Kratom is marketed in many health food stores and online shops as a natural energy booster, pain reliever, and alternative to opioid withdrawal medications. People who use it describe benefits ranging from improved mood to relief from chronic pain. But kratom is also the subject of growing concern among addiction specialists, and for good reason: yes, you can get addicted to kratom, and the addiction closely resembles opioid use disorder.
Understanding what kratom actually is, how it acts in the body, and who is most at risk for dependence helps clarify why the “it’s natural, so it’s safe” framing is misleading. The plant’s active compounds act on the same opioid receptors as morphine and fentanyl. That matters.
What You Should Know About Kratom
- Kratom’s active compounds bind to opioid receptors in the brain
- Physical dependence can develop with regular use over weeks
- Withdrawal symptoms closely resemble opioid withdrawal
- The FDA has not approved kratom for any medical purpose
- Reports of kratom-involved deaths have increased as use has grown
What Is Kratom?
Kratom (Mitragyna speciosa) is a tropical plant native to Southeast Asia, particularly Thailand, Malaysia, Indonesia, and Papua New Guinea. For centuries, workers in those regions chewed its leaves for energy and pain relief. Traditional use was quite different from modern American consumption: fresh leaves chewed in moderation versus concentrated powder, capsules, extract shots, and teas consumed in much larger doses.
In the US, kratom is sold as a dietary supplement even though the FDA has not approved it. It is not currently a controlled substance at the federal level, though several states have banned or regulated it. The absence of federal scheduling creates a misleading appearance of safety.
How Kratom Works in the Brain
Kratom contains over 40 alkaloids, but its primary active compounds are mitragynine and 7-hydroxymitragynine. Both are partial opioid agonists. They bind to mu-opioid receptors, the same receptors targeted by morphine, oxycodone, and fentanyl.
At low doses, kratom produces stimulant-like effects: increased energy, alertness, and sociability. At higher doses, it produces opioid-like effects: sedation, pain relief, and euphoria. The dose-dependent shift from stimulant to sedative is part of what makes kratom complex and difficult to regulate from a pharmacology standpoint.
7-hydroxymitragynine, the more potent of the two compounds, has been found to have opioid receptor potency comparable to or exceeding that of some pharmaceutical opioids. A 2016 paper in the Journal of Medicinal Chemistry found it to be significantly more potent than morphine at mu-opioid receptors in laboratory testing.
“Kratom compounds produce the same receptor-level effects as traditional opioids. That means they carry the same risk of dependence, tolerance, and withdrawal with regular use.” — Dr. Jack Henningfield, Johns Hopkins School of Medicine
How Kratom Addiction Develops
Kratom addiction typically develops gradually, following the same pattern as other opioid use disorders.
Tolerance Builds Quickly
The brain adjusts to the presence of kratom’s alkaloids over time. As tolerance increases, the same dose produces less effect. Users need to take more to get the same relief or energy boost they originally experienced. This dose escalation is a classic marker of physical dependence.
Withdrawal Appears on Missed Doses
Once physical dependence develops, missing a dose produces withdrawal symptoms. For regular users who did not intend to become dependent, this can be a jarring realization. They take kratom in the morning not because they want a boost, but because without it they feel anxious, achey, and poorly.
Continued Use Despite Consequences
An addiction diagnosis requires not just physical dependence but continued use despite negative consequences. Kratom users who qualify for an addiction diagnosis continue using even when it strains finances, relationships, or health, because stopping feels impossible without the discomfort of withdrawal.
Who Uses Kratom and Who Is Most at Risk
Surveys suggest several distinct groups use kratom:
- People managing chronic pain who are trying to avoid or taper off prescription opioids
- People in recovery from opioid use disorder who use kratom as a substitute
- People managing anxiety, depression, or fatigue without a medical diagnosis
- People who began using it recreationally for its euphoric effects at higher doses
The ironic risk group is people who began using kratom to get off opioids. Kratom can ease opioid withdrawal in the short term because it activates the same receptors. But for people with opioid use disorder, it often becomes a substitute rather than an exit. Instead of addressing the underlying disorder, they continue opioid receptor stimulation through a different compound, maintaining the neurochemical cycle of dependence.
Signs of Kratom Addiction
- Needing kratom daily to feel normal
- Escalating doses over time to get the same effect
- Spending significant money on kratom or prioritizing it financially
- Experiencing withdrawal symptoms when you miss a dose
- Unsuccessful attempts to cut down or stop
- Preoccupation with having enough kratom available
- Hiding use from family or doctors
Health Risks Beyond Addiction
Kratom’s risks extend beyond addiction and withdrawal. Because it is sold as a supplement, it is not subject to FDA manufacturing oversight, which means the actual alkaloid content of products varies widely. Several kratom products have been found to be contaminated with heavy metals, salmonella, or other substances.
The CDC and FDA have both issued safety alerts regarding kratom-associated deaths. The majority of these deaths involve kratom in combination with other substances, but cases of kratom alone contributing to respiratory depression have been documented. The risk increases at high doses, particularly with concentrated extract products.
Liver toxicity has also been reported in some kratom users, presenting as jaundice and elevated liver enzymes, though this appears to be relatively rare and may reverse with cessation.
Is Kratom Legal?
At the federal level, yes. The DEA attempted to schedule kratom as a Schedule I substance in 2016 but withdrew the proposal after significant public pushback. States have varying laws:
- Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconsin have banned kratom
- Several cities and counties have banned it locally
- Other states have implemented age restrictions or labeling requirements
- Most states have no kratom-specific regulation
The legal status does not reflect safety. Many legal substances cause addiction and harm. Legality only tells you whether buying it puts you at legal risk, not whether it puts your health at risk.
Getting Help for Kratom Addiction
Because kratom acts through opioid receptors, the same medications used to treat opioid use disorder can be effective for kratom dependence. Buprenorphine has been used successfully in case reports and small studies to manage kratom withdrawal and maintain abstinence. A physician with experience in addiction medicine can assess whether buprenorphine or another medication is appropriate for your situation.
Behavioral treatment including cognitive behavioral therapy and motivational interviewing is also effective for kratom use disorder. Many addiction counselors are now familiar with kratom and can provide appropriate support.
If you have been using kratom regularly and want to stop, do not try to stop suddenly without medical guidance, particularly if you are using large amounts. The withdrawal, while not typically life-threatening, can be severe enough to require medical support. A doctor can help you taper safely or manage symptoms if you want to stop more quickly.
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