Kratom toxicity


Kratom flowers and foliage.
Typical powdered Kratom for commercial use.
  • Derived from Mitragyna speciosa, a plant native to Southeast Asia
  • Contains numerous chemicals acting on mu opioid, adrenergic, serotonin, and GABA receptors
  • Increasingly popular in US for attempted self-treatment of pain, opioid addiction/withdrawal, and depression
    • Patients often perceive incorrectly as a "safe" alternative to opioids

Clinical Features

  • Effects are dose dependent and may mimic those of both opioid and stimulant toxicity
  • Stimulant effects typically predominate at low doses (<5 g) with sedating effects more prevalent at higher doses

Differential Diagnosis

Drugs of abuse


  • Clinical diagnosis
  • Labs not routinely required unless severe vomiting, seizure, or unclear diagnosis
  • Consider EKG
    • Some patients may present with tachycardia and there is theoretical possibility QT prolongation



  • Discharge unless presenting with severe/intractable symptoms

See Also

External Links


  • Swogger M, Walsh D. Kratom use and mental health: A systematic review. Drug and Alcohol Dependence. 2017;183:134-140.
  • Vestal C. Kratom Concerns. State Legislatures Magazine. 2018; 44(4)
  • Killelea E. Kratom: Why Did the FDA Declare the Herbal Supplement an Opiate? Rolling Stone Magazine. March 2018.
  • Gottlieb, S. Statement from FDA Commissioner Scott Gottlieb, M.D., on new warning letters FDA is issuing to companies marketing kratom with unproven medical claims; and the agency’s ongoing concerns about kratom [press release]. Sep 11, 2018.