Writing about kratom comes in two flavours: a safe natural plant unfairly targeted by regulators, or a deadly opioid killing people in gas stations. The research supports neither, and a treatment centre has an obvious incentive to give you the second one — so here is what's actually established, including where the evidence runs thinner than people claim.
Key Takeaways
- Kratom’s compounds activate opioid receptors, but effects only partially resemble heroin or oxycodone
- The "stimulant at low doses, opioid at high doses" claim is NOT established, despite being everywhere
- Dependence and withdrawal are real; how often it becomes a disorder is genuinely uncertain
- Serious effects — seizures, liver damage, cardiac problems — are documented but described as rare
What Kratom Is
Mitragyna speciosa, a tree native to Southeast Asia, where its leaves have been used for a long time. What's sold in the US — powders, capsules, extracts, drinks — is marketed as a herbal supplement.
Its principal active compounds are mitragynine and 7-hydroxymitragynine. Both activate mu-opioid receptors — the same receptors morphine and heroin act on — but NIDA is careful to add that the resulting effects "only partially compare to those of opioids like heroin or oxycodone" [1].
That precision is worth preserving in both directions. "It's not really an opioid, it's a plant" misses that it acts on opioid receptors. "It's just an opioid" overstates a partial resemblance as an equivalence.
The Dose Claim Everyone Repeats
You'll read almost everywhere that kratom is stimulating at low doses and opioid-like at higher doses. It's stated as settled pharmacology on advocacy sites, treatment sites, and news articles alike.
It isn't established. NIDA notes that while many people report exactly that pattern, "studies have not yet established that these effects depend on the amount or method of kratom consumed" [1].
This matters practically, not just pedantically. Someone relying on the low-dose rule to stay in "stimulant territory" is trusting a distinction the research hasn't confirmed — using an unregulated product of unverified potency, where the amount in a given batch isn't reliably known anyway.
7-OH and the Stronger Extracts
7-hydroxymitragynine, usually shortened to 7-OH, is one of the two compounds above. In the leaf it is present in small amounts. What has changed is that concentrated products sold as extracts, tablets or shots contain far more of it, and they are sold alongside ordinary leaf powder as though they were the same thing.
They are not the same thing. A concentrated 7-OH product is substantially more potent than the leaf, and someone moving from one to the other is not making a small change. That matters most for the two situations this page keeps returning to: dependence forms faster, and combination with anything else that slows breathing is more dangerous.
It is worth naming plainly because the language has not caught up. People describe it as kratom, because that is what the shelf said, and the distinction only surfaces later. If what you are taking is an extract or a shot rather than leaf powder, say so when you speak to anyone about coming off it. It changes the clinical picture.
Why People Take It
Worth stating plainly, because it's usually missing from treatment-site coverage: most people who take kratom are trying to solve something. Chronic pain that isn't otherwise managed. Opioid withdrawal, often after being cut off from a prescription with nothing to replace it. Anxiety, low mood, or exhaustion.
That context matters because "just stop taking it" ignores whatever it's being used for. If someone is using kratom to manage withdrawal from prescription opioids, removing it without addressing that leaves them back where they started — which is usually why they found kratom in the first place.
Dependence and Withdrawal
Dependence is real. Studies suggest people may experience mild to moderate withdrawal symptoms when they stop regular use [1] — broadly resembling opioid withdrawal in character: restlessness, aches, irritability, poor sleep, sweating, stomach upset.
On how far this goes, NIDA is candid: "more research is needed to understand to what extent people develop substance use disorder symptoms related to kratom" [1]. Both things are true simultaneously — dependence occurs, and how commonly it becomes a disorder isn't settled. Anyone quoting a confident percentage is filling a gap the research hasn't closed.
Kratom and Mental Health
Psychiatric symptoms are listed among the rare but serious adverse effects [1]. But the more useful point is about direction, and it's routinely gotten wrong.
A great many people start taking kratom because of anxiety, depression, or pain that isn't being treated. So kratom use and mental health difficulty appear together very often — which is not the same as kratom having caused the difficulty. Pages asserting that kratom causes depression are usually reading a correlation backwards.
What can be said with more confidence: withdrawal is reliably accompanied by low mood, anxiety, and irritability, which can be misread as an underlying condition worsening. And where a mental health condition and substance use genuinely coexist, treating them together is what holds [4] — and that's true whichever came first, which is a relief, because working out the order is often impossible.
The Documented Serious Risks
NIDA describes rare but serious adverse effects including psychiatric symptoms, cardiovascular problems, seizures, and liver damage in long-term users [1]. "Rare" is accurate and shouldn't be dropped — but neither should the list.
Liver injury deserves particular attention because it's slow and easy to miss: yellowing skin or eyes, dark urine, itching, severe fatigue, or pain under the right ribs all warrant prompt assessment [3]. Mention kratom to whoever sees you — because it's sold as a supplement, people often don't think of it as something to disclose.
The sharpest risk is combination. Kratom with opioids, benzodiazepines, or alcohol compounds effects on breathing, and that pattern accounts for most of the documented serious harm — covered in more detail on our page about kratom overdose signs.
Legal Isn't the Same as Safe
Kratom remains legal in much of the US, though some states and municipalities restrict it. The DEA lists it as a drug of concern, and it is not FDA-approved for any medical use [1].
The practical consequence is the same one that applies across the supplement category: no manufacturing standards, no dosing standards, and no verification that a product contains what the label says. Two packets from different brands — or the same brand at different times — are not necessarily comparable. Being legally available says something about regulatory timing, not about what's in the bag.
Getting help
If you've tried to stop and found you couldn't — or found yourself taking it to avoid feeling ill rather than for any benefit — that's dependence, and it's treatable.
Kratom treatment and medically supervised detox make coming off it considerably more manageable. If kratom is standing in for opioids, medication-assisted treatment is the better-evidenced route — and it's worth knowing that's available rather than continuing to manage it alone. Where anxiety, depression, or chronic pain is what led here, that gets treated too, because removing the kratom without it doesn't hold.
Slow or shallow breathing, unresponsiveness, seizure, or chest pain is a medical emergency — call 911 and give naloxone if available; it causes no harm if no opioid is present. Yellowing skin or eyes needs prompt medical assessment. If this brings up thoughts of suicide or self-harm, call or text 988, the Suicide & Crisis Lifeline.
FAQs
- What is kratom?
- Kratom is Mitragyna speciosa, a tree native to Southeast Asia, and the products made from its leaves and sold as herbal supplements. Its main active compounds are mitragynine and 7-hydroxymitragynine, both of which activate mu-opioid receptors — though NIDA notes the resulting effects only partially compare to those of opioids like heroin or oxycodone.
- Is kratom a stimulant at low doses and an opioid at high doses?
- That is stated as fact almost everywhere, and it is not established. Many people report exactly that pattern, but NIDA is explicit that studies have not yet established that these effects depend on the amount or method of kratom consumed. It is a widely reported user experience rather than a demonstrated pharmacological rule.
- Is kratom addictive?
- Studies suggest people may experience mild to moderate withdrawal symptoms when they stop regular use, so dependence clearly occurs. How commonly it progresses to a substance use disorder is less settled — NIDA states that more research is needed to understand the extent of that. Dependence being real and its prevalence being uncertain are both true at once.
- Can kratom help with opioid withdrawal?
- Many people use it for exactly that, which is understandable given how difficult opioid withdrawal is and how hard treatment can be to access. But kratom is not an approved treatment, products are unregulated and inconsistent, and it carries its own dependence and withdrawal. Medication-assisted treatment with buprenorphine or methadone has strong evidence behind it and medical supervision that kratom does not.
- Does kratom cause mental health problems?
- Psychiatric symptoms are among the recognised rare but serious adverse effects. What the evidence does not establish is the direction — many people begin taking kratom to manage anxiety, depression, or pain, so the two commonly appear together without that showing kratom caused the condition. Where both are present, treating them together is what works regardless of which came first.
- What is 7-OH?
- 7-hydroxymitragynine, usually shortened to 7-OH, is one of the two main active compounds in kratom, present in the leaf in small amounts. Concentrated products sold as extracts, tablets or shots contain far more of it and are substantially more potent than leaf kratom, even though both are sold as kratom. If what you are taking is an extract rather than leaf powder, say so when you speak to anyone about coming off it.
- Is kratom safe to take with my prescriptions?
- Combining kratom with prescribed medication carries real risk, particularly with benzodiazepines, opioids, or antidepressants. Because it is sold as a supplement, people often do not think of it as something to mention to a doctor. Tell your prescriber, and tell any treatment team everything you are taking.
- Can you detox from kratom, and does Virtue treat it?
- Yes to both. Kratom is one of the substances our medical detox programme treats, including where it sits alongside other substances or prescribed medication. People are often surprised that it is treatable at all, which is part of why it goes untreated for so long.
- Is kratom legal?
- It remains legal in many parts of the United States, though some states and municipalities have banned or restricted it. The DEA lists it as a drug of concern, and it is not FDA-approved for any medical use. That means no manufacturing standards, no dosing standards, and no verification that a product contains what its label claims.
- Does insurance cover kratom treatment?
- Most major plans cover medically necessary substance use treatment. You can verify coverage for free in a few minutes.
Sources
- National Institute on Drug Abuse (NIDA). Kratom.
- National Institute on Drug Abuse (NIDA). Prescription Opioids.
- National Institute of Diabetes and Digestive and Kidney Diseases (NIH). LiverTox: Clinical and Research Information on Drug-Induced Liver Injury.
- National Institute of Mental Health (NIMH). Substance Use and Co-Occurring Mental Disorders.
This article is for informational purposes only and is not a substitute for professional medical advice. It is not guidance on obtaining or using any substance.
Written by
Executive Director
Dominic Perry is a Licensed Clinical Social Worker (LCSW), Licensed Clinical Alcohol and Drug Counselor (LCADC), Master Addiction Counselor (MAC), and DOT Substance Abuse Professional (SAP) with approximately eight years of experience in behavioral health and substance use treatment. Dominic began his work with Virtue as a therapist at the Corbett residential facility before progressing into leadership, and now serves as Executive Director of Virtue Recovery Center – Outpatient in Las Vegas. He earned his Bachelor of Social Work from UNLV and his Master of Social Work from the University of Nevada Reno.
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