Kratom: What It Is, Effects and Risks

Medically reviewed by Alan Lucks | MD, Alan Lucks MDPC Private Practice - New York on November 9th, 2026.

Published on November 3rd, 2026. Updated on November 9th, 2026.

Key Takeaways

Kratom isn't FDA-approved for any medical use, and FDA warns people not to use it.
Its main alkaloids, mitragynine and 7-hydroxymitragynine (7-OH), act on opioid receptors in the brain.
Regular use can lead to dependence, and stopping can bring withdrawal.
Most kratom-involved deaths also involve other substances, such as fentanyl, heroin or benzodiazepines.
Call 911 if someone is unresponsive or has slow or stopped breathing.

What Kratom Is

Kratom is Mitragyna speciosa, a tree native to Southeast Asia, and the products made from its leaves. Kratom isn't approved by the FDA for any medical use, and there are no FDA-approved kratom drugs. FDA also says kratom isn't lawful in dietary supplements. It warns people not to use kratom because of risks including liver toxicity, seizures and substance use disorder.

Kratom's best-studied alkaloids are mitragynine and 7-hydroxymitragynine, or 7-OH. Mitragynine makes up about 66% of the leaf's alkaloids, and 7-OH is a minor one, under 2%, according to FDA's 2025 assessment. The body also turns some mitragynine into 7-OH. Products sold as 7-OH have it added or concentrated, so they aren't the same as kratom leaf. FDA calls 7-OH a potent opioid.

As of November 2026, kratom isn't federally controlled. The DEA has proposed temporarily placing 7-OH above a set strength in Schedule I, and some states and cities restrict kratom or 7-OH. Laws are changing, so check your state's current law.

How Kratom Works

Mitragynine and 7-OH act on mu-opioid receptors, the same receptors that opioid pain medicines act on.

People report stimulant-like effects from smaller amounts and opioid-like or sedating effects from larger ones. Studies haven't established how the amount relates to the effect. Effects last about 5 to 7 hours and are strongest at 2 to 4 hours, according to a 2022 review for health professionals.

Why People Use Kratom

People use kratom for those effects: some want a stimulant-like lift, others an opioid-like, calming effect. Kratom also has a long history of traditional use in Southeast Asia.

In surveys, some people say they use kratom to ease opioid withdrawal on their own. Kratom isn't approved for that, and FDA has found no 7-OH product safe and effective for it. Using kratom this way can lead to kratom dependence. The FDA-approved medicines for opioid use disorder are buprenorphine, methadone and naltrexone, prescribed by doctors who treat it.

Kratom Side Effects

Kratom hasn't been shown to be safe for any use. These are the effects reported in studies, case reports and poison center data.

Reported side effects

Fast heart rate: in a 200-person study, people who used kratom regularly had higher odds of a fast heart rate (sinus tachycardia) than those who didn't.
Sleepiness: drowsiness and sedation are reported, especially with larger amounts.
Nausea and vomiting: reported in poisonings with concentrated 7-OH products, along with sweating and high blood pressure.
Agitation or confusion: also reported in 7-OH poisonings.

Serious risks

Liver injury: uncommon, but published. In a US network, 11 people developed jaundice a median of 14 days after starting kratom; most needed hospital care, and all recovered. A 2026 review found 32 published cases, and 4 people needed a liver transplant.
Heart rhythm problems: case reports describe QT prolongation, dangerous heart rhythms and cardiac arrest.
Seizures: FDA lists seizures as a kratom risk. A 2025 review found 20 reported cases and judged the evidence too thin to show kratom causes them.
Overdose: deaths have been reported, mostly with other substances (see the emergency signs below).

When to get help

Yellow skin or eyes, dark urine, itching or unusual tiredness can be signs of liver injury. If you notice them, stop kratom and see a doctor soon. For emergency signs, see the table below.

Is Kratom Addictive?

It can be. A minority of people who use kratom report withdrawal and substance use disorder symptoms, according to the National Institute on Drug Abuse. In a survey of 293 people in Malaysia who used kratom regularly, over half had severe dependence.

For the signs and what raises the risk, see is kratom addictive.

Is Kratom an Opioid?

In part. Kratom is a plant, and its effects only partly resemble those of opioids like heroin or oxycodone. But FDA calls 7-OH an opioid, and 7-OH causes physical dependence and withdrawal like classic opioids.

For how kratom compares with opioids, see is kratom an opioid.

Kratom Drug Interactions

Mixing kratom with other drugs is where many of the worst outcomes happen. For alcohol, Suboxone and other medicines in detail, see kratom drug interactions.

Opioids

In CDC data on overdose deaths from 2016 and 2017 where kratom was found, fentanyl was also found in 65.1% and heroin in 32.9%. Kratom with opioids adds to sedation and breathing risks.

Benzodiazepines and Sleep Medicines

Benzodiazepines were found in 22.4% of those deaths. Mixing kratom with sedatives adds to drowsiness and slowed breathing.

Alcohol

Alcohol is a sedative too, so together they can deepen drowsiness and slow breathing. No controlled study has tested the combination.

Buprenorphine (Suboxone)

Starting buprenorphine too soon after kratom or 7-OH can bring on sudden, severe withdrawal, called precipitated withdrawal. Doctors time the first dose or use low-dose starts.

Medicines Cleared by CYP3A

In a clinical study, a single serving of kratom tea raised blood levels of midazolam, a sedative, by about 39%. Other drugs cleared by the CYP3A liver and gut enzyme may be affected too.

Stimulants

Combining kratom with amphetamines or other stimulants may raise the risk of problems for people with seizure disorders or psychotic illness, a 2026 review says.

Kratom Overdose and Emergency Signs

Kratom overdose can look like opioid overdose. Poison centers recorded 233 kratom-associated deaths from 2015 to 2025, and 184 of them (79%) involved other substances too, CDC reported in 2026.

Sign	What to do
Unresponsive, or slow or stopped breathing	Call 911
Blue lips or pinpoint pupils	Call 911
Trouble breathing	Call 911
Seizure	Call 911
Chest pain or fainting	Call 911
Possible poisoning, awake and breathing	Call Poison Control at 1-800-222-1222, or 911
Thoughts of harming yourself	Call or text 988

Give naloxone (Narcan) if you have it, and still call 911. In one case report, naloxone reversed a kratom overdose, and the authors advised watching the person for 24 hours because symptoms can return. For more, see can you overdose on kratom.

Kratom Withdrawal

Stopping after regular use may cause mild to moderate withdrawal, which is generally milder and shorter than classic opioid withdrawal. Kratom withdrawal covers the symptoms and timeline.

If you want to cut back or stop, work with a licensed doctor on a plan. For free, confidential referrals to treatment, call SAMHSA's National Helpline at 1-800-662-4357, any hour.

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Frequently Asked Questions

Get answers to common questions about kratom.

Usually not on a standard screen. Routine urine drug screens don't detect mitragynine, but kratom-specific tests can if they're ordered. Our guide to whether kratom shows up on a drug test explains which tests look for it.

It isn't well established. It may be detectable in urine for days, but few studies have measured it, and it depends on how much and how often you use kratom and on the test. Our answer on how long kratom stays in your system covers what's known.

It can, slightly. Published human data show kratom raising blood pressure and pulse a little, not lowering them, so it isn't a treatment for high blood pressure.

Talk with a doctor first. In lab studies, mitragynine blocks a potassium channel the heart relies on. That can lead to QT prolongation, and people with heart disease are at greater risk.

It's best not to. Kava is a different plant, a sedative with its own FDA liver warning from 2002, and some products contain both. In 2025, 30% of kava reports to poison centers also involved kratom, CDC reported in 2026. Our guide to kava vs kratom compares the two.

Yes. Your doctor can then check for interactions with your medicines and for liver or heart effects. They can also help if you want to cut back.

Still have questions? A licensed doctor can talk through your kratom use and your other medicines.

The Bottom Line

Kratom is a plant product, not an approved medicine, and its main alkaloids act on opioid receptors. Regular use can lead to dependence. The biggest dangers come from concentrated 7-OH products and from mixing kratom with opioids, sedatives or alcohol.

Doctronic doesn't treat addiction or run detox. If you have questions about your kratom use, Doctronic's medical AI chat is free, and a video visit with a licensed doctor is $39. The doctor can help with symptoms and refer you to addiction care.

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