In recent years, kratom, a botanical herb indigenous to Southeast Asia, has surged in popularity across the United States.

Marketed aggressively online and sold openly in vape shops, convenience stores, and specialty herbal outlets, kratom is often portrayed as a natural remedy, an herbal escape from chronic pain, anxiety, and opioid withdrawal. But beneath the alluring veneer of wellness and relief lies a dangerous, largely unregulated substance capable of causing severe addiction, psychosis, and even death.

Derived from the leaves of Mitragyna speciosa, a tropical evergreen tree native to countries like Thailand, Malaysia, Indonesia, and Myanmar, kratom has traditionally been used by manual laborers to combat fatigue and manage pain. It was introduced to Western markets as a benign and herbal alternative to prescription opioids, quickly garnering interest among vulnerable populations struggling with chronic pain or opioid dependence. Today, the rise in kratom use has reached alarming proportions, with an estimated 3 to 5 million American adults consuming it regularly, representing approximately 0.9 to 1.5 percent of the U.S. population. Monthly imports to the United States are around 2,000 metric tons, highlighting its rapid growth in popularity and consumption.

At the heart of kratom’s pharmacological allure are two powerful alkaloids: mitragynine and 7-hydroxymitragynine. These substances bind directly to the opioid receptors in the brain, producing stimulant-like effects at low doses and sedative, analgesic effects at higher amounts. Mitragynine alone possesses approximately 13 times more potency than morphine, while 7-hydroxymitragynine is up to 46 times more potent than mitragynine itself, magnifying its risks exponentially. This opioid-like potency translates directly into dependence, tolerance, and debilitating withdrawal symptoms, including anxiety, tremors, severe pain, insomnia, and intense cravings that mirror traditional opioid addiction.

The growing acceptance and availability of kratom have masked its serious side effects and addiction potential. Surveys indicate that kratom consumption exploded during the COVID-19 pandemic, as millions grappled with isolation, economic stress, and disrupted access to traditional health care. People turned to kratom seeking relief from stress, boredom, and pain, often underestimating its risks due to its “natural” label. Tragically, many individuals have discovered only too late the severe consequences of kratom dependency, experiencing withdrawal symptoms comparable in intensity to opioids.

Despite its dangers, some research points to potential beneficial effects of kratom, particularly its analgesic properties and ability to mitigate symptoms of opioid withdrawal. Traditional use in Southeast Asia has shown kratom’s effectiveness in alleviating chronic pain and mood disorders, offering relief where conventional medical interventions have failed. Some preliminary animal studies even suggest it could have antidepressant and antipsychotic properties, though these findings remain to be validated in rigorous clinical trials.

Kratom’s detrimental effects are not confined merely to dependency. Medical research and clinical case studies have documented alarming psychiatric consequences of prolonged kratom use. Psychosis, mania, paranoia, and severe mood disturbances have been observed, especially in users predisposed to mental health disorders. Youth, in particular, are at significant risk due to kratom’s easy accessibility, online availability, and perceived safety. Young adults and adolescents may be especially vulnerable to developing dependence and experiencing severe psychiatric and neurological symptoms.

Different kratom formulations present varied strengths and effects, complicating both usage and regulation. Kratom is available in numerous forms, including capsules, powders, extracts, teas, and resins, each varying significantly in potency and pharmacological impact. Extracts and concentrated formulations contain higher levels of alkaloids, increasing the risk of toxicity, dependence, and overdose. This variability not only amplifies the risks associated with kratom but also creates challenges in clinical management and treatment.

Additionally, the lack of regulatory oversight in kratom production poses a profound public health risk. Unchecked manufacturing and distribution practices have led to contamination and adulteration with toxic substances, including dangerous synthetic opioids and psychoactive chemicals, further increasing the threat of severe health crises and fatalities. Reports have documented organ damage, seizures, coma, and even death associated with contaminated kratom products.

Despite these dangers, treatment options specifically tailored for kratom use disorder remain underdeveloped. Physicians often rely on established opioid dependence treatments, such as buprenorphine-naloxone, to manage withdrawal and reduce cravings. Antidepressants, anxiolytics, and supportive psychological interventions have also shown promise. Yet, without rigorous clinical guidelines and specialized treatments, individuals struggling with kratom dependence frequently fall through the cracks of our health care system.

Public health authorities, clinicians, and lawmakers must urgently confront the unchecked proliferation of kratom. Education campaigns must replace deceptive marketing with transparent, science-based information about kratom’s true nature and risks. Regulatory agencies must implement stringent oversight to curb adulteration and contamination, ensuring consumer safety. And health care providers must receive specialized training to recognize, diagnose, and treat kratom-related disorders effectively.

Kratom’s future hinges upon informed policy decisions, proactive regulation, and robust clinical research. Without action, kratom use and dependency will continue to rise, leaving countless lives irreparably harmed. We must collectively lift the veil from kratom’s seemingly benign image, confronting the harsh realities of its dangers head-on, and protecting vulnerable populations from falling victim to yet another devastating epidemic hidden in plain sight.

Muhamad Aly Rifai is a nationally recognized psychiatrist, internist, and addiction medicine specialist based in the Greater Lehigh Valley, Pennsylvania. He is the founder, CEO, and chief medical officer of Blue Mountain Psychiatry, a leading multidisciplinary practice known for innovative approaches to mental health, addiction treatment, and integrated care. Dr. Rifai currently holds the prestigious Lehigh Valley Endowed Chair of Addiction Medicine, reflecting his leadership in advancing evidence-based treatments for substance use disorders.

Board-certified in psychiatry, internal medicine, addiction medicine, and consultation-liaison (psychosomatic) psychiatry, Dr. Rifai is a fellow of the American College of Physicians (FACP), the American Psychiatric Association (FAPA), and the Academy of Consultation-Liaison Psychiatry (FACLP). He is also a former president of the Lehigh Valley Psychiatric Society, where he championed access to community-based psychiatric care and physician advocacy.

A thought leader in telepsychiatry, ketamine treatment, and the intersection of medicine and mental health, Dr. Rifai frequently writes and speaks on physician justice, federal health care policy, and the ethical use of digital psychiatry.

You can learn more about Dr. Rifai through his Wikipedia page, connect with him on LinkedIn, X (formerly Twitter), Facebook, or subscribe to his YouTube channel. His podcast, The Virtual Psychiatrist, offers deeper insights into topics at the intersection of mental health and medicine. Explore all of Dr. Rifai’s platforms and resources via his Linktree.