Can You Overdose on Kratom? Risks of Use

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What you will learn

• A kratom overdose is possible, largely because kratom's effects can differ greatly based on how much is taken.
• At lower doses, kratom works somewhat similarly to a mild stimulant. However, at higher doses, its active chemicals work very much like an opioid and include the risk of dangerous respiratory distress.
• Using concentrated extracts, mixing kratom with other substances, or consuming unregulated or contaminated kratom products increases the likelihood of experiencing severe reactions.
• Common warning signs of a potentially life-threatening reaction include difficulty breathing, seizures, and loss of consciousness, all of which warrant immediate emergency care.
• Since kratom is not regulated by the Food and Drug Administration (FDA), there is a wide variation in terms of the strength and quality of each product, and the actual impact of a particular amount may be difficult to predict.

Kratom is commonly marketed as a plant-based, natural supplement for pain relief, energy, and mood enhancement. Because it’s natural, many consumers believe it is safer to take compared to pharmaceutical opioids.

The reality is more complicated, however.

Unlike other prescription medications, kratom is sold in gas stations, smoke shops, and online with little regulatory oversight, and that easy accessibility leads to the dangers associated with it being frequently downplayed. Understanding the dangers associated with kratom begins with understanding more about the substance itself.

Why Kratom’s Effects Depend So Heavily on Dose

Kratom comes from the leaves of Mitragyna speciosa, a tropical tree closely related to coffee plants, and its primary effects derive from two main chemical components: mitragynine and 7-hydroxymitragynine.[1] At low doses, these alkaloid compounds tend to produce mild stimulant-like effects such as improved energy, alertness, and sociability.[2]

However, when taken in high doses, these compounds have a different mechanism of action and effect. Both, particularly 7-hydroxymitragynine, act on the same opioid receptors in the brain that opioid drugs like oxycodone and fentanyl target.[3] When kratom is consumed at higher levels, it produces true opioid-like effects, including sedation and pain relief, and also shares the same potential for causing respiratory depression that makes opioid overdose so dangerous.[4]

Because of this, kratom overdose is a possibility, and that mechanism explains how it happens: the relationship between a stimulating dose and a sedative, opioid-like dose is unpredictable and varies per consumer and product, and a number of factors can determine where this relationship exists for a given user, including body weight, individual metabolic rate, and tolerance established through previous use.[5]

Recognizing Kratom Overdose Symptoms

Symptoms of kratom toxicity range across the spectrum from mildly unpleasant symptoms to those that represent a true medical emergency.

Some milder symptoms of kratom toxicity include:

• Nausea and vomiting
• Sweating
• Dry mouth
• Restlessness
• Trembling and shaking
• Rapid heartbeat (tachycardia)

Serious symptoms, indicative of the opioid-like properties, can include:

• Hallucinations
• Seizures
• Significant disorientation and confusion
• Respiratory depression (slowed or labored breathing)
• Loss of consciousness or coma

The presence of more serious symptoms, notably slowed or difficult breathing or seizure activity, clearly represents a transition from an adverse reaction to a legitimate medical emergency.

What Increases the Risk of Kratom Toxicity?

There are several factors that contribute to an increased likelihood of kratom overdose:

Concentrated Products

Concentrated and liquid extracts contain higher, and sometimes unpredictable, levels of alkaloids compared to dried leaves or powder.[5] A person who is used to a standard dose of kratom powder can inadvertently take a much more potent dose without realizing it if they switch to a concentrate.

Polysubstance Use

Combining kratom with other substances is another major contributor to the lethal nature of kratom-related overdose.[6] Many people consume kratom with other substances, such as benzodiazepines, fentanyl, oxycodone, and alcohol. These combinations greatly increase the risk of severe respiratory depression. Many postmortem toxicologies show evidence of polysubstance use, suggesting it was a factor in many kratom-related overdoses.[7]

Lack of Regulation

Kratom’s status in the U.S. is genuinely inconsistent.

Currently, kratom is not a scheduled controlled substance under federal law.[8] The DEA did consider scheduling kratom in 2016, but backed down after receiving negative feedback from the public. That federal legality doesn’t mean kratom is legal everywhere, though. Several states, including Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin, have made kratom illegal at the state level, while many cities and counties within otherwise kratom-legal states have enacted their own local bans or restrictions.

Having no government ban or even regulations on kratom products creates uncertainty among users. Because the FDA does not regulate kratom products as pharmaceuticals do, there can be great variation in alkaloid content, purity, and quality between different kratom products.[9] Even different batches of the same product can result in significant differences in alkaloid concentrations. Some kratom products have also been identified as containing other contaminants or opioids in addition to kratom, making it nearly impossible to determine what a consumer is actually getting.

Tolerance and Dependence

Regular or heavy kratom use leads to tolerance and, often, dependence follows. Once a user develops tolerance and dependence, they may start increasing their daily dosage to get the desired results, moving closer to doses with dangerous opioid-like side effects.

When Kratom Overdose Becomes a Medical Emergency

Certain warning signs indicate that a reaction has crossed over into a full-blown medical emergency:

• Slow or shallow breathing
• Blue-tinted lips or skin
• Seizures
• Unresponsiveness

All of these symptoms warrant calling 911 immediately. Naloxone, which is used to treat opioid overdoses, may also help reduce kratom’s effects, but its efficacy in treating kratom overdoses is not as clear-cut as it is for traditional opioids like heroin and oxycodone.[10] It may be helpful while awaiting emergency assistance, but should never be relied on as the sole solution.

Kratom Dependence and Withdrawal

Besides the risk of acute overdose, long-term use of kratom can lead to genuine physical dependency, with withdrawal symptoms that are similar to those experienced during mild opioid withdrawal, including muscle cramps and aches, irritability, and cravings for kratom once use has stopped.[11]

This is why kratom addiction is considered a legitimate clinical concern, and not something to be dismissed merely because kratom is a natural substance. Medical detoxification, the same as what is used for other opioid dependence and withdrawal, can provide safe and effective management of kratom withdrawal symptoms and make the process more manageable and comfortable than attempting to discontinue use without support.

Getting Support for Kratom Use

The fact that kratom is derived from a natural substance doesn’t mean that it’s safe, and the same dose-dependent effects that make overdose possible also make addiction a real concern for regular users.

Ascendant New York offers medically monitored detoxification and addiction treatment services for people across Manhattan and the surrounding boroughs who have developed dependence on kratom or any other substance. If you feel that your use of kratom is becoming difficult to manage, or if you’re supporting a loved one experiencing difficulty with their use of kratom, reach out to our admissions staff. They are available to answer your questions, verify your insurance, and help you see what treatment can look like for you.