Kratom

Is kratom safe?

No, not by the standards we apply to supplements. Kratom is the leaf of Mitragyna speciosa, a tree from Southeast Asia, and its main alkaloids, mitragynine and 7-hydroxymitragynine, act on the same mu-opioid receptors as morphine. Low doses are stimulating; higher doses are sedating and pain-relieving. People use it for pain, energy, anxiety and to self-manage opioid withdrawal.

It scores 29, in the poor band, close to phenibut (25) and above tianeptine (19). The reasons are dependence, deaths in combination with other drugs, products with no quality control, and a regulatory status that rules it out as a lawful supplement in the US and much of the world.

Why it is not a legal dietary supplement

Kratom is sold in US smoke shops, petrol stations and online as capsules, powders and drinks, often labelled as a supplement. The FDA's position is that kratom is not lawfully marketed in the US as a drug, a dietary supplement or a food additive. It treats kratom as a new dietary ingredient for which there is not enough safety information, and as an unsafe food additive. It has had an import alert in place for years, and it has seized products and warned companies about health claims.

That does not make possession a federal crime. The DEA proposed scheduling kratom in 2016 and withdrew the proposal after public pushback. What it means for buyers is that nothing on the label has been checked.

Elsewhere the rules vary. Several US states ban kratom outright, while others regulate sales with age limits and labelling. Australia, Denmark, Sweden and a number of other countries control it as a drug, and in the UK its supply is illegal under the Psychoactive Substances Act 2016. Thailand, where it grows, removed it from its narcotics list in 2021.

Dependence and withdrawal

Regular daily use can produce tolerance and dependence. Withdrawal resembles mild to moderate opioid withdrawal: cravings, muscle aches, irritability, sleep problems, a runny nose and diarrhoea. The FDA also lists neonatal withdrawal in babies born to mothers who used kratom during pregnancy. Many users began taking kratom to come off opioids and found themselves dependent on kratom instead.

If you use kratom daily and want to stop, talk to your doctor or an addiction service. Approved treatments such as buprenorphine are proven to reduce the risk of death, which kratom is not.

Deaths and interactions

A CDC review of 27,338 overdose deaths in 27 US states between July 2016 and December 2017 found kratom in 152 cases and judged it a cause of death in 91. In only 7 was kratom the only substance detected. Fentanyl was present in 65% of kratom-positive deaths, heroin in 33% and benzodiazepines in 22%.

The lesson is that kratom's main lethal risk comes from mixing:

• Opioids, prescribed or illicit, add to breathing suppression.
• Benzodiazepines, alcohol, gabapentinoids and sleeping pills add sedation.
• Many prescription drugs are cleared by liver enzymes that kratom inhibits, which can raise their levels.

Case reports also describe acute liver injuryDrug-induced liver injuryLiver damage caused by a medicine, herbal product or supplement. It is usually rare and unpredictable, but it can be serious.More in the glossary, typically weeks after starting, and seizures, especially at high doses.

Contamination and the 7-OH problem

With no standards, kratom products vary widely. In 2018 a Salmonella outbreak across dozens of states was traced to kratom, leading to recalls. FDA testing in 2019 found lead and nickel in many products.

A newer worry is 7-OH. Natural kratom contains very little of this alkaloid, less than 2% of the total, but it is much more potent at opioid receptors. Since about 2023, products concentrating or synthetically boosting 7-OH have spread as tablets, gummies and shots. In July 2025 the FDA recommended that 7-OH be scheduled as a controlled substanceControlled substanceA medicine or drug that the law restricts because it can be misused or cause dependence. Countries group them into schedules or classes.More in the glossary and sent warning letters to seven companies.

Practical points

• Kratom should not be combined with opioids, benzodiazepines, alcohol or other sedatives.
• Avoid products marketed for their 7-OH content.
• Do not use it in pregnancy or while breastfeeding.
• Tell any doctor treating you that you use kratom, including before surgery.
• If you have liver disease, a seizure disorder or a history of substance use disorder, the risks are higher.

Compare kava, another plant used for its calming effect, which carries a serious liver risk but not opioid-type dependence.

How we scored it

Regulatory actions (10) is low: not a lawful supplement in the US and banned in many countries. Quality (25) and interactions (30) reflect contamination, spiked products and deaths in combination with opioids. Dose safety (35) and organ toxicity (40) reflect dependence, withdrawal, liver injuryDrug-induced liver injuryLiver damage caused by a medicine, herbal product or supplement. It is usually rare and unpredictable, but it can be serious.More in the glossary and seizures.