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The MEDTOX DAR Hotline has experienced a surge in inquiries about Kratom abuse. The DARS Journal has previously reported on the emergence of this drug as an abused substance. Kratom is a medicinal plant that is grown and harvested in Southeast Asia. Thailand and Malaysia are principle sources for this drug; Bali is the genesis for the most potent Kratom in the world. Processed like marijuana, Kratom leaves are plucked and then dried before being prepared as a powder or oily resin. Kratom crushed leaves or powder can be prepared as a tea or warm beverage, or can also be in capsule form. The drug can be sour tasting, and as a result, Kratom tea drinkers must add flavoring to the beverage to offset the bitterness. The effects of Kratom are dose dependent; with 3 to 5 grams of crushed Kratom leaf (or ½ teaspoon of Kratom 15X powdered extract) needed to get high. Some Kratom users choose to smoke the crushed leaf material in a hand-rolled cigarette. Burning Kratom smells similar to burning marijuana. A Kratom high will last some 2-3 hours with the euphoric effects coming in waves. The initial effects from Kratom are exhilarating and motivational; a later phase is more sedating and relaxing. The drug has qualities as a social lubricant. Some users cite Kratom as having aphrodisiac powers as well.

Kratom's biochemistry is unique. As a member of the Mitragyna plant family, Kratom is believed to exert its effects through interaction with delta and mu opiate receptor sites. To that extent, Kratom displays pharmacological similarities to Salvia divinorum, but the ultimate psychoactive effects are noticeably different. Mitragynineis the major alkaloid found in Kratom, 7- hydroxymitragynine is a minor alkaloid in Kratom that exhibits opiate-like analgesic effects that are similar or greater than morphine. The effects described as relaxing, anxiety reducing, and euphoric are most likely attributable to Kratom's activity at the delta and mu opiate receptors. In fact, there are anecdotal reports from many users that Kratom is an effective therapy for treating the symptoms of opiate withdrawal. Many users have successfully weaned themselves off of prescription opiates through the use of Kratom. It stands to reason however that if Kratom is effective in ameliorating the effects of opiate withdrawal, then it is likely to cause opiate dependency if it is used over an extended period of time. Although there have been sporadic reports of users who have developed Kratom addictions, it is unclear whether or not true opioid mediated dependencies have occurred.

For DAR and DRE trained readers, symptoms of Kratom intoxication include the following:

  • Pulse- near normal
  • Blood pressure- near normal
  • Body temperature- near normal
  • Romberg internal clock- distorted
  • Pupil size- near normal (constriction in high doses)
  • Pupil reaction to light- slow        

Kratom's effect on pupil size is difficult to gauge. In lower doses of 1-3 grams there appears to be little impact on pupil size. But when the dose of the drug reaches 5 or more grams, it is possible for there to be a noticeable slowing of the pupil's reaction to direct light. These effects are probably attributable to Kratom's interaction with delta and mu opiate receptor sites.

Like Salvia divinorum, Kratom is considered a dietary supplement. It is not a controlled substance; it is legal to possess. Head shops and Internet Kratom stores are experiencing brisk sales of its various Kratom products. Kratom is exhibitive of an emerging trend that transcends methods of modern toxicological monitoring. Kratom has been around for nearly 10 years, but only in the last year or two has it attracted widespread attention. With the emergence of K2 and Spice, bath salts, and plant food as drugs of abuse, Kratom's popularity has surged. And because it is viewed as a legal, safer alternative to other more caustic designer drugs, Kratom use will continue to grow and spread.

People are flocking to Florida bars for a legal but dangerous drug

Kratom is being sold legally in bars in Florida and other states, where some people are reportedly using it to wean themselves off their heroin addiction. But as a recent New York Times story reports, the drug may be addictive itself, and could lead to a relapse with heroin, which is cheaper and more potent.

Kratom is a psychoactive drug derived from the leaves of the kratom plant (Mitragyna speciosa) that has been widely used in Southeast Asia especially Thailand, where it is now banned as a recreational drug. But it has recently become popular in the West for its supposed medicinal purposes. 

The drug is known for its sedative effects, but in low doses, it also acts as a stimulant. Reports of kratom's effects vary, but some users report feelings of stimulation, euphoria, sedation, pain relief, and a lasting "glow." At higher doses, some people report dizziness, nausea, and vomiting. And because it's believed to work on the brain similarly to heroin, some people have been self-administering it as a treatment for treatment for heroin addiction.

The Times reports that a growing number of bars in South Florida have started selling the drug as a tea in containers that resemble juice bottles. Powdered forms of the leaf are also available at shops that sell drug paraphernalia and at convenience stores, as well as online. Kratom is also sold in Colorado, New York, and North Carolina.

The FDA doesn't regulate kratom as a drug because it's marketed as a dietary supplement. However, the agency did ban imports of the herb in 2014 over concerns that it was unsafe and possibly toxic.

According to the Times, the drug has been banned by several states, including Indiana, Tennessee, Vermont and Wyoming; meanwhile, Florida and New Jersey are waiting to pass bills until more is known about it.

The legal status of Kratom is currently up in the air in Florida and the rest of the United States. While this medicinal plant is presently legal in the state of Florida, legislators are eyeing a ban that could make the alkaloids in the Kratom plant illegal to sell or use. There is already one county in the state that has passed such a ban and others may soon line up to do the same. Should Kratom use be legal? Can you still buy this herb if you live in Miami, Orlando, Tampa, Jacksonville or other major cities in Florida?

How Kratom affects the brain

Like heroin, kratom belongs to a class of pain-relieving drugs called opioids, which are found naturally in the opium poppy plant and act on opioid systems in the brain. These systems play key roles in modulating how we respond to pain.

Kratom's main psychoactive ingredient is a compound in its leaves called mitragynine, which is thought to act on these receptors in a way that is similar to the powerful pain reliever morphine, Oliver Grundmann, an associate professor at the University of Florida's College of Pharmacy, told Business Insider.

"We don't know directly the potency of mitragynine," Grundmann said, but "it's supposed to be less potent than morphine." While there haven't been any reported fatalities directly linked to kratom use, there was the case of a young man in South Florida who was reportedly addicted to the drug when he died of a car crash. Broward County has taken the first steps towards banning the herbal drug called kratom, that is found in head shops and at kava bars, the designer drug comes from a tree in Southeast Asia and produces both a stimulant and sedative effect. Some say it can become addictive as heroin. Grundmann and other experts warned of the drug's addictive qualities, and don't recommend it as a treatment for opioid addiction.

Treating opioid addiction with opioids

Opioid addiction is commonly treated using other opioids — for example, the drug methadone, an opioid used to treat pain, is sometimes used to treat heroin addiction. But these drugs are of pharmaceutical quality, and have been approved for clinical use.

Kratom, on the other hand, has not been approved for treating opioid addiction. And like all opioids, kratom is potentially addictive itself. Though we don't have as much experience with kratom, it's probably not as addictive as heroin or prescription opioids like morphine, Nelson said. An opioid's effects depend on how quickly it builds up in the brain, as well as how strongly it binds to and stimulates opioid receptors, and kratom takes a far higher dosage to reach the same level of euphoria as something like heroin, he said.

But given that we don't know the dosage or fully understand its effects, "it's probably not an appropriate therapy [for heroin addiction] at this point," Lewis Nelson, head of toxicology at NYU Langone Medical Center, told Business Insider.

However, some say we shouldn't rule out the drug's medical use. Marc Swogger, an assistant professor of psychiatry at the University of Rochester Medical Center, told Business Insider in an email that we should consider its therapeutic potential instead of waging war on it like many other drugs. But he wouldn't recommend using it yet, because its effects haven't been studied in a controlled and thorough way, with medical supervision.

For now, people trying to recover from addiction should probably stick to traditional treatments, said Nelson.

"If anybody does think they have a problem with opioids, they should seek proper therapy," Nelson said. Self-medicating with kratom "is not a safe thing to do, nor is it probably effective."

Kratom Abuse, Treatment and Withdrawal

Kratom is a mind-altering substance that comes from the Mitragyna speciosa tree, which is indigenous to Southeast Asia.

The leaves and stems are dried and either chewed or brewed into tea for stimulant effects at low doses and opioid-like effects at higher doses, the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) reports. Kratom is particularly popular in Thailand where it is sometimes mixed with iced-down caffeinated soda or codeine-containing cough syrup into a drink called 4×100 for its alcohol-like effects.

Kratom can cause euphoria, or a “high,” within 5-10 minutes of ingestion, the DEA reports, and that high may last for 2-5 hours. The active ingredient in kratom, mitragynine, increases energy and alertness at low doses and has sedative and pain-blocking effects when more of the substance is taken.

In the United States, kratom is not a controlled substance by the Drug Enforcement Administration (DEA), although it is listed as a “drug of concern.” Bars in Florida are selling kratom for recreational use in the form of a drinkable tea. The drug may also be purchased in bars or stores in New York, Colorado, and North Carolina, although it is likely more commonly obtained online, Business insider reports. Recent trends in America, which may indicate a rise in kratom abuse, have caused four states – Wyoming, Indiana, Tennessee, and Vermont – to ban kratom, USA Today publishes.

Some people claim that kratom is useful in helping to kick a heroin addiction; however, this claim is greatly disputed by experts. In addition to potential negative side effects like suppressed respiration, nausea, vomiting, itching, constipation, and loss of appetite, kratom may also lead to dependence and addiction much like opioid drugs themselves do, Fox News states.

Kratom may be marketed and sold as a dietary supplement. In 2014, the U.S. Food and Drug Administration (FDA) issued an import alert on the substance. In January 2016, the FDA placed a ban on imports of products containing kratom, detaining one marketed as RelaKzpro. The FDA decided that kratom does not have any legitimate use as a dietary supplement and banned products claiming otherwise from being imported into the United States. In addition, the FDA placed businesses selling known kratom-containing products onto a RED LIST, allowing blanket seizure of any form of kratom, including capsules, resins, leaves, and liquids containing the leaves.Understanding Kratom Abuse. Kratom may be abused as a “legal” way of getting high and may therefore appeal to individuals who deem it safer than illicit drugs, such as younger adults and teens. Bars may sell kratom in powdered form or mixed into a drink. Kratom is also known by slang names, such as Thom, Ketum, Biak, Kakuam, and Thang. Kratom may not be detectable on drug tests either, even though it may behave much like other narcotics. Its abuse has been banned in Thailand for years, The New York Times reports.

Since this drug is relatively new on the recreational drug scene in the United States, its full mechanism may not be completely understood yet, although the general consensus is that it does have psychoactive effects and can lead to dependence and addiction.

When Abuse Becomes Addiction

Dependence and addiction are closely linked, but they are not actually the same thing. A dependence on a drug is when physical changes are made to brain chemistry due to regular drug use or abuse. Since kratom is thought to act like opioid drugs, this means that some neurotransmitters, which are the brain’s chemical messengers that signal pleasure, may be impacted. Since kratom may interfere with the natural production of “happy cells” like serotonin, when the drug leaves the bloodstream, the brain may have lower than normal levels of these neurotransmitters. As a result, withdrawal symptoms can occur that may include depression, fatigue, drug cravings, and trouble feeling pleasure.

The DEA reports that long-term kratom abuse may lead to weight loss or anorexia, a frequent need to urinate, constipation, dry mouth, skin discoloration on the face, and insomnia. Withdrawal side effects may also include hostility, uncontrollable jerky movements, muscle and bone aches, aggression, and runny nose. In some cases, psychotic episodes including hallucinations, confusion, and delusions may occur.

The National Institute on Drug Abuse (NIDA) published a study that reported on psychiatric illness and significant withdrawal symptoms in Thai individuals who abused kratom for a long period of time, citing muscle aches, insomnia, and irritability as the most common symptoms. In addition, hallucinations, paranoia, trouble feeling pleasure, and decreased cognition were also reported.

Addiction is considered a brain disease. Drug dependence is one of the signs and potential side effects of the disease. However, NIDA reports that in order to be diagnosed with addiction, according to the most recent Diagnostic and Statistical Manual of Mental Disorders (DSM-5), a person must exhibit compulsive and drug-seeking behaviors and continue to use drugs with no regard to the negative consequences that may result. Compulsive means that drug use is no longer in the person’s direct control and much of the person’s time is spent trying to get the drug, using it, and coming down from the drug’s effects. Drug abuse may even constitute an obsession, and other interests may go by the wayside.

Some of the behavioral, emotional, social, and physical changes to look for when trying to pinpoint addiction include the following:

  • Change in physical appearance: weight loss and decreased interest in personal hygiene
  • Irregular sleep patterns: sleeping at odd times, or sleeping more frequently
  • Mood swings: from excitability and euphoria when taking kratom, to depression, aggression, irritability, and even potentially suicidal thoughts when withdrawing from kratom
  • Increased risk-taking behaviors: lowered inhibitions when on kratom, encouraging users to potentially do things that may be out of character
  • Irresponsibility: unfilled obligations and decline in grades or work performance
  • Interpersonal relationship conflict: a shift in personality as well as increased secrecy and social withdrawal that lead to relationship problems
  • Financial strain: working less, job loss, or spending significant funds on kratom
  • Legal troubles: increased risky or even dangerous behaviors, leading to run-ins with law enforcement
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