Kratom is a widely available, non-FDA-approved substance derived from the leaves of a tropical tree of Southeast Asia (Mitragyna speciosa). At low doses, kratom can increase energy and alertness; at higher doses, individuals report taking it to manage pain, opioid withdrawal, and anxiety. Although it is not an opioid, kratom interacts with opioid receptors, which helps explain its use and some of its clinical effects. However, these effects are not fully understood, and there are potential safety and health concerns. Policymakers could consider approaches that expand access to treatment for kratom use disorder, regulate product potency and labeling, support data collection and monitoring, and address public health risks as evidence continues to develop.

Kratom Use

Use of kratom in the United States is widespread and varied, with individuals reporting a range of motivations and access points.

• National estimates suggest 1–6 million people in the U.S. have tried kratom, though true prevalence is uncertain and likely underestimated due to limited data and inconsistent screening.
• People report using kratom for a range of reasons, including energy, alertness, pain relief, sedation/anxiety relief, and to manage opioid withdrawal symptoms.
  • Use appears most common among people who currently use or previously used opioids.
• Kratom is easy to obtain and most commonly purchased online, at smoke shops, gas stations, and some bars.
• Kratom is sold as dried leaf, powder, capsules, teas, and increasingly as high-potency extracts and edibles, which carry higher risk due to higher potency.

Health Effects and Risks

Kratom use is associated with both potential benefits and known risks, which vary based on dose, product type, and co-use with other substances.

Potential Benefits

• People who often use kratom at low doses report temporary benefits (e.g., improved daily functioning, mild euphoria, increased energy, and mood enhancement).
• Some evidence suggests kratom may reduce pain and opioid withdrawal symptoms.
• Some people who use kratom report reduced use of other substances.

Known Risks

• Common side effects include nausea, constipation, dizziness, agitation, and increased heart rate.
• Serious harms have been reported, although are uncommon (e.g., seizures, liver toxicity, heart rhythm problems, and respiratory depression).
  • Risks increase at higher doses/concentrations and if used with other substances (e.g., opioids, alcohol). Kratom may interact with such prescribed and non-prescribed medications, which may cause harm.
  • Addiction to kratom/kratom use disorder may also occur, though it may be less severe than other use disorders. Medications for opioid use disorder are also effective for kratom use disorder (e.g., buprenorphine).
• Unregulated products raise concerns about contamination (e.g., heavy metals, bacteria), mislabeling, and inconsistent potency.
• 7-hydroxymitragynine (7-OH), a compound present at low levels in kratom, is increasingly sold as a stand-alone, higher-potency product associated with greater risks of serious harm, including overdose.

Policy Options

As kratom and 7-OH products continue to evolve, policy approaches can help address differences in risk, improve product safety, and strengthen health system responses.

Distinguish between product types based on potency.

• Evidence indicates differences in risk between traditional kratom products and newer high-potency products, such as concentrated extracts and stand-alone 7-OH.
• Policy approaches could differentiate between product types rather than treating all kratom-related products the same.

Address product quality and consistency.

• Address issues through regulation to decrease variability across products, such as:
  • More accurate labeling of warnings of potential risks and suggested directions of use.
  • Regulating product strength to minimize potential health risks associated with use and increase transparency.
  • Regulating production to decrease potential contamination by other harmful substances.
• Improve systems to collect data on use, health effects, and overdose involvement. This could include strengthening toxicology testing, surveillance, and reporting related to kratom and 7-OH.

Support health care and treatment system awareness.

• Support health care and substance use disorder treatment providers in identifying kratom and 7-OH use, understanding potential risks, and responding to dependence or withdrawal using existing evidence-based treatments.
  • For patients who use kratom regularly and are experiencing pain in medical settings (e.g., after surgery, following birth), pain tolerance may be higher, meaning patients may need higher doses of medication to treat pain.
• Reduce barriers to evidence-based medication treatment (e.g., buprenorphine and methadone, expanding access through telehealth and take-home dosing).
• Support individuals who use kratom during pregnancy or who have a kratom use disorder by providing medications for opioid use disorder during and after pregnancy. Neonates who experience withdrawal symptoms should receive evidence-based care using the eat, sleep, console approach and pharmacological treatment when necessary.

Facilitate overdose prevention strategies.

• Support the co-distribution of naloxone alongside kratom.
• Require public health information to be provided alongside kratom products, including risks of contamination (e.g., heavy metals, bacteria), risks of co-use with medications and other substances, potential for addiction, and overdose risk.