{{Short description|Species of plant}} {{Pp-pc}} {{Cs1 config|name-list-style=vanc}} {{Speciesbox | image = Mitragyna speciosa111.JPG | status = LC | status_system = IUCN3.1 | status_ref = <ref>{{Cite iucn|title= ''Mitragyna speciosa''| article-number= e.T192376330A192376332| publisher= IUCN SSC Global Tree Specialist Group & Botanic Gardens Conservation International |year=2021|access-date=6 March 2022 |doi=10.2305/IUCN.UK.2021-1.RLTS.T192376330A192376332.en}}</ref> | genus = Mitragyna | species = speciosa | authority = (Korth.) Havil. | synonyms = * ''Nauclea korthalsii'' Steud. nom. inval. * ''Nauclea luzoniensis'' Blanco * ''Nauclea speciosa'' (Korth.) Miq. * ''Stephegyne speciosa'' Korth. | synonyms_ref = <ref>{{cite web|access-date=2013-12-26 |title=''Mitragyna speciosa'' (Korth.) Havil. is an accepted name |url=http://www.theplantlist.org/tpl/record/kew-128805 |website=theplantlist.org}}</ref> }}
<!-- Definition and description --> '''''Mitragyna speciosa''''' is a tropical evergreen tree of the Rubiaceae family native to Southeast Asia.<ref name="GRIN">{{GRIN | access-date = 2013-12-26}}</ref> It is indigenous to Cambodia, Thailand, Indonesia, Malaysia, Myanmar, and Papua New Guinea,<ref name="Rech2015">{{cite journal |last1=Rech|first1=MA|last2=Donahey|first2=E|last3=Cappiello Dziedzic|first3=JM|last4=Oh|first4=L|last5=Greenhalgh|first5=E| title=New drugs of abuse|journal= Pharmacotherapy| display-authors= 3| date=February 2015|volume= 35|issue=2|pages=189–97|pmid=25471045|doi=10.1002/phar.1522|s2cid=206358469|doi-access=free}}</ref> where its dark green, glossy leaves, known as '''kratom''', have been used in herbal medicine since at least the 19th century.<ref name="Hassan2013">{{cite journal | last1= Hassan | first1=Z | last2=Muzaimi | first2= M | last3=Navaratnam | first3=V | last4= Yusoff | first4=NHM | last5= Suhaimi | first5=FW | last6=Vadivelu | first6=R | last7=Vicknasingam | first7=BK | last8=Amato | first8=D | last9=von Hörsten | first9=S | last10= Ismail | first10= NIW | last11= Jayabalan | first11= N | last12=Hazim | first12=AI| last13= Mansor | first13=SM | last14=Müller|first14=CP | display-authors= 3 | year= 2013| title=From Kratom to mitragynine and its derivatives: Physiological and behavioural effects related to use, abuse, and addiction|journal=Neurosci Biobehav Rev | volume=37 | issue=2 | pages=138–151 | doi=10.1016/j.neubiorev.2012.11.012 | issn= 0149-7634 | pmid=23206666 | s2cid= 8463133 }}</ref> They have also historically been consumed via chewing, smoking, and as a tea.<ref name="Julien's Primer">{{cite book |last1= Advokat |first1=Claire D. |last2=Comaty |first2=Joseph E. |last3=Julien |first3= Robert M. |title= Julien's Primer of Drug Action: a comprehensive guide to the actions, uses, and side effects of psychoactive drugs |date=2019 |publisher= Worth Publishers |location= New York |isbn=978-1-319-20054-1 |page=570 |edition=14th}}</ref> Kratom contains multiple alkaloids (primarily, mitragynine and to a lesser extent, 7-hydroxymitragynine) that bind to opioid receptors, mostly as partial μ-opioid agonists. Kratom can also be subjectively stimulating to some, though this is likely not achieved through typical stimulant mechanisms (such as reuptake inhibition or release of monoamines), nor is this a universal effect.<ref name="AcevedoCanabal2022">{{cite book |last1=Acevedo-Canabal |first1=Agnes |last2=Pantouli |first2=Fani |last3=Ravichandran |first3=Akshaya |last4=Rullo |first4=Laura |last5=Bohn |first5=Laura M. |chapter=Pharmacological Diversity in Opioid Analgesics: Lessons From Clinically Useful Drugs |editor-last=Kenakin |editor-first=Terry |title=Comprehensive Pharmacology |publisher=Elsevier |year=2022 |pages=478–493 |isbn=9780128208762 |doi=10.1016/B978-0-12-820472-6.00188-2}}</ref><ref name="FDA2018">{{cite web|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm595622.htm|archive-url=https://web.archive.org/web/20180206201508/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm595622.htm|archive-date=February 6, 2018|title=Statement from FDA Commissioner Scott Gottlieb, M.D., on the agency's scientific evidence on the presence of opioid compounds in kratom, underscoring its potential for abuse| last=Gottlieb | first= Scott|date=6 February 2018| website = FDA.gov| publisher=US Food and Drug Administration| access-date=6 February 2018}}</ref><ref name="Cin2015">{{cite journal|pmc= 4657101|year=2015|last1=Cinosi|first1= E|title= Following 'the Roots' of Kratom (''Mitragyna speciosa''): The Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries|journal=BioMed Research International|volume=2015|pages=1–11|last2= Martinotti|first2=G|last3=Simonato|first3= P|last4=Singh|first4=D|last5= Demetrovics|first5=Z|last6=Roman-Urrestarazu|first6=A|last7=Bersani|first7= F. S|last8= Vicknasingam|first8= B|last9=Piazzon|first9=G|last10=Li|first10= J. H|last11=Yu|first11=W. J|last12= Kapitány-Fövény|first12=M|last13= Farkas|first13=J|last14= Di Giannantonio|first14=M|last15= Corazza|first15=O | display-authors= 3 |doi= 10.1155/2015/968786|pmid=26640804|doi-access=free}}</ref>
<!-- Uses and mechanism --> The efficacy and safety of kratom are unclear.<ref name="white">{{cite journal| vauthors=White CM|year=2018|title=Pharmacologic and clinical assessment of kratom|journal=Am J Health Syst Pharm|type=Review|volume= 75|issue=5|pages=261–267|doi= 10.2146/ajhp161035|pmid= 29255059}}</ref> In 2019, the United States Food and Drug Administration (FDA) stated that there is no evidence that kratom is safe or effective for treating any condition.<ref name="fda4-3-19" /> Kratom has been used for managing chronic pain, for treating opioid withdrawal symptoms, or for recreational purposes.<ref name="Rech2015" /><ref name="warner">{{cite journal |vauthors=Warner ML, Kaufman NC, Grundmann O |year=2016 |title=The pharmacology and toxicology of kratom: from traditional herb to drug of abuse |journal=Int. J. Legal Med. |type=Review |volume=130 |issue=1 |pages=127–38 |doi=10.1007/s00414-015-1279-y |pmid= 26511390 |s2cid=2009878}}</ref> It is under preliminary research for possible antipsychotic and antidepressant properties.<ref name="ReferenceA">{{Cite journal |last1=Johnson |first1=Lindsay E. |last2=Balyan |first2=Lilian |last3=Magdalany |first3=Amy |last4=Saeed |first4=Fizza |last5=Salinas |first5=Robert |last6=Wallace |first6=Starla |last7=Veltri |first7=Charles A. |last8=Swogger |first8=Marc T. |last9=Walsh |first9=Zach |last10=Grundmann |first10=Oliver |display-authors=3 |date=2020-06-29 |title=The Potential for Kratom as an Antidepressant and Antipsychotic |journal=The Yale Journal of Biology and Medicine |volume=93 |issue=2 |pages=283–289 |issn=0044-0086 |pmc=7309668 |pmid=32607089}}</ref><ref name="Jack T 2019">{{Cite journal |last1=Taylor Levine |first1=M. |last2=Gao |first2=Jin |last3=Satyanarayanan |first3=Senthil Kumaran |last4=Berman |first4=Sarah |last5=Rogers |first5=Jack T. |last6=Mischoulon |first6=David |display-authors=3 |year=2020 |title=S-adenosyl-l-methionine (SAMe), cannabidiol (CBD), and kratom in psychiatric disorders: Clinical and mechanistic considerations |journal=Brain, Behavior, and Immunity |volume=85 |pages=152–161 |doi=10.1016/j.bbi.2019.07.013 |issn=1090-2139 |pmid=31301401 |s2cid=195848995}}</ref> Kratom use has not been shown to positively affect mental health.<ref name=":12" />
<!-- Effects --> Anecdotal reports describe increased alertness, physical energy, talkativeness, sociability, sedation, changes in mood, and pain relief following kratom use at various doses.<ref name="warner" /> Common side effects include appetite loss, erectile dysfunction, nausea and constipation.<ref name=corkery/> More severe side-effects may include respiratory depression (decreased breathing), seizure, psychosis,<ref name=Rech2015/><ref name=FDA2018/><ref name="usdea">{{cite web|url=http://www.deadiversion.usdoj.gov/drug_chem_info/kratom.pdf|title=Kratom (''Mitragyna speciosa'' Korth)|date=January 2013| website = usdoj.gov |publisher= Drug Enforcement Administration, US Department of Justice |archive-url=https://web.archive.org/web/20160611063419/http://www.deadiversion.usdoj.gov/drug_chem_info/kratom.pdf|archive-date=11 June 2016}}</ref><ref name= Rosen>{{cite book|author1=Marx, John|author2=Walls, Ron|author3= Hockberger, Robert|title=Rosen's emergency medicine: concepts and clinical practice|date=2014|publisher= Elsevier Health Sciences|location= London|isbn=978-1-4557-4987-4|pages=2015–23|edition= 8th |chapter= Chapter 156: Hallucinogens|chapter-url=https://books.google.com/books?id=uggC0i_jXAsC&pg=RA2022}}</ref> elevated heart rate and blood pressure, trouble sleeping, and liver injury.<ref name=Rech2015/><ref name= "liverreview">{{cite journal |last1= Schimmel |first1=Jonathan |last2=Dart |first2=Richard C. |date= February 2020 |title=Kratom (''Mitragyna speciosa'') Liver Injury: A Comprehensive Review |journal=Drugs |volume=80 |issue=3 |pages=263–283 |doi=10.1007/s40265-019-01242-6 |pmid=31919755 |s2cid=210088143}}</ref><ref name="livertox">{{cite journal|title= Kratom|url=https://livertox.nih.gov/Kratom.htm|archive-url=https://web.archive.org/web/20141116072813/http://www.livertox.nih.gov/Kratom.htm|archive-date=November 16, 2014| website= livertox.nih.gov |publisher= National Library of Medicine, US National Institutes of Health |access-date=17 January 2026|date=3 April 2020|pmid= 31643176 |journal=|quote=Chronic use of kratom recreationally has been associated with rare instances of acute liver injury. The onset of injury is usually within 1 to 8 weeks of starting regular use of kratom powder or tablets, with symptoms of fatigue, nausea, pruritus and dark urine followed by jaundice. [...] Likelihood Score: B (likely cause of clinically apparent liver injury).}}</ref><ref name=cdc>{{Cite journal|last1=Anwar|first1=Mehruba|last2= Law|first2=Royal|last3=Schier|first3=Josh|date=2016-01-01|title= Notes from the Field: Kratom (''Mitragyna speciosa'') Exposures Reported to Poison Centers – United States, 2010–2015|journal= Morbidity and Mortality Weekly Report|volume=65|issue=29|pages=748–49|doi=10.15585/mmwr.mm6529a4|issn= 0149-2195|pmid=27466822|doi-access= free}}</ref> Addiction is a possible risk with regular use: when use is stopped, withdrawal symptoms may occur.<ref name="Cin2015" /><ref name=warner/> Serious toxicity is relatively rare and generally appears at high doses or when kratom is used with other substances.<ref name="Rech2015" /><ref name="warner" /> A small number of deaths have been connected to the use of kratom, most commonly when mixed with other substances.<ref name=corkery/> <!-- Society and culture -->
As of 2018, kratom is a controlled substance in sixteen countries.<ref name="FDA2018" /> Some countries, like Indonesia and Thailand, have recently moved toward regulated legal production for medical use. There is growing international concern about a possible threat to public health from kratom use.<ref name="FDA2018" /><ref name="warner" /><ref name="EMCDDA">{{cite web|title=Kratom profile (chemistry, effects, other names, origin, mode of use, other names, medical use, control status)|url=http://www.emcdda.europa.eu/publications/drug-profiles/kratom#control| website= emcdda.europa.eu |publisher= European Monitoring Centre for Drugs and Drug Addiction |access-date=12 September 2016|date=8 January 2015}}</ref> In some jurisdictions its sale and importation have been restricted, and several public health authorities have raised alerts.<ref name="warner" /><ref name="EMCDDA" /> {{TOC limit}}
== Description == alt=Kratom has dark green oval-acuminate leaves and yellow globular flowers.|thumb|Kratom flowers and foliage ''Mitragyna speciosa'' is an evergreen tree in the genus ''Mitragyna'' that can grow to a height of {{convert|25|m|ft|abbr=on}}. Its trunk may grow to a {{convert|3|ft|m|abbr=on|1|order=flip}} diameter.<ref name="Eisenman" /> The trunk is generally straight, and the outer bark is smooth and grey.<ref name="Eisenman" /> The leaves, ovate-acuminate in shape and opposite in growth pattern, are dark green, glossy on their upper surfaces,<ref name="warner" /> and can grow to over {{convert|14|-|20|cm|in|abbr=on}} long and {{convert|7|-|12|cm|in|abbr=on}} wide. They have 12 to 17 pairs of veins.<ref name="Eisenman" /> The spherical inflorescences, which are deep yellow, grow in clusters of three at the ends of the branches.<ref>{{Cite book|last=Rahman|first=Atta-ur|url=https://books.google.com/books?id=d7cCEAAAQBAJ&pg=PA195|title=Studies in Natural Products Chemistry|date=2021-04-16|publisher=Elsevier|isbn=978-0-323-89815-7|language=en}}</ref> The calyx-tube is {{convert|2|mm|in|abbr=on |sigfig=1}} long and has five lobes; the corolla-tube is {{convert|2.5|-|3|mm|sigfig=2}} long.<ref name="Eisenman">{{cite book|last= Eisenman | first= Sasha W.|editor1-last=Raffa|editor1-first=Robert B.|title=Kratom and Other Mitragynines: The Chemistry and Pharmacology of Opioids from a Non-Opium|date=2014|publisher=CRC Press|isbn= 978-1-4822-2519-8| pages= 57–76|chapter= Chapter 5. The Botany of ''Mitragyna speciosa'' (Korth.) Havil. and Related Species}}</ref>
''Mitragyna speciosa'' is indigenous to Thailand, Indonesia, Malaysia, Myanmar, and Papua New Guinea.<ref name="Rech2015" /> It was first formally described by the Dutch colonial botanist Pieter Korthals in 1839, who named it ''Stephegyne speciosa''; it was renamed and reclassified several times before George Darby Haviland provided the final name and classification in 1859.<ref name="Eisenman" />{{rp|59}}
==Uses of the leaves== {{See also|Mitragynine#Uses}} {{Infobox botanical product |image = Powdered kratom.jpg |caption = Powder produced from unspecified tissues of the plant |name = Kratom |plant = |part = Leaves |origin = Southeast Asia<ref name=EMCDDA /> |active = {{flatlist| * Mitragynine<ref name=warner/> * 7-hydroxymitragynine<ref name=warner/> * Other alkaloids<ref name=warner/> * Raubasine<ref name=warner/> * and more than 40 other compounds<ref name="Adkins 2011-05-01" /> }} |producers = {{hlist|Indonesia<ref name=EMCDDA />|Thailand<ref name=Hassan2013 />}} |consumers = Worldwide (No. 1: Thailand)<ref name=EMCDDA /><ref name=Hassan2013 /> |wholesale = |retail = |legal_AU = S9 - Prohibited substance<ref>{{Cite web |title=Therapeutic Goods (Poisons Standard—October 2025) Instrument 2025 |url=https://www.legislation.gov.au/F2025L01181/latest/text |website=Federal Register of Legislation |date=25 September 2025 |publisher=Australian Government |access-date=2025-12-04}}</ref> |legal_BR = E |legal_BR_comment = <ref>{{Cite web |author=Anvisa |author-link=Brazilian Health Regulatory Agency |date=2023-09-15 |title=RDC Nº 816 - Listas de Substâncias Entorpecentes, Psicotrópicas, Precursoras e Outras sob Controle Especial |trans-title=Collegiate Board Resolution No. 816 - Lists of Narcotic, Psychotropic, Precursor, and Other Substances under Special Control|url=https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-816-de-15-de-setembro-de-2023-510390164 |url-status=live |archive-url=https://web.archive.org/web/20231019120956/https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-816-de-15-de-setembro-de-2023-510390164 |archive-date=2023-10-19 |access-date=2023-10-19 |publisher=Diário Oficial da União |language=pt-BR |publication-date=2023-09-18}}</ref> |legal_CA = Unscheduled (Not authorized for sale or use), legal for religious use, such as incense <ref>{{cite web |title=Unauthorized "Sāj" kratom products seized from two Edmonton stores may pose serious health risks |url=http://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2018/66710a-eng.php |website=Health Canada |publisher=Canada |access-date=8 August 2018 |date=4 May 2018}}</ref> <ref name=EMCDDA /> |legal_US = Unscheduled (Drug of concern),<ref name=Hassan2013 /> subject to import bans<ref name=FDAImportAlert /><ref name=Tave>{{cite web|url=https://www.fda.gov/downloads/AboutFDA/CentersOffices/OfficeofFoods/CFSAN/CFSANFOIAElectronicReadingRoom/UCM598251.pdf|archive-url=https://web.archive.org/web/20180424064742/https://www.fda.gov/downloads/AboutFDA/CentersOffices/OfficeofFoods/CFSAN/CFSANFOIAElectronicReadingRoom/UCM598251.pdf|archive-date=April 24, 2018|title=FDA warning letter to Industrial Chemicals, LLC, and INI Botanicals|publisher=Office of Dietary Supplement Programs, Center for Food Safety and Applied Nutrition, US Food and Drug Administration| last=Tave |first=Steven J.|date=26 February 2018|access-date=7 March 2018}}</ref><ref name="fda4-3-19">{{cite web |title=FDA and kratom |url=https://www.fda.gov/news-events/public-health-focus/fda-and-kratom |publisher=US Food and Drug Administration |access-date=8 August 2019 |date=3 April 2019}}</ref> |legal_UN = Unscheduled |legal_status = Illegal in Malaysia, Myanmar, Indonesia<ref name=EMCDDA /><ref name=Hassan2013 /> }} thumb|right|Kratom leaves {{As of|2013}}, kratom has been studied in cells and in animals, but no clinical trials have been conducted in the United States.<ref name="Hassan2013" /> The U.S. Drug Enforcement Administration (DEA) stated in 2013 that there is no legitimate medical use for kratom,<ref name="usdea" /> and in 2019, the U.S. Food and Drug Administration (FDA) said that there is no evidence that kratom is safe or effective for treating any condition, and that there are no approved clinical uses for kratom.<ref name="fda4-3-19" />
Kratom is commonly ingested by chewing, as a tea, powdered in capsules or pills, or extracted for use in liquids.<ref name="Hassan2013"/> Kratom is rarely smoked.<ref name="EMCDDA" /> Different varieties of kratom contain different relative proportions of alkaloids such as mitragynine.<ref name="warner" />
===Traditional use=== In cultures where the plant grows, kratom has been used in traditional medicine.<ref name=Cin2015 /> The leaves are chewed to relieve musculoskeletal pain and increase energy, appetite, and sexual desire in ways similar to khat and coca.<ref name= warner/> The leaves, or extracts from them, are used to heal wounds and as a local anesthetic. Extracts and leaves have been used to treat coughs, diarrhea, and intestinal infections.<ref name=Rech2015/><ref name="Hassan2013" /><ref name=Eisenman/> They are also used as intestinal deworming agents in Thailand.<ref name="EMCDDA" /><ref>{{Cite journal|last1=Singh|first1=Darshan|last2=Narayanan|first2=Suresh|last3=Vicknasingam|first3=Balasingam|last4=Corazza|first4=Ornella|last5=Santacroce|first5=Rita|last6=Roman-Urrestarazu|first6=Andres|date=2017|title=Changing trends in the use of kratom (''Mitragyna speciosa'') in Southeast Asia|journal=Human Psychopharmacology: Clinical and Experimental|language=en|volume=32|issue=3|article-number=e2582|doi=10.1002/hup.2582|pmid=28544011|issn=1099-1077|doi-access=free|hdl=2299/18790|hdl-access=free}}</ref>
Kratom is often used by workers in laborious or monotonous occupations to stave off exhaustion and as a mood-enhancer and painkiller.<ref name="Eisenman" /> In Thailand, kratom was "used as a snack to receive guests and was part of the ritual worship of ancestors and gods".<ref>{{cite journal|last1=Singh|first1= Darshan|last2=Narayanan|first2= Suresh| last3=Vicknasingam|first3= Balasingam| title= Traditional and non-traditional uses of Mitragynine (Kratom): A survey of the literature|journal=Brain Research Bulletin|date=September 2016|volume=126|issue=Pt 1|pages=41–46|doi=10.1016/j.brainresbull.2016.05.004|pmid=27178014|s2cid= 3952688}}</ref> The herb is bitter and is generally combined with a sweetener.<ref name="Adkins 2011-05-01">{{cite journal |last=Adkins |first=Jessica E. |author2=Edward W. Boyer |author3=Christopher R. McCurdy |date=2011-05-01 |title=''Mitragyna speciosa'', a psychoactive tree from Southeast Asia with opioid activity |journal=Current Topics in Medicinal Chemistry |volume=11 |issue=9 |pages=1165–75 |doi=10.2174/156802611795371305 |pmid=21050173}}</ref>
===Opioid withdrawal=== Because the withdrawal effects of kratom are often reported to be less severe than those associated with traditional opioids,<ref name="warner" /> some people use kratom in the attempt to manage opioid use disorder,<ref name=":2">{{Cite journal|last1=Swogger|first1=Marc T.|last2=Walsh|first2=Zach|date=2018-02-01|title=Kratom use and mental health: A systematic review|journal=Drug and Alcohol Dependence|volume=183|pages=134–140|doi=10.1016/j.drugalcdep.2017.10.012|issn=1879-0046|pmid=29248691}}</ref> though no clinical trials have been done supporting this use. {{As of|2018}}, there have been no formal trials to study the efficacy or safety of kratom to treat opioid addiction.<ref name="FDA2018" /> Stanciu et al. conducted a review of all literature and found insufficient evidence for any conclusions concerning whether kratom is harmful or whether can serve as harm reduction for those with opioid addiction.<ref>{{Cite journal |last1=Stanciu |first1=Cornel |last2=Ahmed |first2=Saeed |last3=Gnanasegaram |first3=Samantha |last4=Gibson |first4=Stephen |last5=Penders |first5=Thomas |last6=Grundmann |first6=Oliver |last7=McCurdy |first7=Christopher |date=2022-09-03 |title=Kratom as an opioid alternative: harm, or harm reduction? A systematic review of literature |journal=The American Journal of Drug and Alcohol Abuse |volume=48 |issue=5 |pages=509–528 |doi=10.1080/00952990.2022.2111685 |issn=1097-9891 |pmid=36001875|s2cid=251810402 }}</ref> While some literature reviews claim that kratom has less potential for dependence or overdose than traditional opioids,<ref>{{Cite journal|last1=Henningfield|first1=Jack E.|last2=Fant|first2=Reginald V.|last3=Wang|first3=Daniel W.|date=2018|title=The abuse potential of kratom according the 8 factors of the controlled substances act: implications for regulation and research|journal=Psychopharmacology|volume=235|issue=2|pages=573–589|doi=10.1007/s00213-017-4813-4|issn=1432-2072|pmc=5813050|pmid=29273821}}</ref><ref name=":3">{{Cite journal|last1=Eastlack|first1=Steven C.|last2=Cornett|first2=Elyse M.|last3=Kaye|first3=Alan D.|date=2020|title=Kratom—Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review|journal=Pain and Therapy|volume=9|issue=1|pages=55–69|doi=10.1007/s40122-020-00151-x|issn=2193-8237|pmc=7203303|pmid=31994019}}</ref> other reviews note that kratom withdrawal itself can still be quite severe.<ref name="Stan2019" />
Data on how widely it is used worldwide are lacking, as it is not detected by typical drug screening tests.<ref name="Adkins 2011-05-01"/> Rates of kratom use appear to be increasing among those who have been self-managing chronic pain with opioids purchased without a prescription and are cycling (but not quitting) their opioid use.<ref name="Adkins 2011-05-01"/>
In 1836, kratom was reported to have been used as an opium substitute in Malaysia. Kratom was also used as an opium substitute in Thailand in the 19th century.<ref name="Hassan2013" />
===Recreational use=== At low doses, kratom produces euphoric effects comparable to those of coca.<ref name=":0">{{Cite journal|last1=Babu|first1=Kavita M.|last2=McCurdy|first2=Christopher R.|last3=Boyer|first3=Edward W.|date=2008|title=Opioid receptors and legal highs: ''Salvia divinorum'' and Kratom|journal=Clinical Toxicology|volume=46|issue=2|pages=146–152: 149|doi=10.1080/15563650701241795|pmid=18259963|s2cid=32501470|issn=1556-3650}}</ref> At higher doses, kratom produces opioid-like effects.<ref name=":0" /> The onset of effects typically begins within five to ten minutes and lasts for two to five hours.<ref name="Rech2015" /> Some anecdotal reports describe increased work capacity, alertness, talkativeness, sociability, increased sexual desire, positive mood, and euphoria following the consumption of kratom.<ref name="warner" />
According to the U.S. DEA and a 2020 survey, kratom is used to alleviate pain, anxiety, depression, or opioid withdrawal.<ref name=usdea/><ref name=":1">{{Cite journal|last1=Garcia-Romeu|first1=Albert|last2=Cox|first2=David J.|last3=Smith|first3=Kirsten E.|last4=Dunn|first4=Kelly E.|last5=Griffiths|first5=Roland R.|date=2020|title=Kratom (''Mitragyna speciosa''): User demographics, use patterns, and implications for the opioid epidemic|journal=Drug and Alcohol Dependence|volume=208|article-number=107849|doi=10.1016/j.drugalcdep.2020.107849|pmid=32029298|pmc=7423016|issn=0376-8716}}</ref>
In Thailand, a 2007 survey found that the lifetime, past year, and past 30 days kratom consumption rates were 2.32%, 0.81% and 0.57%, respectively, among respondents aged 12–65 years,<ref name="EMCDDA" /> and that kratom was the most widely used recreational drug in Thailand.<ref name="EMCDDA" />
Kratom may be mixed with other psychoactive drugs, such as caffeine and codeine.<ref name="Cin2015" /><ref>{{cite book|url=https://books.google.com/books?id=M9KYCgAAQBAJ&pg=PA528|title=Karch's Pathology of Drug Abuse|last1=Karch|first1=Steven B.|last2=Drummer|first2=Olaf|date=2015|publisher=CRC Press|isbn=978-1-4398-6147-9|edition=Fifth|page=528}}</ref> Starting in the 2010s, a tea-based cocktail known as "4×100" became popular among some young people across Southeast Asia and especially in Thailand. It is a mix of kratom leaves, cough syrup, Coca-Cola, and ice. Around 2011, people who consumed the cocktail were often viewed more negatively than users of traditional kratom, but not as negatively as users of heroin.<ref>{{cite web| last1=Tanguay|first1=Pascal|title=Kratom in Thailand: Decriminalisation and Community Control?|url=https://www.tni.org/files/download/kratom-briefing-dlr13.pdf|publisher= Transnational Institute|date= April 2011|quote= Young people feel the need to drink 4x100 in hidden settings due to fears of arrest by law enforcement. In one district, 21 of 39 villages reported the presence of 4x100 users in their community. Compared to traditional use, 4x100 users are subject to some measure of community discrimination, though community perceptions are far milder than for yaba or heroin users.}}</ref> As of 2012, use of the cocktail was a severe problem among youth in three provinces along the border of Malaysia and southern Thailand.<ref>{{cite news|last1= Fuller|first1= Thomas|title=A Fading Thai Drug Finds Its Resurgence in a Cocktail|url=https://query.nytimes.com/gst/fullpage.html?res=9E05EFDC103EF930A15754C0A9649D8B63| work= The New York Times| date=23 July 2012}}</ref>
In the U.S., {{as of|2015|lc=y}}, kratom was available in outlets such as head shops and over the Internet; the prevalence of its U.S. use was unknown at the time.<ref name= warner/> In the United States, kratom use increased rapidly between 2011 and 2017.<ref name="Post">{{cite journal|last1=Post|first1=Sara|last2=Spiller|first2=Henry A.|last3=Chounthirath|first3=Thitphalak|last4=Smith|first4=Gary A.|date=20 February 2019|title=Kratom exposures reported to United States poison control centers: 2011–2017|journal=Clinical Toxicology|volume=57|issue=10|pages=847–854|doi=10.1080/15563650.2019.1569236|issn=1556-3650|pmid=30786220|s2cid=73507086}}</ref> By 2020, it was estimated that 15 million people worldwide use kratom.<ref>{{Cite journal|last1=Ramanathan|first1=Surash|last2=McCurdy|first2=Christopher R.|date=2020|title=Kratom (''Mitragyna speciosa''): worldwide issues|journal=Current Opinion in Psychiatry|volume=33|issue=4|pages=312–318|doi=10.1097/YCO.0000000000000621|issn=1473-6578|pmid=32452943|s2cid=218893286}}</ref>
==Adverse effects==
''Mitragyna speciosa'' may cause many adverse effects, and in November 2017 the FDA issued a public health advisory for the drug.<ref name=white/> The side effects of kratom appear to be dose-dependent and are more common with doses that exceed 8 g.<ref name=":3" /> While the incidence of adverse effects in people who use kratom is unknown, a 2019 review of 935 kratom exposures reported to U.S. poison control centers over a seven-year period listed the following signs and symptoms: agitation (18.6%), tachycardia (16.9%), drowsiness (13.6%), vomiting (11.2%), confusion (8.1%), seizures (6.1%), withdrawal symptoms (6.1%), hallucinations (4.8%), respiratory depression (2.8%), coma (2.3%), and cardiac or respiratory arrest (0.6%).<ref name=":5">{{Cite journal|last1=Eggleston|first1=William|last2=Stoppacher|first2=Robert|last3=Suen|first3=Kyle|last4=Marraffa|first4=Jeanna M.|last5=Nelson|first5=Lewis S.|date=2019|title=Kratom Use and Toxicities in the United States|journal=Pharmacotherapy|volume=39|issue=7|pages=775–777|doi=10.1002/phar.2280|issn=1875-9114|pmid=31099038|s2cid=157058636}}</ref><ref name=":3" /> The study also reported two deaths and four cases of neonatal abstinence syndrome.<ref name=":5" /> A different 2019 review listed as common side effects: decreased appetite, weight loss, erectile dysfunction, insomnia, sweating, hyperpigmentation, hair loss, tremor, and constipation.<ref name=corkery/>
Kratom products in the U.S. are commonly used in doses of 2–6 g of dried leaf, and doses exceeding 8 g are relatively uncommon.<ref>{{Cite journal|last=Grundmann|first=Oliver|date=2017-07-01|title=Patterns of Kratom use and health impact in the US-Results from an online survey|journal=Drug and Alcohol Dependence|volume=176|pages=63–70|doi=10.1016/j.drugalcdep.2017.03.007|issn=1879-0046|pmid=28521200}}</ref> Given that kratom products may vary greatly in potency, there is no standard dosing system. At relatively low doses (1–5 g of raw leaves), at which there are mostly stimulant effects, side effects include contracted pupils and blushing; adverse effects related to stimulation include anxiety and agitation, and opioid-related effects such as itching, nausea, loss of appetite, and increased urination begin to appear.<ref name=Rech2015/><ref name=warner/> At moderate to high doses (5–15 g of raw leaves), at which opioid effects generally appear, additional adverse effects include tachycardia (an increased stimulant effect) as well as the opioid side effects of constipation, dizziness, hypotension, dry mouth, and sweating.<ref name="warner" /><ref name="Rosen" /><ref name=":4">{{Cite journal|last1=Meireles|first1=Vânia|last2=Rosado|first2=Tiago|last3=Barroso|first3=Mário|last4=Soares|first4=Sofia|last5=Gonçalves|first5=Joana|last6=Luís|first6=Ângelo|last7=Caramelo|first7=Débora|last8=Simão|first8=Ana Y.|last9=Fernández|first9=Nicolás|last10=Duarte|first10=Ana Paula|last11=Gallardo|first11=Eugenia|date=2019-03-04|title=''Mitragyna speciosa'': Clinical, Toxicological Aspects and Analysis in Biological and Non-Biological Samples|journal=Medicines|volume=6|issue=1|page=35|doi=10.3390/medicines6010035|issn=2305-6320|pmc=6473843|pmid=30836609|doi-access=free}}</ref>
Long-term use of high doses of kratom may lead to development of tolerance, dependence, and withdrawal symptoms, including loss of appetite, weight loss, decreased libido, insomnia, muscle spasms, muscle and bone pain, increased yawning and/or sneezing, myoclonus, watery eyes, hot flashes, fever, diarrhea, restlessness, anger, and sadness.<ref name=Cin2015/> This may lead to resumption of use.<ref name=Cin2015/><ref name=warner/><ref name=Stan2019>{{Cite journal|last1=Stanciu|first1=Cornel N.|last2=Gnanasegaram|first2=Samantha A.|last3=Ahmed|first3=Saeed|last4=Penders|first4=Thomas|date=January 2019|title=Kratom Withdrawal: A Systematic Review with Case Series|journal=Journal of Psychoactive Drugs|volume=51|issue=1|pages=12–18|doi=10.1080/02791072.2018.1562133|issn=2159-9777|pmid=30614408|s2cid=58643707}}</ref>
Frequent use of high doses of kratom may cause tremors, anorexia, weight loss, seizures, psychosis and other mental health conditions.<ref name="warner" /><ref name=bachu>{{cite journal |vauthors=Bachu AK, Singal P, Griffin B, Harbaugh L, Prasad S, Jain L, Mohiuddin S, Papudesi BN, Nagi T, Youssef NA, Chopra A, Ahmed S |title=Kratom use and mental health: A systematic literature review and case example |journal=J Addict Dis |volume= 42|issue= 4|pages=301–312 |date=November 2023 |pmid=37942896 |doi=10.1080/10550887.2023.2273192 |s2cid=265064749 |url=}}</ref> Kratom use has a small but statistically significant association with externalizing mental health disorders.<ref name=":12">{{Cite journal |last1=Yang |first1=Yuting |last2=Müller |first2=Christian P. |last3=Singh |first3=Darshan |date=2024 |title=Kratom (Mitragyna speciosa) Use and Mental Health: A Systematic Review and Multilevel Meta-Analysis |journal=European Addiction Research |volume=30 |issue=4 |pages=252–274 |doi=10.1159/000539338 |issn=1421-9891 |pmid=38889703}}</ref> Kratom use may worsen existing mental health conditions.<ref name=bachu/> In case reports associating kratom use with psychosis, it remains unclear whether kratom use directly caused psychosis or simply unmasked the condition.<ref>{{Cite book|last1=Dye|first1=Leslie R.|url=https://books.google.com/books?id=cEFEDwAAQBAJ&q=kratom+psychosis&pg=PA238|title=Case Studies in Medical Toxicology: From the American College of Medical Toxicology|last2=Murphy|first2=Christine|last3=Calello|first3=Diane P.|last4=Levine|first4=Michael D.|last5=Skolnik|first5=Aaron|date=2017-12-22|publisher=Springer|isbn=978-3-319-56449-4|language=en}}</ref> Serious toxicity is relatively rare and generally appears at high doses or when kratom is used with other substances.<ref name=Rech2015/><ref name=warner/> Herb–drug interactions may result when kratom is combined with alcohol, sedatives, benzodiazepines, opioids, caffeine, cocaine, yohimbine, or monoamine oxidase inhibitors (MAOIs).<ref name=":4" /> Rhabdomyolysis is one of the rare and serious complications of this herb at high dosage.<ref name="pmid34430176">{{cite journal |vauthors=Patel P, Aknouk M, Keating S, Richard I, Kata P, Ali RY, Cheriyath P |title=Cheating Death: A Rare Case Presentation of Kratom Toxicity |journal=Cureus |volume=13 |issue=7 | date=July 2021 |article-number=e16582 |pmid=34430176 |pmc=8378318 |doi=10.7759/cureus.16582 |doi-access=free |url= |issn=}}</ref>
In July 2016, the Centers for Disease Control issued a report stating that between 2010 and 2015, US poison control centers received 660 reports of exposure to kratom. Medical outcomes associated with kratom exposure were reported as minor (minimal signs or symptoms, which resolved rapidly with no residual disability) for 162 (24.5%) exposures, moderate (non-life-threatening, with no residual disability, but requiring some form of treatment) for 275 (41.7%) exposures, and major (life-threatening signs or symptoms, with some residual disability) for 49 (7.4%) exposures. Overall, 92.6% of outcomes were resolved with no residual disability.<ref name=cdc/> One death was reported in a person who was exposed to the medications paroxetine (an antidepressant) and lamotrigine (an anticonvulsant and mood stabilizer) in addition to kratom. For 173 (26.2%) exposure calls, no effects were reported, or poison center staff members were unable to follow up regarding effects.<ref name=cdc/>
A 2019 report from the American Association of Poison Control Centers (AAPCC) noted that kratom use was increasing rapidly, with 1807 kratom exposures and a 52-fold increase occurring over the years 2011 to 2017.<ref name=Post/> Most exposures occurred intentionally by adult males in their homes, with 32% of the incidents requiring admission to a health care facility and half of the admissions as a serious medical condition.<ref name=Post/> Multiple-substance exposures were associated with a higher number of hospitalizations than kratom-only exposures and involved 11 deaths, including two due to kratom alone.<ref name=Post/> Post-mortem toxicology testing detected multiple substances for almost all those who died, with fentanyl and fentanyl analogs being the most frequently identified co-occurring substances.<ref name="cdc2019" />
Overdoses of kratom are managed similarly to opioid overdoses, and naloxone can be considered to treat an overdose that results in a reduced impulse to breathe, despite mixed results for its utility, based on animal models.<ref name= Rech2015/>
From October 2017 to February 2018 in the United States, 28 people in 20 different states were infected with salmonella, an outbreak linked to the consumption of contaminated pills, powder, tea, or unidentified sources of kratom.<ref name="cdc18">{{cite web|title=Multistate Outbreak of Salmonella I 4,[5],12:b:- Infections Linked to Kratom Products {{!}} February 2018 {{!}} Salmonella |url= https://www.cdc.gov/salmonella/kratom-02-18/index.html|website= cdc.gov| publisher= Centers for Disease Control| access-date=22 February 2018|date=20 February 2018}}</ref> An analytical method using whole genome sequencing applied to samples from the infected users indicated that the salmonella outbreak likely had a common kratom source.<ref name= cdc18/>
===Addiction=== Kratom is a botanical with a known addiction liability and, in vulnerable individuals, dependence may develop rather quickly with tolerance noted at three months and four- to ten-fold dose escalations required within the first few weeks.<ref>Alsarraf E, Myers J, Culbreth S, Fanikos J. Kratom from head to toe—case reviews of adverse events and toxicities. Curr Emerg Hosp Med Rep. 2019;7(4):141-168. doi:10.1007/s40138-019-00194-1</ref> A survey by Stanciu et al. of kratom consumers found that 25.5% of respondents reported symptoms consistent with a substance use disorder diagnosis based on the Diagnostic and Statistical Manual's criteria. After controlling for variables such as age, gender, daily kratom use frequency, and a history of substance use disorders or mental health conditions, individuals with a concurrent diagnosis of another substance use disorder (SUD) had 2.83 times the odds of meeting criteria for kratom addiction compared to those without a concurrent SUD diagnosis.<ref>Hill K, Grundmann O, Smith KE, Stanciu CN. Prevalence of Kratom Use Disorder Among Kratom Consumers. J Addict Med. 2024 May-Jun 01;18(3):306-312. doi: 10.1097/ADM.0000000000001290.</ref> Kratom addiction carries a relapse risk as high as 78–89% at three months post-cessation.<ref>Vicknasingam B, Narayanan S, Beng GT, Mansor SM. The informal use of ketum (''Mitragyna speciosa'') for opioid withdrawal in the northern states of peninsular Malaysia and implications for drug substitution therapy. Int J Drug Policy.2010;21(4):283-288. doi:10.1016/j.drugpo.2009.12.003</ref><ref>Singh D, Müller CP, Vicknasingam BK. Kratom (''Mitragyna speciosa'') dependence, withdrawal symptoms, and craving in regular users. Drug Alcohol Depend. 2014;139:132-137. doi:10.1016/j.drugalcdep.2014.03.017</ref><ref>Singh D, Müller CP, Vicknasingam BK, Mansor SM. Social functioning of kratom (''Mitragyna speciosa'') users in Malaysia. J Psychoactive Drugs. 2015;47(2):125-131. doi:10.1080/02791072.2015.1012610</ref> In cases of severe addiction, an approach similar to the treatment of opioid addiction may be warranted.<ref>Stanciu C, Ahmed S, Hybki B, Penders T, Galbis-Reig D. Pharmacotherapy for Management of 'Kratom Use Disorder': A Systematic Literature Review With Survey of Experts. WMJ. 2021;120(1)</ref>
===Respiratory depression=== Respiratory depression is the leading cause of death from opioid use.<ref name= Beckett2014>{{cite book| first= Jaclyn R. | last= Beckett|editor1-last=Raffa|editor1-first= Robert B.|title=Kratom and other mitragynines: the chemistry & pharmacology of opioids from|date= 2014| publisher= CRC Press|isbn= 978-1-4822-2518-1|pages= 195–204|chapter= Non-Analgesic CNS Effects}}</ref> Although evidence is sparse, the risk of respiratory depression caused by taking kratom appears to be low, but, {{as of|lc=yes|2016}}, the Food and Drug Administration listed respiratory depression as a concern.<ref name=white/><ref name="FDAImportAlert">{{cite web |date=20 December 2016 |title=Import Alert 54-15; Detention without physical examination of dietary supplements and bulk dietary ingredients that are or contain ''Mitragyna speciosa'' or kratom |url=http://www.accessdata.fda.gov/cms_ia/importalert_1137.html |archive-url=https://web.archive.org/web/20140305094019/http://www.accessdata.fda.gov/cms_ia/importalert_1137.html |archive-date=March 5, 2014 |access-date=7 March 2018 |publisher=U.S. Food and Drug Administration}}</ref> A 2018 review found that the alkaloids in kratom do not induce respiratory depression.<ref name="Kruegel">{{Cite journal|last1=Kruegel|first1=Andrew C.|last2=Grundmann|first2=Oliver|date=2018|title=The medicinal chemistry and neuropharmacology of kratom: A preliminary discussion of a promising medicinal plant and analysis of its potential for abuse|journal=Neuropharmacology|volume=134|issue=Pt A|pages=108–120|doi=10.1016/j.neuropharm.2017.08.026|pmid=28830758|s2cid=24009429|issn=0028-3908}}</ref>
===Liver toxicity=== Chronic use of kratom can be hepatotoxic, and may cause acute liver injury; symptoms include abdominal discomfort, dark urine, itching and jaundice.<ref name="liverreview" /><ref name=livertox/> Liver injury has been reported with a latency (time from first use to the onset of symptoms) of median 20.6 days. Reported liver biopsies tend to show cholestasis; however, blood biomarkers can show a range of cholestatic, mixed, or hepatocellular injury patterns.<ref name=liverreview/> Although cases are likely underreported, many users do not seem to develop liver injury, and it is unclear which users are at heightened risk. The mechanism by which kratom causes liver damage in some people is unknown and poorly studied, but a model has been proposed.<ref name=liverreview/>
=== Infants === Neonatal abstinence syndrome has been noted in infants born to mothers taking kratom during pregnancy.<ref name=":13">{{Cite journal |last1=Wright |first1=Mary Ellen |last2=Ginsberg |first2=Claire |last3=Parkison |first3=Abigail M. |last4=Dubose |first4=Melissa |last5=Sherbondy |first5=Madison |last6=Shores |first6=Emily |date=June 2021 |title=Outcomes of mothers and newborns to prenatal exposure to kratom: a systematic review |journal=Journal of Perinatology|volume=41 |issue=6 |pages=1236–1243 |doi=10.1038/s41372-021-00952-8 |issn=1476-5543 |pmc=8225511 |pmid=33589723}}</ref> These infants display similar symptoms to infants born with opioid withdrawal syndrome, such as jitteriness, reduced feeding, irritability, and sleeplessness. Infants impacted by kratom withdrawal may require hospitalization and pharmacologic weaning using morphine.<ref name=":13" /> Although morphine treatment was effective in most reported cases, little is known about the best dosing and medication schedule to mitigate withdrawal symptoms.<ref name=":13" /> Although most affected infants in the literature were born to mothers taking daily doses of kratom, it is unknown what degree of kratom use can cause neonatal abstinence syndrome. It is recommended that mothers taking kratom work with their physician to discontinue kratom usage.<ref name=":13" />
===Death=== Kratom overdose is a subject of concern in many countries because of the associated rising number of hospitalizations and deaths in which chronic kratom use is a contributing factor.<ref name=warner/><ref name=livertox/> According to clinical reviews, a kratom overdose can cause liver toxicity, seizures, coma, and death,<ref name=livertox/> especially in combination with excessive alcohol use. Between 2011 and 2017, 44 U.S. deaths were kratom-related.<ref name=FDA2018/> However, many cases could not be fully assessed, due to limited information.<ref name=FDA2018/> People who die from kratom use typically have taken it in combination with other substances, or have underlying health conditions.<ref name=corkery>{{cite journal |vauthors=Corkery JM, Streete P, Claridge H, Goodair C, Papanti D, Orsolini L, Schifano F, Sikka K, Körber S, Hendricks A |title=Characteristics of deaths associated with kratom use |journal=J. Psychopharmacol. (Oxford) |volume=33 |issue=9 |pages=1102–1123 |year=2019 |pmid=31429622 |doi=10.1177/0269881119862530 |hdl=2299/21622 |s2cid=201095094 |url=http://openaccess.sgul.ac.uk/111141/15/Characteristics%20of%20deaths%20associated%20with%20kratom%20use%20-%20JP%20-%20final%20version%20accepted%2017%20June%202019.docx |type=Review|hdl-access=free }}</ref>
Over 18 months in 2016 and 2017, 152 overdose deaths involving kratom were reported in the United States, with kratom as the primary overdose agent in 91 of the deaths, and 7 with kratom being the only agent detected.<ref name="cdc2019">{{cite journal|vauthors=Olsen EO, O'Donnell J, Mattson CL, Schier JG, Wilson N|title=Notes from the Field: Unintentional Drug Overdose Deaths with Kratom Detected — 27 States, July 2016 – December 2017|journal= MMWR. Morbidity and Mortality Weekly Report|date=12 April 2019|volume=68|issue=14|pages=326–327|doi=10.15585/mmwr.mm6814a2|pmid=30973850|pmc=6459583}}</ref><ref>{{cite news| title=CDC: Kratom linked to 91 U.S. overdose deaths |author=Mari A. Schaefer | agency=The Philadelphia Inquirer | publisher=Lodi News-Sentinel |page=16 |date=April 13, 2019}}</ref><ref>{{cite web|title=Kratom Caused 91 Overdose Deaths During 18-Month Period: CDC – Partnership News Service from the Partnership for Drug-Free Kids|url=https://drugfree.org/drug-and-alcohol-news/kratom-caused-91-overdose-deaths-during-18-month-period-cdc/|access-date=2020-08-05|website=Partnership to End Addiction {{!}} Where Families Find Answers|language=en-US}}</ref> Nine deaths occurred in Sweden during 2010–11 relating to use of ''Krypton'', a mixture of kratom, caffeine and O-desmethyltramadol, a metabolite of the opioid analgesic tramadol.<ref name="toxnet12">{{cite web|title=Mitragynine|url=https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+hsdb:@term+@DOCNO+7901|archive-url=https://web.archive.org/web/20181116131700/https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+hsdb:@term+@DOCNO+7901|archive-date=November 16, 2018|publisher=Toxnet, National Library of Medicine, US National Institutes of Health|access-date=15 February 2018|date=14 February 2012}}</ref><ref name="rosenbaum_2012">{{cite journal |vauthors=Rosenbaum CD, Carreiro SP, Babu KM |year=2012 |title=Here today, gone tomorrow…and back again? A review of herbal marijuana alternatives (K2, Spice), synthetic cathinones (bath salts), kratom, ''Salvia divinorum'', methoxetamine, and piperazines |journal=Journal of Medical Toxicology |volume=8 |issue=1 |pages=15–32 |doi=10.1007/s13181-011-0202-2 |pmc=3550220 |pmid=22271566}}</ref>
==Pharmacology== {| class="wikitable floatright" style="text-align: center;" |+ ''Mitragyna speciosa'' alkaloids at opioid receptors |- ! rowspan="2" | Compound || colspan="3" | Affinities ({{abbrlink|K<sub>i</sub> (nM)|Inhibitor constant}}) || Ratio || rowspan="2" | Ref |- ! {{abbrlink|MOR|μ-Opioid receptor}} !! {{abbrlink|DOR|δ-Opioid receptor}} !! {{abbrlink|KOR|κ-Opioid receptor}} !! MOR:DOR:KOR |- | 7-Hydroxymitragynine || 13.5 || 155 || 123 || 1:11:9 || <ref name="pmid11960505">{{cite journal | vauthors = Takayama H, Ishikawa H, Kurihara M, Kitajima M, Aimi N, Ponglux D, Koyama F, Matsumoto K, Moriyama T, Yamamoto LT, Watanabe K, Murayama T, Horie S | title = Studies on the synthesis and opioid agonistic activities of mitragynine-related indole alkaloids: discovery of opioid agonists structurally different from other opioid ligands | journal = J. Med. Chem. | volume = 45 | issue = 9 | pages = 1949–56 | year = 2002 | pmid = 11960505 | doi = 10.1021/jm010576e}}</ref> |- | Mitragynine || 7.24 || 60.3 || 1,100 || 1:8:152 || <ref name="pmid11960505" /> |- | Mitragynine pseudoindoxyl || 0.087 || 3.02 || 79.4 || 1:35:913 || <ref name="pmid11960505" /> |}
Kratom contains at least 54 alkaloids.<ref>{{Cite journal|last1=Kerrigan|first1=Sarah|last2=Basiliere|first2=Stephanie|title=Kratom: A systematic review of toxicological issues|url=https://onlinelibrary.wiley.com/doi/abs/10.1002/wfs2.1420|journal=WIREs Forensic Science|year=2021|volume=4|language=en|article-number=e1420|doi=10.1002/wfs2.1420|s2cid=236630556|issn=2573-9468|url-access=subscription}}</ref><ref>{{Cite journal|last1=Chakraborty|first1=Soumen|last2=Uprety|first2=Rajendra|last3=Daibani|first3=Amal E.|last4=Rouzic|first4=Valerie L.|last5=Hunkele|first5=Amanda|last6=Appourchaux|first6=Kevin|last7=Eans|first7=Shainnel O.|last8=Nuthikattu|first8=Nitin|last9=Jilakara|first9=Rahul|last10=Thammavong|first10=Lisa|last11=Pasternak|first11=Gavril W.|date=2021-07-21|title=Kratom Alkaloids as Probes for Opioid Receptor Function: Pharmacological Characterization of Minor Indole and Oxindole Alkaloids from Kratom|journal=ACS Chemical Neuroscience|volume=12|issue=14|pages=2661–2678|doi=10.1021/acschemneuro.1c00149|issn=1948-7193|pmc=8328003|pmid=34213886}}</ref><ref>{{Cite journal|last1=Flores-Bocanegra|first1=Laura|last2=Raja|first2=Huzefa A.|last3=Graf|first3=Tyler N.|last4=Augustinović|first4=Mario|last5=Wallace|first5=E. Diane|last6=Hematian|first6=Shabnam|last7=Kellogg|first7=Joshua J.|last8=Todd|first8=Daniel A.|last9=Cech|first9=Nadja B.|last10=Oberlies|first10=Nicholas H.|date=2020-07-24|title=The Chemistry of Kratom [''Mitragyna speciosa'']: Updated Characterization Data and Methods to Elucidate Indole and Oxindole Alkaloids|journal=Journal of Natural Products|volume=83|issue=7|pages=2165–2177|doi=10.1021/acs.jnatprod.0c00257|issn=0163-3864|pmc=7718854|pmid=32597657|bibcode=2020JNAtP..83.2165F }}</ref> These include mitragynine, 7-hydroxymitragynine (7-HMG), speciociliatine, paynantheine, corynantheidine, speciogynine, mitraphylline, rhynchophylline, mitralactonal, raubasine, and mitragynaline.<ref name="white" /><ref name="warner" /><ref name=":3" /> The alkaloids mitragynine and 7-hydroxymitragynine are responsible for many of the complex effects of kratom,<ref name="white" /><ref name="warner" /> but other alkaloids may also contribute synergistically.<ref name=":3" />
The effects of both mitragynine and 7-HMG remain disputed despite substantial study. Both are partial agonists of the μ-opioid receptor. While most data indicates agonism at all three opioid receptors, other data suggests the alkaloids are antagonists of the δ-opioid receptor with low affinity for the κ-opioid receptor.<ref name=":3" /><ref name=":4" /> 7-HMG appears to have higher affinity at the μ-opioid receptor than mitragynine.<ref name="white" /><ref name="Kruegel" /> These compounds display functional selectivity and do not activate the β-arrestin pathway partly responsible for the respiratory depression, constipation, and sedation associated with traditional opioids.<ref name=":3" /><ref>{{Cite journal|last1=Ya|first1=Kimheang|last2=Tangamornsuksan|first2=Wimonchat|last3=Scholfield|first3=C. Norman|last4=Methaneethorn|first4=Janthima|last5=Lohitnavy|first5=Manupat|date=2019|title=Pharmacokinetics of mitragynine, a major analgesic alkaloid in kratom (''Mitragyna speciosa''): A systematic review|journal=Asian Journal of Psychiatry|volume=43|pages=73–82|doi=10.1016/j.ajp.2019.05.016|pmid=31100603|s2cid=157067698|issn=1876-2018}}</ref> Both mitragynine and 7-HMG readily cross the blood–brain barrier.<ref name=":4" /><ref>{{Cite journal|last1=Gonçalves|first1=Joana|last2=Luís|first2=Ângelo|last3=Gallardo|first3=Eugenia|last4=Duarte|first4=Ana Paula|date=2021-03-05|title=Psychoactive Substances of Natural Origin: Toxicological Aspects, Therapeutic Properties and Analysis in Biological Samples|journal=Molecules|volume=26|issue=5|page=1397|doi=10.3390/molecules26051397|issn=1420-3049|pmc=7961374|pmid=33807728|doi-access=free}}</ref>
Mitragynine also appears to inhibit COX-2, block L-type and T-type calcium channels, and interact with other receptors in the brain including 5-HT<sub>2C</sub> and 5-HT<sub>7</sub> serotonin receptors, D<sub>2</sub> dopamine receptors, and A<sub>2A</sub> adenosine receptors.<ref name=":3" /> Mitragynine stimulates α<sub>2</sub>-adrenergic receptors, inhibiting the release of norepinephrine (noradrenaline); other compounds in this class include dexmedetomidine, which is used for sedation, and clonidine, which is used to manage anxiety and some symptoms of opioid withdrawal. This activity might explain why kratom can be dangerous when used in combination with other sedatives.<ref name="white" /> Kratom also contains rhynchophylline, a non-competitive NMDA receptor antagonist.<ref name="warner" /><ref>{{Cite journal|last1=Brown|first1=Paula N.|last2=Lund|first2=Jensen A.|last3=Murch|first3=Susan J.|date=2017-04-18|title=A botanical, phytochemical and ethnomedicinal review of the genus ''Mitragyna'' korth: Implications for products sold as kratom|journal=Journal of Ethnopharmacology|volume=202|pages=302–325|doi=10.1016/j.jep.2017.03.020|issn=1872-7573|pmid=28330725}}</ref>
Mitragynine is metabolized in humans via phase I and phase II mechanisms with the resulting metabolites excreted in urine.<ref name="warner" /> In ''in vitro'' experiments, kratom extracts inhibited CYP3A4, CYP2D6, and CYP1A2 enzymes, which results in significant potential for drug interactions.<ref name="warner" />
{| class="wikitable" |+ Table 1: Pharmaceutical profile of Kratom | colspan="2" |Kratom (Mitragynine, 7-Hydroxy-Mitragynine, Speciogynine, Paynantheine, Speciociliatine, Corynantheidine, Corynoxeine, Corynoxine B, Speciofoline) |- |Bioavailability: |PO estimated at 30%<ref name=":11">{{Cite journal |last1=Tanna |first1=Rakshit S. |last2=Nguyen |first2=James T. |last3=Hadi |first3=Deena L. |last4=Layton |first4=Matthew E. |last5=White |first5=John R. |last6=Cech |first6=Nadja B. |last7=Oberlies |first7=Nicholas H. |last8=Rettie |first8=Allan E. |last9=Thummel |first9=Kenneth E. |last10=Paine |first10=Mary F. |date=June 2023 |title=Clinical Assessment of the Drug Interaction Potential of the Psychotropic Natural Product Kratom |journal=Clinical Pharmacology & Therapeutics |language=en |volume=113 |issue=6 |pages=1315–1325 |doi=10.1002/cpt.2891 |issn=0009-9236 |pmc=10198846 |pmid=36924284}}</ref> |- |Onset: |PO: 30 minutes |- |Peak plasma time: |1–4.5 hrs<ref name=":11" /> |- |Duration: |3 or more hours<ref name=":11" /> |- |Half-life: |12–45 hours<ref name=":11" /> |- |Receptors: |{{unbulleted list|Kappa: competitive antagonist |Delta: competitive antagonist |Mu: partial agonist |''α''2 adrenergic |Adenosine A2a |Dopamine D2 |Serotonin receptors 5-HT2C and 5-HT7<ref name=":11" />}} |- |Mechanism of action: |Competitive antagonist at Kappa opioid receptors with stronger affinity compared to other receptors, competitive antagonist at Delta opioid receptors. Partial agonist at Mu opioid receptors. Causes G-protein linked second messenger activation, and calcium channel blocker.<ref name=":11" /> |- |Metabolism: |Cytochrome P-450, inhibitor of CYP2D6 and CYP3A<ref name=":11" /> |- |Excretion: |Renally |}
== Chemistry == {{Main|Mitragynine}}
Many of the key psychoactive compounds in ''M. speciosa'' are indole alkaloids related to mitragynine, which is a tetracyclic relative of the pentacyclic indole alkaloids, yohimbine and voacangine.<ref name="warner" /> In particular, mitragynine and 7-hydroxymitragynine (7-HMG) compose significant proportions of the natural products isolable from ''M. speciosa''; e.g., in one study, mitragynine was 12% by weight from Malaysian leaf sources, ''versus'' 66% from Thai sources, and 7-hydroxymitragynine constituted ~2% by weight.<ref name="NIH Kratom Pharmacology">{{cite web |date=November 10, 2015 |vauthors=Cinosi E, Martinotti G, Simonato P, Singh D, Demetrovics Z, Urrestarazu A, Bersani F, Vicknasingam B, Piazzon G, Li W, Yu W, Foveny M, Farkas J, Giannantonio M, Corazza O|title=Following “the Roots” of Kratom (Mitragyna speciosa): The Evolution of an Enhancer from a Traditional Use to Increase Work and Productivity in Southeast Asia to a Recreational Psychoactive Drug in Western Countries |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC4657101/ |access-date=February 3, 2026 |website=National Institute of Health, National Council for Behavioral Health}}</ref> At least 40 other compounds have been isolated from ''M. speciosa'' leaves,<ref name="Adkins 2011-05-01" /> including ~25 additional alkaloids, including raubasine/ajmalicine (originally isolated from ''Rauvolfia serpentina''), corynantheidine (also found in ''Corynanthe johimbe''),<ref name="pmid11960505" /> as well as mitraphylline, mitragynine pseudoindoxyl, and rhynchophylline.<ref>{{cite journal |vauthors=Suhaimi FW, Yusoff NH, Hassan R, Mansor SM, Navaratnam V, Müller CP, Hassan Z |year=2016 |title=Neurobiology of Kratom and its main alkaloid mitragynine |journal=Brain Res Bull |volume=Mar 25 |issue=Pt 1 |pages=29–40 |doi=10.1016/j.brainresbull.2016.03.015 |pmid=27018165 |s2cid=3952200}}</ref><ref name="Pharmacology">{{Cite journal |last1=Prozialeck |first1=WC |last2=Jivan |first2=JK |last3=Andurkar |first3=SV |year=2012 |title=Pharmacology of kratom: an emerging botanical agent with stimulant, analgesic, and opioid-like effects |journal=The Journal of the American Osteopathic Association |volume=112 |issue=12 |pages=792–99 |pmid=23212430}}</ref>
In addition to alkaloids, ''M. speciosa'' produces many other secondary metabolites. These include various saponins, iridoids and other monoterpenoids, triterpenoids such as ursolic acid and oleanic acid, as well as various polyphenols including the flavonoids apigenin and quercetin.<ref name="StudiesNatProductsChemKratom">{{cite web |date=April 15, 2021 |vauthors=Ramanathan S, Leon F, Nelson Chear N, Yusof S, Murugaiyah V, McMahon L, McCurdy C |title=Kratom (''Mitragyna speciosa'' Korth.): A description on the ethnobotany, alkaloid chemistry, and neuropharmacology |pages=195–225 |url=https://www.sciencedirect.com/science/chapter/bookseries/abs/pii/B9780128194874000033?via%3Dihub |access-date=February 3, 2026 |website=Science Direct}}</ref> Although some of these compounds possess antinociceptive, anti-inflammatory, gastrointestinal, antidepressant, antioxidant, and antibacterial effects in cells and non-human animals, there is no sufficient evidence to support the clinical use of kratom in humans.<ref name=":4" />
=== Detection in body fluids=== The plant's active compounds and metabolites are not detected by a typical drug screening test but can be detected by more specialized testing.<ref name="rosenbaum_2012" /><ref>{{cite journal |vauthors=Le D, Goggin MM, Janis GC |year=2012 |title=Analysis of mitragynine and metabolites in human urine for detecting the use of the psychoactive plant kratom |journal=Journal of Analytical Toxicology |volume=36 |issue=9 |pages=616–25 |doi=10.1093/jat/bks073 |pmid=23024321 |doi-access=free}}</ref> Blood mitragynine concentrations are expected to be in a range of 10–50'' ''μg/L in persons using the drug recreationally. Detection in body fluids is typically by liquid chromatography-mass spectrometry.<ref name="rosenbaum_2012" /><ref>{{cite book |author=Baselt RC |title=Disposition of toxic drugs and chemicals in man |publisher=Biomedical Publications |year=2014 |isbn=978-0-9626523-9-4 |location=Seal Beach, Calif. |page=1382}}</ref>
==Regulation== thumb|upright=1.35|Kratom status by country {{legend-col |{{legend|#cc3333|Illegal}} |{{legend|#edf8b1|Prescription required}} |{{legend|#6999bc|Legal as not for human consumption}} |{{legend|#a8ddb5|Legal and regulated}} |{{legend|#41ae76|Legal and unregulated}} }} {{As of|2018|January}}, neither the plant nor its alkaloids were listed in any of the Schedules of the United Nations Drug Conventions.<ref name=EMCDDA/>
In 2021, the World Health Organization's Executive Committee on Drug Dependency investigated the risks of kratom and declined to recommend a critical review of it. The committee, however, recommended kratom be kept "under surveillance."<ref>{{cite web|url=https://s3.documentcloud.org/documents/21150126/ecdd-report-dec-2021.pdf|title=Summary of assessments, findings and recommendations of the 44th World Health Organization's (WHO) Expert Committee on Drug Dependence (ECDD)|date=October 2021|website=SD3.documentcloud.org|access-date=24 June 2022}}</ref>
===ASEAN=== {{As of|2013}}, kratom was listed by ASEAN in its annex of products that cannot be included in traditional medicines and health supplements that are traded across ASEAN nations.<ref>{{cite web|publisher=Association of South East Asian Nations (ASEAN)|url=http://www.fda.gov.ph/attachments/article/218035/ANNEX%20I%20ASEAN%20GP%20for%20the%20Negative%20List%20Ver%203.0%20(14Nov14).pdf|title=Annex I: ASEAN Guiding Principles For Inclusion into or Exclusion from the Negative List of Substances for Traditional Medicines and Health Supplements|date=June 28, 2014|access-date=September 12, 2016|archive-url=https://web.archive.org/web/20161026164939/http://www.fda.gov.ph/attachments/article/218035/ANNEX%20I%20ASEAN%20GP%20for%20the%20Negative%20List%20Ver%203.0%20(14Nov14).pdf|archive-date=October 26, 2016}}</ref>
===Australia and New Zealand=== Mitragyna speciosa is a prohibited substance in Australia.<ref>{{Cite web |title=Therapeutic Goods (Poisons Standard—October 2025) Instrument 2025 |url=https://www.legislation.gov.au/F2025L01181/latest/text |website=Federal Register of Legislation |date=25 September 2025 |publisher=Australian Government |access-date=2025-12-04}}</ref> In New Zealand, Mitragyna speciosa is designated a prescription medicine, and its use in herbal remedies is prohibited under section 2 of the Medicines Act 1981.<ref>{{Cite web |title=Kratom – not such a nice cup of tea |url=https://www.medsafe.govt.nz/profs/PUArticles/December2021/Kratom-not-such-a-nice-cup-of-tea.html |website=Medsafe |publisher=New Zealand Medicines and Medical Devices Safety Authority |date=2 December 2021 |access-date=2025-12-04}}</ref>
===Canada=== {{As of|2020|October}}, Health Canada disallowed marketing of kratom for any use by ingestion<ref>{{cite web |title=Unauthorized products may pose serious health risks (kratom) |url=https://www.healthycanadians.gc.ca/recall-alert-rappel-avis/hc-sc/2020/74169a-eng.php |publisher=Health Canada |access-date=18 January 2021 |date=21 October 2020}}</ref> and has taken action against companies marketing it for such purposes.<ref>{{cite web|title=Health Product Advertising Complaints|date=26 March 2015 |url=http://www.hc-sc.gc.ca/dhp-mps/advert-publicit/complaint-plaintes/index-eng.php|publisher=Health Canada, Health Products and Food Branch|archive-url=https://web.archive.org/web/20170214220337/http://www.hc-sc.gc.ca/dhp-mps/advert-publicit/complaint-plaintes/index-eng.php|archive-date=14 February 2017}}</ref><ref>{{cite news|url=https://globalnews.ca/news/3561227/kratom-a-controversial-herbal-product-seized-from-2-edmonton-stores-health-canada/|title=Kratom, a controversial herbal product, seized from 2 Edmonton stores: Health Canada|author=Phil Heidenreich|date=27 June 2017|newspaper=Global News}}</ref> Kratom can be marketed for other uses, such as incense.<ref>{{cite web|url=https://ca.news.yahoo.com/after-us-delayed-decision-on-kratom-a-look-at-213934868.html|title=After U.S. delayed decision on kratom, a look at Canada's laws on the {{sic|psych|adelic|hide=y}} plant|publisher=Yahoo News Canada|date=14 October 2016|author=Coles, Terri}}</ref>
===Europe=== {{As of|2011}}, the plant was controlled in Denmark, Latvia, Lithuania, Poland, Romania, and Sweden.<ref name=EMCDDA/>
In Bulgaria and Norway, kratom is a controlled substance.<ref>{{Cite web |title=Какво е кратом? |url=https://www.drugsinfo-bg.org/azbuka-na-narkoticite/kratom/kakvo-e-kratom/ |access-date=2023-11-28 |website=Национална информационн�� линия за наркотиците, алкохола и хазарта}}</ref><ref>{{Cite web |url=https://www.legemiddelverket.no/nyheter/nye-stoff-pa-narkotikalista |title=Nye stoff på narkotikalista |trans-title=New Drugs on Narcotics List |language=Norwegian Bokmål |date=13 December 2023 |access-date=2025-01-25 |publisher=Norwegian Medical Products Agency |archive-url=https://web.archive.org/web/20241109100909/https://www.dmp.no/nyheter/nye-stoff-pa-narkotikalista |archive-date=9 November 2024 }}</ref>
In the Czech Republic, regulated sales of kratom and kratom extracts became legal starting in July 2025.<ref>{{cite web |date= 8 January 2025 |title= Czechia to regulate low-THC cannabis in 2025: Not a win for legalization, but a start |url= https://www.expats.cz/czech-news/article/czech-republic-to-regulate-sales-of-kratom-and-low-thc-cannabis-in-2025-what-it-means-for-consumers |website= Expats.cz |access-date= 19 August 2025}}</ref>
In Finland, scheduled in the "government decree on psychoactive substances banned from the consumer market".<ref>{{cite web | title=Valtioneuvoston asetus kuluttajamarkkinoilta kielletyistä psykoaktiivisista aineista | 1130/2014 | Lainsäädäntö | Finlex | url=https://finlex.fi/fi/lainsaadanto/2014/1130 }}</ref>
In the Republic of Ireland in 2017, kratom was designated a Schedule'' ''1 illegal drug (the highest level), under the names 7-hydroxymitragynine and mitragynine.<ref>{{cite web|url=https://health.gov.ie/wp-content/uploads/2017/05/si174.pdf|title=MISUSE OF DRUGS (DESIGNATION) ORDER 2017|date=2017|website=STATUTORY INSTRUMENTS, S.I. No. 174 of 2017. Stationery Office, Dublin}}</ref>
In the UK, the sale, import, and export of kratom is prohibited under the Psychoactive Substances Act 2016, which broadly bans any substance that "produces a psychoactive effect".<ref>{{cite web |url=http://www.legislation.gov.uk/ukpga/2016/2/contents |title=Psychoactive Substances Act 2016 |publisher=The National Archives, HM Government Publishing |date=9 September 2016}}</ref><ref>{{cite news | url=https://www.heraldscotland.com/news/18448896.father-son-charged-154-kilos-kratom-found-airports/ | title=Father and son charged after 154 kilos of Kratom found at airports | date=14 May 2020 | newspaper=The Herald | access-date=26 August 2025}}</ref>
=== South America === Chile banned Kratom in 2021.<ref>{{cite web|date=January 21, 2021|title=UNODC - Drug Laws/Individual Listing for CHILE|url=https://www.unodc.org/LSS/Country/DetailsLegalSystem?code=DLIL&country=CL|access-date=2025-01-27|website=beritasatu.com|language=id}}</ref>
Argentina banned Kratom in 2017.<ref>{{Cite web |title=Argentina.gob.ar |url=https://www.argentina.gob.ar/normativa/nacional/decreto-69-2017-271200/texto |access-date=2025-03-31 |website=Argentina.gob.ar |date=25 January 2017 |language=es}}</ref>
Brazil listed kratom as a New Psychoactive Substance (NPS) in 2020. However, it remains legal until it is included among prohibited substances.<ref>[https://worldpopulationreview.com/country-rankings/kratom-legality-by-country Kratom Legality by Country 2025]</ref><ref>{{Cite web | title=Lista de substâncias sujeitas a controle especial no Brasil |work=Agência Nacional de Vigilância Sanitária - Anvisa |url=https://www.gov.br/anvisa/pt-br/assuntos/medicamentos/controlados/lista-substancias | language = pt-BR | access-date=2025-06-27}}</ref>
=== Indonesia === Kratom was previously scheduled to become an illegal substance in Indonesia in 2024 once new regulations from the Indonesian National Narcotics Agency (BNN) go into effect.<ref>{{cite web|date=December 22, 2020|title=Mulai 2024, Pemerintah Larang Penggunaan dan Ekspor Kratom|url=https://www.beritasatu.com/nasional/811035/mulai-2024-pemerintah-larang-penggunaan-dan-ekspor-kratom|access-date=2022-06-12|website=beritasatu.com|language=id}}</ref> However, in 2024, a revision to a regulation by Ministry of Trade legalized production and export of kratom leaves.<ref name=":9">{{Cite web |last=adminkalbaronline |date=2024-09-04 |title=Bupati Kapuas Hulu: Sudah Terbit Permendag RI Nomor 21 Tahun 2024 Tentang Ekspor Komoditi Kratom - KalbarOnline.Com |url=https://kalbaronline.com/2024/09/04/bupati-kapuas-hulusudah-terbit-permendag-ri-nomor-21-tahun-2024-tentang-ekspor-komoditi-kratom/ |archive-url=https://web.archive.org/web/20240909211800/https://kalbaronline.com/2024/09/04/bupati-kapuas-hulusudah-terbit-permendag-ri-nomor-21-tahun-2024-tentang-ekspor-komoditi-kratom/ |url-status=usurped |archive-date=September 9, 2024 |access-date=2024-09-04 |website=kalbaronline.com/ |language=en-US}}</ref> Later in September 2024, Indonesia's Ministry of Cooperatives and Small Medium Business stated that Indonesia will start building downstream industries for kratom exports.<ref>{{Cite web |title=Teten Masduki Akan Wariskan Program Hilirisasi Kratom untuk Prabowo |url=https://kumparan.com/kumparanbisnis/teten-masduki-akan-wariskan-program-hilirisasi-kratom-untuk-prabowo-23XfQMRRM7n |access-date=2024-09-18 |website=kumparan |language=id-ID}}</ref><ref name=":10">{{Cite web |title=Menkop Teten Dorong Hilirisasi Produk Kratom, Bisa Dijual Rp90 Juta per Kilogram |url=https://www.merdeka.com/uang/menkop-teten-dorong-hilirisasi-produk-kratom-bisa-dijual-rp90-juta-per-kilogram-198673-mvk.html |access-date=2024-09-18 |website=merdeka.com |date=17 September 2024 |language=en}}</ref> These developments made kratom legal to export and manufacture in Indonesia.<ref name=":9" /><ref name=":10" />
=== Japan === Kratom is classified as a designated drug, and its manufacture, import, possession, and use, are illegal.<ref>{{cite web |date=March 3, 2016 |title=危険ドラッグの成分５物質及び１植物種を新たに指定薬物に指定 |url=https://www.mhlw.go.jp/stf/houdou/0000115295.html |trans-title=Five dangerous drug ingredients and one plant species are newly designated as designated drugs |website=Ministry of Health, Labour and Welfare, Japan |language=Japanese |access-date=November 26, 2025}}</ref>
===Malaysia=== The use of kratom leaves, known locally as ''ketum or Biak'' is prohibited to use, import, export, manufacture, compound, mix, dispense, sell, supply, administer or possess in Malaysia under Section 30(3) of the Poisons Act 1952, and will be punished by imprisonment or fine or both.<ref name=Utusan>{{cite web|title=Amend the Act leaves the density of the Dangerous Drugs Act|url=https://translate.google.com/translate?hl=en&sl=auto&tl=en&prev=_dd&u=http%3A%2F%2Fwww.utusan.com.my%2Futusan%2FParlimen%2F20121213%2Fpa_02%2FPinda-akta-daun-ketum-kepada-Akta-Dadah-Berbahaya|access-date=18 April 2014|date=13 December 2012}}</ref> Although prohibited by statute, the use of kratom remains widely spread especially in Northern and East Coast region of Malaysia's Peninsula because the tree grows natively and tea decoctions are readily available in local communities.<ref>Veltri C, Grundmann O. Current perspectives on the impact of Kratom use. Subst Abuse Rehabil. 2019;10:23–31. Published 2019 Jul 1. doi:10.2147/SAR.S164261</ref> Certain parties have urged the government to penalize the use of kratom under the Dangerous Drugs Act instead of the Poisons Act, which would carry heavier penalties.<ref name="TMI">[https://web.archive.org/web/20121029094717/http://www.themalaysianinsider.com/malaysia/article/pengasih-wants-abuse-of-kratom-leaves-penalised-under-dangerous-drugs-act/ Pengasih wants abuse of kratom leaves penalised under Dangerous Drugs Act]. The Malaysian Insider. October 28, 2012.</ref>
===Thailand=== Possession of kratom was illegal in Thailand until 2018.<ref name=AJ-20181226>{{cite news |title=Thailand legislature legalises medical cannabis and kratom |url=https://www.aljazeera.com/news/2018/12/thailand-legislature-legalises-medical-cannabis-kratom-181226010249208.html |access-date=26 December 2018 |work=Aljazeera English |date=26 December 2018}}</ref> The Thai government had passed the Kratom Act 2486, effective 3 August 1943, which made planting the tree illegal,<ref name=usdea/> in response to a rise in its use when opium became very expensive in Thailand and the government was attempting to gain control of the opium market.<ref name=warner/> In 1979, the government placed kratom, along with cannabis, in Category'' ''V of a five-category classification of narcotics.<ref name=usdea/> Kratom accounted for less than two percent of arrests for narcotics between 1987 and 1992.<ref>{{cite journal |last1=Cheurprakobkit |first1=Sutham |title=The drug situation in Thailand: the role of government and the police |journal=Drug and Alcohol Review |volume=19 |issue=1 |year=2000 |pages=17–26 |doi=10.1080/09595230096101 }}</ref>
The Thai government has considered legalizing kratom for recreational use in 2004, 2009, 2013, and 2020.<ref>{{cite news |title=Leafy highs: Kratom personal use push under way |url=https://www.bangkokpost.com/thailand/general/1850589/leafy-highs-kratom-personal-use-push-under-way |access-date=5 February 2020 |work=Bangkok Post |date=5 February 2020}}</ref><ref>{{cite news|last1=Prasert|first1=Poungchompoo|title=Decision yet to be reached on making 'kratom' legal|url=http://www.nationmultimedia.com/national/Decision-yet-to-be-reached-on-making-kratom-legal-30216276.html|work=The Nation|date=4 October 2013|access-date=13 September 2016|archive-date=16 May 2019|archive-url=https://web.archive.org/web/20190516113645/http://www.nationmultimedia.com/national/Decision-yet-to-be-reached-on-making-kratom-legal-30216276.html}}</ref> In 2018, Thailand became the first Southeast Asian country to legalize kratom for medical purposes.<ref name=AJ-20181226 /> In 2021, Thailand fully legalized kratom and removed it from the list of Category'' ''V narcotics, and more than 12,000 people who had been convicted for kratom-related offences when it was still considered a narcotic were granted an amnesty.<ref>{{Cite news|title=Parliament votes to remove kratom from narcotics list|work=Bangkok Post|date=27 January 2021 |url=https://www.bangkokpost.com/thailand/general/2058139/parliament-votes-to-remove-kratom-from-narcotics-list|access-date=2021-06-22 | vauthors = Sattaburuth A }}</ref><ref>{{cite news |last=Laohong |first=King-oua |date=2021-08-23 |title=Kratom now listed as legal herb |url=https://www.bangkokpost.com/thailand/general/2169411/kratom-now-listed-as-legal-herb |work=Bangkok Post |access-date=2021-08-24}}</ref>
===United States=== In 2014, the United States Food and Drug Administration (FDA) banned the import of kratom into the U.S. due to a lack of evidence for its safety.<ref name="FDAImportAlert" /> {{as of|2026}}, kratom is illegal in seven states: Alabama, Arkansas, Connecticut, Indiana, Louisiana, Rhode Island, Vermont, and Wisconsin, and it may be outlawed by local ordinance in other states.<ref name="KratomSummaryStateLaws">{{cite web |date=April 2025 |title=Kratom: Summary of State Laws |url=https://legislativeanalysis.org/wp-content/uploads/2025/07/Kratom-Summary-of-State-Laws.pdf |access-date=February 3, 2026 |website=Legislative Analysis}}</ref> As of early 2026, the states of Iowa, Nebraska, and South Dakota introduced bills with legislation that would ban kratom, while Iowa and Nebraska would also classify kratom as a Schedule I drug.<ref name ="TheMarijuanaHerald">{{cite web |date=January 22, 2026 |title=Numerous Kratom Bills Filed Throughout the U.S in Early 2026 |url=https://themarijuanaherald.com/2026/01/numerous-kratom-bills-filed-throughout-the-u-s-in-early-2026/ |access-date=February 3, 2026 |website=The Marijuana Herald}}</ref> In 2025, it was banned in the following Massachusetts communities: Belchertown, Canton, Chelmsford, Dracut, Kingston, Lowell, Marlborough, and Northampton.<ref name ="TheProvincetownIndependent">{{cite web |date=December 23, 2025 |title=Considering Kratom |url=https://provincetownindependent.org/news/2025/12/23/considering-kratom/ |access-date=February 3, 2026 |website=Province Town Independent}}</ref> As of December 12, 2025, the state of Ohio temporarily banned kratom-related products for 180 days, with the Ohio Board of Pharmacy moving toward a permanent ban on all forms of kratom by mid-2026.<ref name ="HealthPolicyOhio">{{cite web |date=January 9, 2026 |title=Ohio Pharmacy Board moves to ban natural kratom |url=https://www.healthpolicyohio.org/health-policy-news/2026/01/09/ohio-pharmacy-board-moves-to-ban-natural-kratom |access-date=February 3, 2026 |website=Health Policy Institute of Ohio}}</ref> In late 2025, California Governor Gavin Newsom's administration began warning retailers that it is illegal to sell or manufacture kratom, which led to Los Angeles County banning kratom and Orange County significantly restricting kratom by banning synthetic or concentrated kratom products containing more than 2% 7-hydroxymitragynine.<ref name ="San Francisco Gate">{{cite web |date=February 2, 2026 |title='Gone overnight' Newsom launches major crackdown on painkiller |url=https://www.sfgate.com/bayarea/article/california-kratom-7oh-crackdown-21324555.php |access-date=February 3, 2026 |website=SFGate}}</ref> In 2016, kratom was banned in the cities of San Diego and Oceanside in the state of California.<ref name ="nbcSanDiego">{{cite web |date=September 17, 2025 |title=Feds call for crackdown on 7-OH products, widely available across San Diego County |url=https://www.nbcsandiego.com/news/local/kratom-product-san-diego-county/3901746/ |access-date=February 3, 2026 |website=NBC San Diego}}</ref> There was consideration in late 2017 to make kratom a Schedule I drug.<ref>{{cite web|url=https://www.statnews.com/2018/11/09/hhs-recommended-dea-ban-kratom-documents-show/|title=HHS recommended that the DEA ban kratom, documents show – STAT|date=9 November 2018|website=STAT|access-date=15 November 2018}}</ref> In 2019, the FDA warned consumers that kratom remains unapproved for interstate commerce for use as a drug,<ref name="fda6-19">{{cite web |title=FDA issues warnings to companies selling illegal, unapproved kratom drug products marketed for opioid cessation, pain treatment and other medical uses |url=https://www.fda.gov/news-events/press-announcements/fda-issues-warnings-companies-selling-illegal-unapproved-kratom-drug-products-marketed-opioid |publisher=US Food and Drug Administration |access-date=16 January 2020 |date=25 June 2019}}{{dead link|date=May 2025|bot=medic}}{{cbignore|bot=medic}}</ref> may be unsafe in commercially available products, and is on an import alert, which can lead to confiscation of imported supplies.<ref name="fda4-3-19" /> Efforts to schedule kratom generated significant controversy, both among the general public and the scientific community, and were ultimately unsuccessful.<ref name=":2" /><ref>{{cite web|last=MD|first=Peter Grinspoon|date=2019-08-07|title=Kratom: Fear-worthy foliage or beneficial botanical?|url=https://www.health.harvard.edu/blog/kratom-fear-worthy-foliage-or-beneficial-botanical-2019080717466|access-date=2021-06-21|website=Harvard Health}}</ref><ref>{{cite web|date=2016-09-08|title=Kratom ban will hinder studies of the plant as a treatment|url=https://www.statnews.com/2016/09/08/kratom-ban-hinders-research/|access-date=2021-06-21|website=Stat}}</ref>
On August 13, 2025, Florida Attorney General James Uthmeier announced an emergency rule placing 7-hydroxymitragynine into Schedule I status under Florida state law, without any mention of a carve out or any exclusions for ''Mitragyna speciosa'' which contains low amounts of 7OH, effectively making kratom illegal in Florida.<ref>{{cite web | title=Attorney General James Uthmeier Files Emergency Rule; Immediately Removing Dangerous 7-OH from Store Shelves | My Florida Legal | url=https://www.myfloridalegal.com/newsrelease/attorney-general-james-uthmeier-files-emergency-rule-immediately-removing-dangerous-7 }}</ref><ref>{{cite web | title=Florida AG announces ban on "7-OH" products | date=13 August 2025 | url=https://www.axios.com/local/tampa-bay/2025/08/13/florida-ag-ban-7-oh-kratom-products }}</ref>
==== FDA assessment ==== In April 2019, the FDA issued a statement declaring that kratom was not approved for any medical use, was potentially unsafe in commercial products available in the United States, and remained on an import alert where imported supplies would be confiscated.<ref name="fda4-3-19" /> On April 4, 2018, the FDA issued the first mandatory recall in its history over concerns of salmonella contamination of several kratom-containing products.<ref name="Chappell">{{cite news|last1=Chappell|first1=Bill|title=FDA Orders An Unprecedented Recall After Kratom Company Ignored Its Requests|url=https://www.npr.org/sections/thetwo-way/2018/04/04/599443476/fda-orders-an-unprecedented-recall-after-kratom-company-ignored-its-requests|access-date=5 April 2018|work=NPR|date=4 April 2018}}</ref> Samples of the products, manufactured by Triangle Pharmanaturals, and marketed under the brand name 'Raw Form Organics', tested positive for contamination and the manufacturer did not comply with federal requests for voluntary recall.<ref name="FDArecall">{{cite web|last1=FDA News Release|title=FDA orders mandatory recall for kratom products due to risk of salmonella|url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm603517.htm|archive-url=https://web.archive.org/web/20180405080743/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm603517.htm|archive-date=April 5, 2018|website=Press Announcements|publisher=United States Food and Drug Administration|access-date=5 April 2018}}</ref> FDA Commissioner Gottlieb stated that the recall was "...based on the imminent health risk posed by the contamination of this product with salmonella" and not related to other regulatory concerns.<ref name="Chappell" /> Consumers were advised to immediately discard any such products to prevent serious health risks.<ref name="FDArecall" />
In February 2018, the commissioner of the FDA, Scott Gottlieb, released a statement describing further opioid-like properties of kratom and stating that it should not be used for any medical treatment or recreational use.<ref name=FDA2018/> Also in 2018, the FDA supervised the voluntary destruction of kratom dietary supplements by a nationwide distributor in Missouri, and encouraged all companies involved in kratom commerce to remove their products from the market.<ref>{{cite web|title=FDA oversees destruction and recall of kratom products; and reiterates its concerns on risks associated with this opioid| url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm597649.htm| archive-url=https://web.archive.org/web/20180222111732/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm597649.htm| archive-date=February 22, 2018|publisher=U.S. Food and Drug Administration|access-date=7 March 2018|date=21 February 2018|quote=The FDA recommends that consumers not use these or any kratom products and dispose of any products currently in their possession. While the FDA is not aware of recent reports of illness specifically associated with the use of Divinity Products Distribution's kratom-containing products, the agency asks healthcare professionals and consumers to report adverse events or quality problems associated with the use of Divinity Products Distribution's products or any kratom product to the agency's online Safety Reporting Portal}}</ref> On February 26, the FDA warned a California manufacturer of a kratom product called "Mitrasafe" that the supplement was not confirmed as safe, was not approved as a dietary supplement or drug, and was illegal for interstate commerce.<ref name=Tave />
Although it was a federally legal dietary supplement, kratom was not approved as a therapeutic agent in the United States due to the poor quality of the research.<ref name="white" /><ref name="warner" /> In November 2017, the FDA cited serious concerns over the marketing and effects (including death) associated with the use of kratom in the United States, stating that "There is no reliable evidence to support the use of kratom as a treatment for opioid use disorder; there are currently no FDA-approved therapeutic uses of kratom... and the FDA has evidence to show that there are significant safety issues associated with its use."<ref>{{cite web|title=Statement from FDA Commissioner Scott Gottlieb, M.D. on FDA advisory about deadly risks associated with kratom| url=https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm584970.htm| archive-url=https://web.archive.org/web/20171114183438/https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm584970.htm| archive-date=November 14, 2017|publisher=U.S. Food and Drug Administration|access-date=14 November 2017|date=14 November 2017|quote=Patients addicted to opioids are using kratom without dependable instructions for use and more importantly, without consultation with a licensed health care provider about the product's dangers, potential side effects or interactions with other drugs. There's clear data on the increasing harms associated with kratom. Calls to U.S. poison control centers regarding kratom have increased 10-fold from 2010 to 2015, with hundreds of calls made each year. The FDA is aware of reports of 36 deaths associated with the use of kratom-containing products. There have been reports of kratom being laced with other opioids like hydrocodone. The use of kratom is also associated with serious side effects like seizures, liver damage, and withdrawal symptoms}}</ref>
==== DEA scheduling ==== On August 30, 2016, the Drug Enforcement Administration (DEA) announced its intention to place the active materials in the kratom plant into Schedule I of the Controlled Substances Act as a warning about an imminent hazard to public safety, citing over 600 calls to poison control centers between 2010 and 2015 and 15 kratom-related deaths between 2014 and 2016.<ref name=dea>{{cite web | url=https://www.dea.gov/divisions/hq/2016/hq083016.shtml | title=DEA Announces Intent to Schedule Kratom: SE Asian drug is imminent hazard to public safety | publisher=US Drug Enforcement Administration | date=30 August 2016 | access-date=31 August 2016 | archive-url=https://web.archive.org/web/20160915180244/https://www.dea.gov/divisions/hq/2016/hq083016.shtml | archive-date=15 September 2016 }}</ref> This drew strong protests among those using kratom to deal with chronic pain or wean themselves off opioids or alcohol.<ref>{{cite web|last1=Silverman|first1=Lauren|title=Kratom Advocates Speak Out Against Proposed Government Ban|url=https://www.npr.org/sections/health-shots/2016/09/12/493295493/kratom-advocates-speak-out-against-proposed-government-ban|website=NPR|access-date=12 September 2016|date=12 September 2016}}</ref> A group of 51 members of the U.S. House of Representatives and a group of nine Senators each sent letters to acting DEA administrator Chuck Rosenberg protesting the listing and around 140,000 people signed an online White House Petition protesting it.<ref>{{cite news|last1=Ingraham|first1=Christopher|title=DEA defies senators' appeal to reconsider 'unprecedented' kratom ban |url=https://www.washingtonpost.com/news/wonk/wp/2016/09/30/dea-defies-senators-appeal-to-reconsider-unprecedented-kratom-ban/ |newspaper=The Washington Post|date=September 30, 2016}}</ref><ref>{{cite news|last1=Stapleton|first1=Christine|title=Congress members ask DEA not to ban kratom: opioid research needed|url=http://www.mypalmbeachpost.com/news/news/national-govt-politics/kratom-ban-starts-friday-frankel-among-lawmakers-t/nshQ6/|work=Palm Beach Post|date=September 29, 2016|access-date=October 2, 2016|archive-date=November 3, 2016|archive-url=https://web.archive.org/web/20161103190439/http://www.mypalmbeachpost.com/news/news/national-govt-politics/kratom-ban-starts-friday-frankel-among-lawmakers-t/nshQ6/}}</ref>
The DEA noted the responses but said that it intended to go forward with the listing; a spokesman said: "We can't rely upon public opinion and anecdotal evidence. We have to rely upon science."<ref>{{cite news|last1=Nelson|first1=Steven|title=Kratom Will Remain Legal for Days, Possibly Longer|url=https://www.usnews.com/news/articles/2016-09-30/kratom-will-remain-legal-for-days-possibly-longer|work=U.S. News & World Report|date=September 30, 2016}}</ref> In October 2016, the DEA withdrew its notice of intent while inviting public comments over a review period ending on December 1, 2016.<ref>{{Cite news|url=https://www.npr.org/sections/health-shots/2016/10/12/497697627/kratom-gets-reprieve-from-drug-enforcement-administration|title=Kratom Gets Reprieve From Drug Enforcement Administration|newspaper=NPR.org|access-date=2016-10-12}}</ref><ref>{{cite web|url=https://www.federalregister.gov/documents/2016/10/13/2016-24659/withdrawal-of-notice-of-intent-to-temporarily-place-mitragynine-and-7-hydroxymitragynine-into|title=Withdrawal of Notice of Intent to Temporarily Place Mitragynine and 7-Hydroxymitragynine Into Schedule I: A Proposed Rule by the Drug Enforcement Administration on 10/13/2016|date=2016-10-13|website=Federal Register|publisher=Drug Enforcement Administration|access-date=2016-10-18}}</ref> As of July 2016, Alabama, Arkansas, Indiana, Vermont, and Wisconsin had made kratom illegal,<ref>{{cite news|last1=Brown|first1=Melissa|title=States ban kratom supplement over abuse worries|url=https://www.usnews.com/news/us/articles/2016-05-20/states-ban-kratom-supplement-over-abuse-worries|work=Associated Press via US News & World Report|date=May 20, 2016}}</ref> and the US Army had forbidden soldiers from using it.<ref>{{cite news|last1=Schwarz|first1=Alan|title=Kratom, an Addict's Alternative, Is Found to Be Addictive Itself|url=https://www.nytimes.com/2016/01/03/us/kratom-an-addicts-alternative-is-found-to-be-addictive-itself.html|work=The New York Times|date=2 January 2016}}</ref> Between February 2014 and July 2016, U.S. law-enforcement authorities "encountered 55 tons of kratom," or roughly "50 million individual doses," according to the International Narcotics Control Board.<ref>{{cite web|url=https://www.outsideonline.com/2387546/kratom-safety|title=The Herbal Supplement That Might Be a Deadly Drug|last=Smith|first=Peter Andrey|date=2019-02-19|website=Outside Online|access-date=2019-02-20}}</ref>
==== Public response ==== The FDA's arguments for the federal prohibition of kratom have drawn both criticism and support.<ref name=":8">{{cite web|title=The U.S. May Ban Kratom. But Are its Effects Deadly or Lifesaving?|url=https://www.discovermagazine.com/health/the-us-may-ban-kratom-but-are-its-effects-deadly-or-lifesaving|access-date=2021-06-22|website=Discover Magazine|language=en}}</ref><ref name=":6">{{Cite magazine|last1=Garber-Paul|first1=Elisabeth|last2=Garber-Paul|first2=Elisabeth|date=2018-08-15|title=Kratom Association Calls FDA Review of Drug 'Junk Science' in Scathing Report|url=https://www.rollingstone.com/culture/culture-news/kratom-drug-industry-fda-opioid-711169/|access-date=2021-06-22|magazine=Rolling Stone|language=en-US}}</ref><ref name=":7">{{cite web|last=Marlan|first=Dustin|date=2021-06-08|title=A Sensible, Evidence-Based Proposal for Kratom Reform|url=https://blog.petrieflom.law.harvard.edu/2021/06/08/a-sensible-evidence-based-proposal-for-kratom-reform/|access-date=2021-06-22|website=Bill of Health|language=en-US}}</ref> FDA commissioner Gottlieb responded to criticism in 2018 by stating that "The FDA has done an exhaustive review of adverse event reports, clinical literature and other sources of information related to kratom."<ref name=":6" /> However, in 2021, former Acting Commissioner of Food and Drugs Brett Giroir claimed that the FDA's recommendation to schedule kratom was rejected because of "embarrassingly poor evidence [and] data."<ref name=":7" /> The FDA's position on kratom has also been criticized by the American Kratom Association and researchers including Walter Prozialeck.<ref name=":8" /><ref name=":6" /><ref>{{Cite journal|last1=Prozialeck|first1=Walter C.|last2=Avery|first2=Bonnie A.|last3=Boyer|first3=Edward W.|last4=Grundmann|first4=Oliver|last5=Henningfield|first5=Jack E.|last6=Kruegel|first6=Andrew C.|last7=McMahon|first7=Lance R.|last8=McCurdy|first8=Christopher R.|last9=Swogger|first9=Marc T.|last10=Veltri|first10=Charles A.|last11=Singh|first11=Darshan|date=2019|title=Kratom policy: The challenge of balancing therapeutic potential with public safety|journal=The International Journal on Drug Policy|volume=70|pages=70–77|doi=10.1016/j.drugpo.2019.05.003|issn=1873-4758|pmc=7881941|pmid=31103778}}</ref> Former commissioner Gottlieb continued to defend the agency's position in 2021, stating that he was convinced that kratom was fueling the U.S. opioid epidemic, though Gottlieb's partiality has been called into question as he has since gone on to become a member of the board of directors of Pfizer Inc., a company that has been heavily criticized for its sale and marketing of opioid drugs.<ref name=":7" />
== Research== Kratom is under preliminary research for possible antipsychotic and antidepressant properties, as well as pain management, withdrawal management, and dependence reduction.<ref name="ReferenceA"/><ref name="Jack T 2019"/><ref>{{Cite journal |last1=Prevete |first1=Elisabeth |last2=Kuypers |first2=Kim Paula Colette |last3=Theunissen |first3=Eef Lien |last4=Corazza |first4=Ornella |last5=Bersani |first5=Giuseppe |last6=Ramaekers |first6=Johannes Gerardus |date=2022 |title=A systematic review of (pre)clinical studies on the therapeutic potential and safety profile of kratom in humans |journal=Human Psychopharmacology: Clinical and Experimental |language=en |volume=37 |issue=1 |article-number=e2805 |doi=10.1002/hup.2805 |issn=1099-1077 |pmc=9285932 |pmid=34309900}}</ref>
Kratom use has not been shown to positively affect mental health and shows a very small association with negative indicators (mainly externalizing disorders).<ref name=":12" />
== See also == {{Portal|Medicine}} * Deumitragynine * ''Pausinystalia johimbe''
== References == {{reflist}}
== External links == {{Scholia|topic}} {{Commons category}} * {{Cite web | url = https://www.euda.europa.eu/publications/drug-profiles/kratom_en | publisher = European Union Drugs Agency (EUDA) | title = Kratom }}
{{Opioid receptor modulators}} {{Chemical classes of psychoactive drugs}} {{Taxonbar|from=Q139698}}
Category:Naucleeae Category:Trees of Indo-China Category:Trees of Malesia Category:Trees of New Guinea Category:Anxiolytics Category:Antidepressants Category:Antidiarrhoeals Category:Euphoriants Category:Herbal and fungal stimulants Category:Herbal teas Category:Medicinal plants Category:Opioids Category:Least concern flora of Asia Category:Taxa named by Pieter Willem Korthals