People think because it’s natural and legal, it’s safe — but that’s dangerously misleading,” says Dr. Caleb Alexander, professor of epidemiology at Johns Hopkins University. Despite its mind-altering effects, Kratom is not regulated by the FDA, and it remains legal in most U.S. states. In low doses, Kratom acts as a stimulant. Its leaves contain compounds that interact with opioid receptors in the brain. After further questioning, the patient herself noted that she did try over-the-counter kratom from the gas station for the first time that morning, eight capsules (400 milligrams/capsule) and a full bottle of liquid kratom extract (three times the normal strength). At this point, the patient’s husband reported that he noticed her lips turning blue earlier that morning, after which time she quickly became unresponsive, prompting him to bring her to the hospital. However, as soon as the patient was more alert and able to converse, she adamantly denied opioid use. Specifically, patients must be observed for this 24-hour high-risk time period, and if the patient leaves against medical advice (AMA) with a companion despite this medical recommendation, they should be given naloxone with clear instructions in anticipation of rebound symptoms and hypoxia. The Poison Control Center advised that kratom overdose can cause rebound hypoxia hours after ingestion. A news publication of Texas A&M Health, Vital Record offers insight on the latest in health, medicine and scientific discovery from experts across our five schools and numerous centers and institutes. The FDA raised concern about the ease of access to concentrated 7-OH products and their misleading labeling. However, concerns about kratom’s safety prompted Texas lawmakers to propose Senate Bill 1868. In a statement released May 29, the Department of the Army Criminal Investigation Division (CID) warned soldiers about the “dangers of kratom”. One of the most dangerous aspects of kratom use is adulteration from unethical vendors. Millions of users are sharing their experiences and recommendations online. Be patient and wait for the effects to accumulate and start showing up in your body. Liver disease, kidney disease, and heart disease all contraindicate the use of kratom for any reason. Only one human study to date evaluated the pharmacokinetics of mitragynine following oral administration of a traditionally prepared kratom tea in 10 male volunteers (Trakulsrichai et al., 2015). This supports the conclusion that the absorption of mitragynine is influenced by the presence of other kratom leaf compounds. A study using traditionally prepared kratom tea and a hydroalcoholic kratom extract given orally to rats resulted in a cmax of 63.8 and 111.9 ng/ml and tmax of 1.3 and 3.1 h, respectively, while the t1/2 was not determined (Kamble et al., 2021). The same cautions apply to use in combination with other substances. Specifically, mitragynine and 7-hydroxymitragynine have partial affinity for the mu opioid receptor (Kapp et al., 2011; Prozialeck et al., 2012), whereas morphine is a full agonist. One should not mix alcohol with kratom if you are experiencing pain. Even if a person wants to enhance the analgesic properties of kratom by using alcohol with it, there is no supported evidence that this works to manage pain. The risk of developing tolerance and dependence on both substances is imminent with combined use, making it harder to manage pain in the long term. The combination of kratom and alcohol can lead to acute intoxication and mask pain in a way that dulls the body’s natural response to injury or illness, usually expressed as discomfort or pain. Though its legal status and ease of access make it seem harmless, growing concerns about its addictive potential and health risks are now emerging.On the flip side, there also has been movement in the U.S. to “protect access to kratom” through several bills introduced into Congress.The line between casual use and addiction can blur quickly, leaving people unaware of how deep they’ve fallen into reliance on the drug.Many people with major depression and generalized anxiety disorder develop coping strategies to self-control symptoms and assure independent living and job engagement (Houle et al., 2013; Stelzer et al., 2019).At the time of discharge from the ward, the patient reported that he had started regular Kratom consumption again about 2–3 weeks ago.If you or someone you know is using kratom, it's essential to talk to a trusted adult, doctor, or counselor.Adrenal insufficiency and posttraumatic stress disorder (PTSD) were considered both in the differential and potential confounding factors in his presentation. Knowledge about illness and its treatment could also play a significant role in decisionmaking. Their own experience with the medicine also helped participants to assess risks of sharing. Participants reported different strategies that helped them to assess whether it was safe for them to share medicines and these were classified into three sub-themes. Some of them reported sharing their spare medicines (e.g. antibiotics), and they believed that having an oversupply of medicines motivated them to do so. To me I would put that into a more serious; it’s not like an aspirin. He rarely drank alcohol, and he suspected a contribution from kratom. He said he enjoyed trying new drugs, but did not identify as a “psychonaut.” He first purchased kratom in a head shop, but then purchased online. She noted that “the littlest things can make (kratom) not work” and that she must take kratom on an empty stomach to experience effects. Many contend that, instead of supporting patients who self-medicate their addictions with unregulated supplements, we should focus on increasing the availability of approved treatments like buprenorphine and methadone. In 2021, only 22 per cent of Americans with opioid addictions received effective care How can physicians promote patient wellbeing without exerting the disciplinary power characteristic of paternalistic medical systems that has thus far failed to curb overdose deaths from opioids? However, as a result of DSHEA, the FDA lacks a robust infrastructure for reviewing the safety of products and creating clear delineations between indications and risks. Physicians like Woods depend on the FDA to provide information and ‘black box’ warnings of potential serious side-effects to guide clinical decision-making, especially when it comes to off-label supplement use. That means that if you take Kratom, you may have withdrawal symptoms. When it comes to a substance that can cause seizures, comas, depressed breathing, and death, Kratom would have impressive positive effects to be worth taking or to get approved as a therapeutic medication. These side effects can occur whether you’re taking the drug for medicinal reasons or recreationally. To be clear, we’re only reporting side effects or the things Kratom can do that aren’t why most people use it. CBT helps individuals identify the thoughts and behaviors that contribute to substance use, giving them tools to make healthier choices. This helps manage withdrawal symptoms and prevents complications. Treatment begins with a medical detox program, where healthcare professionals monitor patients as their bodies eliminate the substance. Recovering from kratom addiction or overdose often requires professional care. Kratom’s effects vary widely because its active compounds, mitragynine and 7-hydroxymitragynine, are present in different concentrations depending on the product. Like any addiction, when you need to break free from it, then your body will go through withdrawal. Most users of kratom use it as a way to reduce their anxiety. Unfortunately, the addict may turn to kratom as a new addiction instead. Some individuals even claim that kratom can help symptoms of diabetes. What began as a way to help them relieve their anxiety can quickly turn into a full-blown opioid addiction. More research on humans is needed to see if kratom has similar effects. Early studies suggest that kratom may have potential as an antidepressant and a hunger suppressant. Although kratom targets opioid receptors just like morphine and codeine do, it is considered an atypical opioid. One compound found in kratom, 7-hydroxymitragynine, is 13 times more potent than morphine. Kratom is a substance originating from a tree native to Southeast Asia, the Mitragyna speciosa. In June, the FDA issued warning letters to seven companies for illegally distributing products containing 7-OH, including tablets, gummies, drink mixes and shots. The FDA has also published educational materials for consumers to be more informed about these harmful products. The FDA is particularly concerned with the growing market of 7-OH products that may be especially appealing to children and teenagers, such as fruit-flavored gummies and ice cream cones. It is technically possible to overdose on kratom, but you are not at risk for any severe consequences unless you combine it with something else. Opiate withdrawal, for example, can cause seizures, dehydration, and heart failure in extreme cases. Eventually, the symptoms start to subside, and you feel more energized with each passing day. Stay informed, prioritize your health, and never hesitate to seek professional advice when in doubt. However, it is crucial to consult with a healthcare professional before considering its use, especially if you have pre-existing medical conditions or are taking medications. This doesn’t mean that kratom is entirely without its merits. These effects may range from digestive issues, such as nausea and vomiting, to more severe conditions like liver damage. Kratom-induced sickness can manifest in varying degrees, ranging from mild gastrointestinal discomfort to more severe symptoms such as nausea, vomiting, and liver toxicity. This herbal substance is currently considered a “drug of concern” by the Drug Enforcement Administration (DEA), which initially was to classify the extract as a Schedule I drug, but the classification was postponed . It behaves as a stimulant at low doses, opioid-like at moderate doses, and sedative at high doses 6-9. On further questioning, she endorsed using an herbal supplement, Kratom, for several years to aid with her opioid abuse and withdrawal. She reported the onset of symptoms after biliary stent removal and also endorsed lethargy, poor appetite, non-bilious vomiting, and watery diarrhea. He denied any inciting event and reported the pain had been constant since onset. For regular kratom users, loss of weight, tiredness, constipation and hyperpigmentation of the cheek may be notable negative effects of kratom. Most published studies of kratom addiction are case reports of heavy, compulsive users. The opioid-like analgesic effects are the main reason for possible addiction. There have also been documented “kratom hangovers,” where symptoms of a more traditional alcoholic hangover are present. It remains an unregulated substance with documented health dangers. While there is no doubt that kratom has several benefits and is generally very safe, it is vital to be aware of possible side effects before taking it. Red vein kratom powder can be a powerful tool for fighting pain or insomnia. Knowing your kratom strains is another crucial factor in avoiding side effects, as each has different properties. Short-Term Effects # Perhaps most concerning are the potential changes in brain structure and function observed in some studies. It’s like kratom is whispering in your ear, “Go on, do it! Some users report increased risk-taking behavior or difficulty making sound judgments. Decision-making and impulse control are other areas where kratom might be leaving its mark. Finally, the observational literature indicates that people consistently report the utility of kratom for pain relief, and this is corroborated by the only clinical trial to examine kratom and analgesia in humans. Assessment of patient values and goals can lead to rich, meaningful discussions of the potential risks and benefits of a number of treatments and can contribute to trust, and thus effectiveness, in the clinician-provider relationship. For people without histories of opioid dependence, however, switching from kratom to buprenorphine or methadone should be considered judiciously on a patient-by-patient basis. Regardless, we do not recommend routine screening for illicit substances without consideration of the potential impact on patient-provider trust, which may be necessary for honesty and positive outcomes. Embedding questions about the use of “herbal medicines, like Valerian root or kratom” in an assessment of pharmaceuticals and supplements acknowledges kratom’s place among other treatments that people choose to use. And in the past few years, many companies have started selling kratom vapes and kratom vape juice. The simple answers to the questions “can you vape kratom? It’s important to know that companies are selling these kratom vapes despite the fact that no one has thoroughly tested them for safety or effectiveness. This makes it critical for individuals to understand that legal status does not always mean a substance is safe. One of the most misleading aspects of kratom use is the false sense of security that comes from its legal availability. An overdose on kratom can indeed be a serious, potentially life-threatening event. The United States is currently contemplating classifying kratom as an illegal substance, largely because of the fatalities linked to its use. As with any supplement or drug, moderation and understanding of one’s own tolerance levels are key to minimizing potential negative impacts. Often, kratom products are not adequately labeled with ingredients or dosage instructions, which can lead to unintentional overconsumption. It delves into the key aspects of kratom overdose, covering its signs, symptoms, risk factors, and other critical information to be aware of. However, urine toxicology results were negative, and it was later revealed that high-dose kratom had recently been ingested. There is limited literature on kratom toxicity and its clinical presentation, and thus, it is easily missed in the emergency department (ED) differential diagnosis. The Drug Enforcement Administration lists kratom as a Drug and Chemical of Concern . It is important for emergency medicine practitioners to be aware of kratom overdose as a possible item on the differential diagnosis. We report a case of a female in her 40s presenting with signs of hypoxia reversed with naloxone administration, initially suspected to be a case of opioid overdose. Several studies have highlighted kratom’s potential to cause cognitive impairment and alter brain function. While the jury is still out on many aspects of kratom’s effects on the brain, the scientific community is working overtime to unravel this herbal enigma. And let’s not forget about interactions with other substances. Adverse effects upon taking “too much” kratom varied, but the interviews converge upon the point that a person can consume enough kratom to make them uncomfortable at a minimum, though among these and other users, not alarmed enough to seek medical treatment (Garcia-Romeu et al., 2020). It’s not as high, but it’s also not as low…I always wanted more opioids; with kratom, if I take too much, ugh, it gives me kind of a ‘blah’ feeling, it’s kind of a negative return on investment, I guess you’d say. Participant 7 is a 52-year-old male who learned about kratom from a friend who had chronic pain and who had a daughter “battling a heroin addiction” who had used kratom to attenuate heroin withdrawal. Participant 1 is a 60-year-old female who learned about kratom online when searching for alternatives to opioids for cancer-related pain. Regular kratom consumption leads to an opioid-like syndrome called kratom use disorder, where withdrawal symptoms occur when decreasing or discontinuing use for a day or more. “We do need desperately for something to be as efficacious (as opioids) in pain treatment, but hopefully without the liabilities. 7-hydroxymitragynine is the principal source of kratom’s opioid-like addiction and overdose risk. Participants reported a range of benefits and these were categorised into two sub-themes. Participants also reported sharing homeopathic preparations which were sometimes recommended by their GP. The interpretation of findings was guided by a ‘harm reduction’ philosophy focusing on minimising the risks/harms of sharing without necessarily considering it essential to eliminate sharing practices. Therefore, the information may help healthcare providers to identify and address problems related to medicine sharing. Without regulation, 7-OH could contribute to the ongoing opioid crisis. He emphasized the need for regulation and public education to avert another wave of the opioid epidemic. “7-OH is an opioid that can be more potent than morphine,” said Marty Makary, MD, FDA commissioner, in an FDA news release. A number of educational institutions offer CPE for pharmacists to understand kratom and counsel patients on its use,” said Grundmann. For these communities, kratom wasn't necessarily a recreational drug; it was a part of their daily life and was often used as a pain remedy. However, kratom is still relatively new to Western countries, and various drug agencies are wary of its potential for abuse and harm. Only those who have experienced kratom’s effects and know how their bodies will react should experiment with higher doses. However, treatment with opioids such as buprenorphine and methadone should be judicious and possibly limited to kratom users with histories of opioid use so as not to establish opioid tolerance, physical dependence, and possibly a new use disorder in people who do not have a current or past OUD (Smith et al., 2022c). Research shows that the majority of adverse effects, hospitalizations, and overdoses related to kratom involve other substances of abuse as well. While mixing kratom and alcohol is not illegal, combining these two substances can lead to trouble breathing and other serious health complications. However, this exploratory study only examined the acute effects of kratom at self-selected servings among a small sample of long-term kratom consumers, not kratom-naïve individuals. Papsun et al. (2023) reported detectable blood MG concentrations in 127 impaired driving investigations; however, there is presently no accepted basis for determining what blood mitragynine concentrations produce impairment. The authors are not aware of publications indicating that kratom contributes to violent behavior or serious crime related to its effects on behavior, distribution, or marketing. However, as summarized by Smith et al. (2024), even among kratom consumers who had indicators of KUD or withdrawal, it was not accompanied by social or functional impairment, hazardous use, or use despite adverse consequences (Smith et al., 2024). Taken together, (e.g., Grundmann, 2017; Garcia-Romeu et al., 2020), these findings and those from a recent EMA study indicate that some users with KUD may experience withdrawal (Smith et al., 2024). In the codebook, we combined “addiction” and “dependence” into a single code of “professed physical dependence/addiction,” though we hasten to acknowledge that they are separate constructs in clinical nosology (see footnote 1). In terms of reddit communities that these posts originated from, 177 (47.8%) were from kratom subreddits dedicated to general discussion, 96 (25.9%) were from kratom subreddits dedicated to discussing negative kratom experiences, and 197 (53.2%) were from communities dedicated to topics other than kratom. Posts left uncoded, while containing at least one kratom-related search term, did not contain text related to any codebook theme. Themes were identified at the first level (in bold text) and then further specified at the second level (e.g., Dependence/Addiction as level 1, specific mentions of withdrawal and tolerance as level 2 specifiers). While traditional kratom leaf has been used for opioid withdrawal and pain management, the emergence of concentrated 7-hydroxymitragynine (7-OH) and mitragynine pseudoindoxyl products represents a significant shift in potency and risk profile. Patients with polydrug, opioid, and alcohol use histories have used kratom to self-manage substance use disorder (SUD) symptoms. And we see that kratom could be something promising in that area,” says Dr. McCurdy of the University of Florida.While traditional kratom leaf has been used for opioid withdrawal and pain management, the emergence of concentrated 7-hydroxymitragynine (7-OH) and mitragynine pseudoindoxyl products represents a significant shift in potency and risk profile. There are also reports of potential hepatic toxicity risks at higher kratom doses (e.g., Gurley et al., 2022); however, the contribution of the well-established hepatic toxins acetaminophen and alcohol that may have been heavily used in persons who use kratom to manage pain and SUDs needs to be disentangled. By enhancing the release of these neurotransmitters, kratom can increase focus, energy levels, and a sense of well-being. Kratom’s effects on the body and brain are complex and primarily arise from its interaction with various neurotransmitter systems. Despite these widespread reports of benefits, it is important to note that the FDA has not approved kratom for any medical use, and its efficacy and safety for these conditions have not been confirmed in controlled clinical trials. The calming effects can decrease inhibitions similarly to mild sedatives, allowing individuals to feel more comfortable in social situations. If you have been purchasing kratom for a while, you probably have a favorite vendor already. Dealing with a kratom-related injury or losing a loved one to this dangerous supplement can leave you feeling overwhelmed and unsure where to turn. Take the immediate steps to protect your case, including preserving evidence, such as receipts proving purchase and kratom packaging. When you combine that with the fact that every kratom case needs similar medical and scientific expert testimony, coordinated litigation makes sense. He also recommends talking to your healthcare provider if you take medication for a chronic condition, to make sure kratom is safe. “For anyone who wants to engage with kratom, definitely make sure you’re choosing products that have labels on them that actually tell you what’s in it,” says Dr. Grundmann. Drug interactions are one of the greatest risks for those taking kratom. “There don’t seem to be long-term effects that last beyond the intake of kratom.” Grundmann says taking kratom leaves in capsule or tea form is self-limiting “because you can only ingest so much before nausea, and potentially vomiting, sets in,” he says. His urine drug screening was positive for cannabinoids, tricyclic antidepressants, and oxycodone. Pathological study identified a drug-induced cholestatic injury, a canalicular cholestasis (29). On day 8, he developed intense abdominal pain concomitant with brown discoloration of the urine (29). However, you don’t need a prescription for kratom — it’s legal and easy to purchase.This narrative review highlighted the pressing need for continued research regardingkratom use patterns in the U.S., the medicinal potential of this herb, and treatmentconsiderations—when kratom is used individually or concurrently with othersubstances.Despite the ongoing research on kratom, there are still many unanswered questions.Jarka C, Gregoire K. Precipitated withdrawal with kratom use following naltrexone administration.Kratom is natural supplement, which is derived from a plant native to Southeast Asia, which has grown in popularity in the United States, for its potential to ease pain, reduce anxiety and boost energy.This emotional reliance often leads to more frequent use, and as their tolerance grows, users need higher doses to achieve the same effects.Research shows that regular use leads to physical dependence, with users experiencing withdrawal symptoms when they try to stop.In the evaluation of physical dependence and withdrawal potential, four studies showed MG did not carry morphine-like physical dependence or withdrawal potential (Harun et al., 2020; Hassan et al., 2020; Wilson et al., 2020; Johari et al., 2021).Many users rave about the effects and purity. These strategies are helpful when searching for a disposable kratom vape, but also apply other kratom formulations as well. Crushed leaf tea bags, low-concentration extracts, or tinctures are popular liquid kratom options that can provide a more moderate, controlled experience. If you’re interested in vaping kratom because you’re tired of consuming powder, there are still options for you. Moreover, a 2020 review of the effects of vaping and smoking cigarettes observed that “vaping nicotine has been found to cause similar effects as smoking on lung function and cardiovascular function.” They don’t always reference particular brands/products, and the ingredients on the label may not match what a brand actually puts in their e-liquid. Seeking Medical Advice Nonetheless, some people do consume kratom for purposes of getting “high,” “intoxicated,” or “wasted” as self-reported on various websites and the incidence as discussed in Section 2.5.1. As confirmed by NFLIS, kratom is available to persons who have been found with substances of abuse, yet kratom has not emerged as a substance of abuse by any of the federal surveillance systems. Nearly two million analyses of drugs and other substances are tested annually from more than one million distinct drug cases. Harm reduction techniques, such as responsible use, minimizing potential negative effects, and considering dosage and frequency, should be considered for safe usage. It is equally important to mention the potential long-term effects and the impacts of regular Kratom consumption. Kratom, a natural substance that is gaining popularity for its potential benefits, has become a subject of interest. Harven M. Herbal drug kratom faces uncertain legal future, despite public outpouring. Prevalence and motivations for kratom use in a sample of substance users enrolled in a residential treatment program. “Absence of withdrawal symptoms upon discontinuation of daily kratom use in three formulations in a controlled clinical study,” in College on problems of drug dependence 84th annual scientific meeting. We note that the FDA has recommended development of new drug applications for potential kratom-derived products, including by its botanical drug development pathway. In fact, kratom-related fatalities were reported in SEA, though the role of co-ingested substances, and the failure to quantify MG, as in United States cases, makes discerning causality practically impossible (Davidson et al., 2021; Weiss and Brent, 2023). Similarly, seizures were also reported in some kratom users, and it is possible that the stimulant effects of kratom might reduce seizure threshold; however, these reports are rare. (The agency started the process to criminalize possession of kratom in 2016 but withdrew the plan following public comment.) Kratom is viewed as a “drug of concern” by the U.S. Globally, kratom is illegal or restricted in more than a dozen countries, including parts of Europe, Japan and Russia. Some individual cities and counties have adopted kratom bans, too. Six states in the U.S. ban kratom, while 16 other states have regulations restricting access, requiring warnings or limiting the strength of the compounds. Consuming the leaves can result in medicinal effects, like uplifted moods and pain relief. The leaves contain psychoactive opioid compounds that mimic opioids and opiates. For years, Asian countries have relied on the medicinal effects of kratom, otherwise known as Mitragyna speciose korth. Kratom produces a high similar to that of opioids and opiates, and can be incredibly dangerous. This guide highlights the potential dangers of mixing kratom with alcohol. The CDC reported 85 different DNA fingerprints of Salmonella bacteria were identified in samples of kratom products. The CDC declared the 17-month outbreak over in May, but said additional illnesses are possible because people likely have unused portions of the kratom products in their homes. Medications changed by the liver (Cytochrome P450 2D6 (CYP2D substrates) interacts with Kratom Kratom use can lead to tachycardia and hypertension, which are significant cardiovascular effects. Recognizing neurological and psychiatric effects is vital for taking appropriate measures and seeking medical help when necessary. Additionally, some users have experienced severe mood alterations, including anxiety and depression. The internet contains a vast amount of misinformation, but when it comes to your health only peer reviewed, research centered data matters. If you’re ready to overcome Kratom addiction and see what life without addiction can look like, Ocean Recovery is here to help you. These are big decisions, and it’s important to ensure you’re ready to commit to whatever option you choose. It’s also okay if you need to get more information about different treatment options before you make a decision or are willing to commit to a specific treatment. Common side effects of kratom include nausea, constipation, dizziness, drowsiness, itching and mild respiratory depression. Although kratom is not currently federally classified as a controlled substance, it can lead to dependence, and the FDA considers it a substance of concern. Its leaves contain the alkaloids mitragynine and 7-OH, which primarily act on the brain’s mu-opioid and kappa-opioid receptors. Many states like Indiana, Rhode Island, Alabama, and Wisconsin have classified it as a controlled substance and limited its use in products. Federal agencies have taken strict actions against the manufacturing of Kratom and other mitragynine products. Notably, officials in Thailand have thrice considered ending their kratom ban since 2000, citing no known cases of overdose, death, or violence following at least 100 years of traditional use. With regard to international regulatory agencies, neither kratom, nor any of its alkaloids, are currently listed in the 1961 and 1971 Schedules of the United Nations Drug Conventions, although kratom has been criminalized in Thailand, Malaysia, Myanmar, and Australia, as well as several European nations. As of this writing, kratom remains legal throughout most of the US, although a few states, including Alabama, Arkansas, Indiana, Vermont, and Wisconsin, have banned it. In response to the intense public outcry, the DEA withdrew its notice of intent to schedule kratom and has placed the final decision on indefinite hold pending an 8-factor analysis by the US FDA (DEA, 2016b, 2016c; Kroll, 2016; Prozialeck, 2016). Users often report short-term side effects, such as increased alertness or sedation, depending on the dose. Such research is critical to developing a comprehensive understanding of kratom’s pharmacology and toxicology. Institutions like the National Institute on Drug Abuse (NIDA) have funded studies to explore how kratom affects the brain and whether it has a viable medical use. For instance, kratom is banned in countries like Australia, Thailand, and several European countries. As research continues, a clearer picture of how kratom works will help guide safer use and inform regulatory and therapeutic strategies. “A provider can help manage and treat symptoms or address opioid use disorder if needed, and recommend safer, more effective alternatives.” “My recommendation is to avoid kratom due to the inconsistency of products and instead seek medical care,” Alonzo said. Right now, the future of kratom is at a crossroads in Texas and across the United States, caught between public health caution and consumer demand. We will also touch on the regulatory framework that governs the permissible amount of mitragynine usage in medicine and the consequences of non-compliance. This article covers how kratom poisoning can be fatal in some cases. Kratom is a herbal supplement that is popular for its psychotropic and opioid-like activity. Alternative medicine supplements have become the second most common cause of drug-induced liver injury (DILI) in the US. Some of the adverse reactions reported by participants are potentially life threatening. Language, cultural barriers and a lack of information about the healthcare system were reported to be contributing factors to poor access to health services and medicine sharing practices amongst immigrants in New Zealand and elsewhere . Instead, they weighed up the risks and benefits of sharing particular medicines primarily based on their previous illness experiences and symptoms matching. I assumed that he didn’t have any sort of particular allergies or something towards the chemical but I think it’s not up to the person who’s offering the medicine to diagnose the other person and give him the right drugs. However, most participants were unaware of the potential risks of topical antimicrobials and were willing to share them. For inspiration, we turnedto known chemical transformations of indole alkaloids, including mitragynine,under oxidative conditions. (A) Mitragynine was unstable in both MLMand HLM, while deuteration of all three methyl groups, as in mitragynine-d9, had little effect on microsomal stability.(B) Loss of mitragynine in microsomal preparations was accompaniedby formation of 7-OH as a metabolite, and this conversion was moreefficient in HLM. Decomposition of mitragynineand formation of 7-OH in liver microsomeswas quantified by LC-MS/MS. Surprisingly, whenwe examined the stability of mitragynine-d9 head-to-head with its undeuterated counterpart in human liver microsomes(HLM) and mouse liver microsomes (MLM), stability was unchanged (Figure 2A). Both methanolic and crude alkaloid extracts of kratom havealsodemonstrated analgesic properties in rodents.1 However, it currently remains unsettled which of kratom’salkaloids are the most important contributors to the analgesic propertiesof such preparations or to those of the raw leaf. By following these best practices, kratom users can enjoy the benefits of this herbal supplement while minimizing risks. Starting with low doses and gradually increasing them, while keeping a detailed log of kratom use, can help mitigate risks and ensure a safer experience. Until more is known, kratom users should approach new kratom products with caution, seek out reputable sources, and stay informed about the latest research. Despite the increasing use of kratom for conditions like opioid use disorder and chronic pain, there are still significant gaps in our scientific understanding of this herbal supplement. The growing number of poison control calls underscores the urgency of addressing is kratom dangerous. The lack of regulation and safety standards is a significant factor in determining is kratom dangerous. This means that the quality and safety of kratom, sold anywhere from gas stations to vitamin shops, cannot be guaranteed. The FDA discourages the use of kratom as its production and distribution as a food is not regulated. Still, research says the opposite is true, citing an increased risk of suicidal thoughts and behaviors in long-term Kratom users. Typical withdrawal symptoms include hostility, aggression, excessive tearing, inability to work, aching of muscle or bones, and jerky limb movements. There have not been laboratory studies of physical or psychological dependence or abuse potential in humans caused by kratom. These reports as summarized by the FDA document seem to agree with the general finding that these deaths were not solely attributable to kratom and generally leave the potential role of kratom unclear (see also Wing 2017). Although there has been little systematic study of the pharmacodynamic effects of kratom, there is little clinical or scientific evidence of respiratory depression, and this would be consistent with the absence of documented overdose deaths attributable to kratom.