In Southeast Asia, people for centuries have chewed the leaves of the kratom tree — part of the coffee family — as a pain-relieving, energy- and mood-boosting remedy.
In the United States, as kratom has gained popularity along with its availability in recent years, the botanical substance remains the focus of an ongoing debate and regulatory battle.
While advocates say the plant’s properties can help manage everything from anxiety to opioid withdrawal, there’s limited research to substantiate their claims and US regulators continue to warn of kratom’s potential health risks.
Americans are nonetheless buying so much kratom and kratom-based products — whether online or in gas stations, convenience stores, smoke shops and bars — that it’s become a $1-billion industry.
Leaves of the kratom tree are usually dried and ground into a powder, a form that resembles how it’s traditionally used by Thai and Malaysian farmworkers. In the US, kratom is often swallowed as capsules, sipped as a drink, brewed into tea, chewed as gummies or tossed back as shots.
In low doses, kratom acts as a stimulant; in higher doses, kratom becomes more of a sedative with addictive, opioid-like properties, according to the National Institutes of Health and Mayo Clinic.
Kratom’s two main chemical components, the compounds mitragynine and 7-hydroxymitragynine, give the plant its stimulant and pain-relief properties. The buzz from kratom takes effect within minutes and can last a few hours.
There isn’t sufficient data yet and, according to researchers, more studies are needed to better assess kratom’s safety. Consuming the unaltered kratom leaf rarely results in adverse effects, they say, yet taking kratom in other more concentrated forms may pose additional risks.
“Danger is when we know there’s a foreseeable harm and right now we don’t have the data to say that kratom is absolutely dangerous,” said Kirsten Smith, an assistant professor of psychiatry and behavioural sciences at Johns Hopkins University.
Still, kratom-based products can be dangerous and even toxic if consumed in large doses; that’s especially true for kratom-based beverages, which can contain higher levels of the active compounds.
For example, the US Food and Drug Administration has issued a warning against Black Liquid Kratom, citing side effects such as aggressive behaviour, increased anxiety and, in one event, a reported case of death.
“It’s like saying coffee and caffeine pills are the same thing, but they’re not,” said Abhisheak Sharma, assistant professor of Pharmaceutics and co-director of the Translational Drug Development Core at the University of Florida. (Story continues below)
Kratom plants and drinks are displayed at a presentation by the Ministry of Justice, which was behind removing kratom plants from Thailand’s narcotics list in August 2021. (Photo: Apichart Jinakul)
The FDA warns that using kratom can cause liver damage, seizures and substance use disorder. In rare cases, people who have used kratom have died — although other drugs have mostly been involved in those instances, making kratom’s contribution uncertain.
Plaintiffs in dozens of wrongful death lawsuits against companies selling kratom have claimed that misleading marketing claims and a lack of clear safety labels have left consumers in the dark about how the drug may interact with other substances.
Kratom is also often marketed as a safe substitute for opioids or way to self-medicate for opioid withdrawals, but these claims are not medically substantiated, said Matthew Rossheim, a University of North Texas professor who led a 2024 survey on the substance’s widespread availability in tobacco and vape shops around the US.
In 2016, the US Drug Enforcement Administration attempted to make kratom a controlled substance — the same category as heroin and ecstasy — which would’ve made possession and distribution illegal. Those efforts were abandoned after public outcry from pro-kratom advocacy groups. The DEA still considers it a “drug of concern”. (Story continues below)
A woman displays products made with kratom, which was reclassified as a legal herb in Thailand in 2021. (Photo: Apichart Jinakul)
Kratom’s legal status varies from state by state. Six states have completely banned kratom over health and safety concerns: Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin. Others, including Tennessee and Ohio, have recently considered bills regulating kratom.
Thirteen states have passed versions of the Kratom Consumer Protection Act, or KCPA, a bill the American Kratom Association advocates for at the federal and state level. The KCPA explicitly legalises kratom while also banning kratom products adulterated with other substances and regulating products’ contents and labeling.
In some states where kratom is legal, there may still be age restrictions or local exceptions, such as city bans. For example, while kratom is legal in California, the manufacturing, sale, distribution and possession of kratom is prohibited in San Diego.
While kratom is not a household name in the US, it has not gone unnoticed by the FDA, which warns consumers against using kratom for medical purposes until it has fully evaluated its safety. Over the years the FDA has sent warning letters and seized products from specific kratom manufacturers over reports of adverse events, including death.
Kratom hasn’t been approved by the FDA for any medical use, and the agency has concluded that kratom cannot be marketed as a dietary supplement or as a “food additive in conventional foods”.
The FDA has partnered with other federal agencies, such as US Customs and Border Protections, to limit the sale of these products and warn the public about the risks of kratom use, but the FDA only has the authority to regulate drug products that are in its jurisdiction, and kratom remains in a legal grey area.
Early findings from the FDA’s first study on kratom suggest that dried, ground leaves in capsule form showed no significant complications; vomiting was the most frequent side effect, occurring most often in those who received higher doses.
While the conclusions appear to be promising, there are important limitations to keep in mind – the study hasn’t yet been peer —reviewed or published, though that’s planned for the near future, the FDA said. The study was also small, just 40 participants, and findings may not apply to the more popular drinks and concentrates.
The agency currently has three ongoing studies on kratom and is seeking applications for millions in funding about its abuse potential. In August, the FDA announced its intention to conduct a fourth study but withdrew plans shortly thereafter. PubMed, a database of scientific literature, includes data from two clinical trials of kratom. ClinicalTrials.gov, which tracks ongoing studies, notes eight.
In the United States, as kratom has gained popularity along with its availability in recent years, the botanical substance remains the focus of an ongoing debate and regulatory battle.
While advocates say the plant’s properties can help manage everything from anxiety to opioid withdrawal, there’s limited research to substantiate their claims and US regulators continue to warn of kratom’s potential health risks.
Americans are nonetheless buying so much kratom and kratom-based products — whether online or in gas stations, convenience stores, smoke shops and bars — that it’s become a $1-billion industry.
Leaves of the kratom tree are usually dried and ground into a powder, a form that resembles how it’s traditionally used by Thai and Malaysian farmworkers. In the US, kratom is often swallowed as capsules, sipped as a drink, brewed into tea, chewed as gummies or tossed back as shots.
In low doses, kratom acts as a stimulant; in higher doses, kratom becomes more of a sedative with addictive, opioid-like properties, according to the National Institutes of Health and Mayo Clinic.
Kratom’s two main chemical components, the compounds mitragynine and 7-hydroxymitragynine, give the plant its stimulant and pain-relief properties. The buzz from kratom takes effect within minutes and can last a few hours.
There isn’t sufficient data yet and, according to researchers, more studies are needed to better assess kratom’s safety. Consuming the unaltered kratom leaf rarely results in adverse effects, they say, yet taking kratom in other more concentrated forms may pose additional risks.
“Danger is when we know there’s a foreseeable harm and right now we don’t have the data to say that kratom is absolutely dangerous,” said Kirsten Smith, an assistant professor of psychiatry and behavioural sciences at Johns Hopkins University.
Still, kratom-based products can be dangerous and even toxic if consumed in large doses; that’s especially true for kratom-based beverages, which can contain higher levels of the active compounds.
For example, the US Food and Drug Administration has issued a warning against Black Liquid Kratom, citing side effects such as aggressive behaviour, increased anxiety and, in one event, a reported case of death.
“It’s like saying coffee and caffeine pills are the same thing, but they’re not,” said Abhisheak Sharma, assistant professor of Pharmaceutics and co-director of the Translational Drug Development Core at the University of Florida. (Story continues below)
Kratom plants and drinks are displayed at a presentation by the Ministry of Justice, which was behind removing kratom plants from Thailand’s narcotics list in August 2021. (Photo: Apichart Jinakul)
The FDA warns that using kratom can cause liver damage, seizures and substance use disorder. In rare cases, people who have used kratom have died — although other drugs have mostly been involved in those instances, making kratom’s contribution uncertain.
Plaintiffs in dozens of wrongful death lawsuits against companies selling kratom have claimed that misleading marketing claims and a lack of clear safety labels have left consumers in the dark about how the drug may interact with other substances.
Kratom is also often marketed as a safe substitute for opioids or way to self-medicate for opioid withdrawals, but these claims are not medically substantiated, said Matthew Rossheim, a University of North Texas professor who led a 2024 survey on the substance’s widespread availability in tobacco and vape shops around the US.
In 2016, the US Drug Enforcement Administration attempted to make kratom a controlled substance — the same category as heroin and ecstasy — which would’ve made possession and distribution illegal. Those efforts were abandoned after public outcry from pro-kratom advocacy groups. The DEA still considers it a “drug of concern”. (Story continues below)
A woman displays products made with kratom, which was reclassified as a legal herb in Thailand in 2021. (Photo: Apichart Jinakul)
Kratom’s legal status varies from state by state. Six states have completely banned kratom over health and safety concerns: Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin. Others, including Tennessee and Ohio, have recently considered bills regulating kratom.
Thirteen states have passed versions of the Kratom Consumer Protection Act, or KCPA, a bill the American Kratom Association advocates for at the federal and state level. The KCPA explicitly legalises kratom while also banning kratom products adulterated with other substances and regulating products’ contents and labeling.
In some states where kratom is legal, there may still be age restrictions or local exceptions, such as city bans. For example, while kratom is legal in California, the manufacturing, sale, distribution and possession of kratom is prohibited in San Diego.
While kratom is not a household name in the US, it has not gone unnoticed by the FDA, which warns consumers against using kratom for medical purposes until it has fully evaluated its safety. Over the years the FDA has sent warning letters and seized products from specific kratom manufacturers over reports of adverse events, including death.
Kratom hasn’t been approved by the FDA for any medical use, and the agency has concluded that kratom cannot be marketed as a dietary supplement or as a “food additive in conventional foods”.
The FDA has partnered with other federal agencies, such as US Customs and Border Protections, to limit the sale of these products and warn the public about the risks of kratom use, but the FDA only has the authority to regulate drug products that are in its jurisdiction, and kratom remains in a legal grey area.
Early findings from the FDA’s first study on kratom suggest that dried, ground leaves in capsule form showed no significant complications; vomiting was the most frequent side effect, occurring most often in those who received higher doses.
While the conclusions appear to be promising, there are important limitations to keep in mind – the study hasn’t yet been peer —reviewed or published, though that’s planned for the near future, the FDA said. The study was also small, just 40 participants, and findings may not apply to the more popular drinks and concentrates.
The agency currently has three ongoing studies on kratom and is seeking applications for millions in funding about its abuse potential. In August, the FDA announced its intention to conduct a fourth study but withdrew plans shortly thereafter. PubMed, a database of scientific literature, includes data from two clinical trials of kratom. ClinicalTrials.gov, which tracks ongoing studies, notes eight.
