Dangers of Kratom: Is Kratom Safe?

What is Kratom?

Kratom has been abused for thousands of years, originating in Southeast Asia, where it saw widespread use. Over the last decade it’s gained a great deal of popularity within The United States, largely based on the misunderstanding that it is a safe way to get high. This simply isn’t the case. Kratom addiction (both as a primary substance of abuse, and as a bridge back to the addict’s substance of choice) is a very real possibility. Five more of the top dangers of Kratom abuse are explored in detail below.

Kratom Overdoses

Contrary to popular belief, it is possible to overdose on Kratom. Terms typically used to describe Kratom, such as “all natural” or “herbal” mask the nature of the active ingredients which act both as Psychostimulants and Opioids, depending on the dose consumed. While the neurotoxic or fatal doses have not been firmly established in Humans, there are confirmed reports of fatalities where Kratom was the only drug present in the body¹. Some of the symptoms you may experience during a Kratom overdose include:

  • Seizure / Coma
  • Irritability or Increased Aggression
  • Nausea / Vomiting
  • Hypertension (very high blood pressure)
  • Tachycardia (very fast heart rate)
  • Confusion / Delirium

With Kratom use in the United States on the rise, there has been a significant increase in the incidence of Kratom overdoses. Between 2011 and 2017 in the United States, there were 1,807 cases of Kratom exposure which had been called into Poison Control Centers. Of these, 65% were reported between 2016 and 2017 which indicates the use rates spiked drastically during this time.

Furthermore, 31.8% of these cases resulted in admission to a hospital, while 51.9% resulted in serious medical consequences. From these particular cases, 9 deaths have involved Kratom and other drugs, while 2 deaths resulted from Kratom use alone¹. These 2 deaths are not the only ones attributed to Kratom use, as there have been dozens of deaths¹ in the US that involved Kratom.

Serious Health Risks from Using Kratom

While Kratom is rumored to be harmless, there are a number of serious risks associated with regular use. The exact processes behind the dangers of Kratom use are not well understood, but it is clear to pose a threat to several vital organs, particularly the liver, kidneys, heart, and the brain. These risks specifically include, but are not limited to:

  • Intrahepatic Cholestasis¹²³: A type of acute liver damage which is most commonly seen during pregnancy, it results from a blockage or backup of bile in the liver which impairs liver function. Symptoms include jaundice (yellow of the skin or whites of eyes), severe itching, very dark urine, pale or gray stool, and pain in the upper right abdomen.
  • Drug Induced Liver Injury¹: A spectrum of different types of acute liver damage precipitated by drug use, the specific symptoms can be diverse depending on the drug in question. In the case of Kratom, Cholestasis is the main outcome observed as of yet. The National Institutes of Health have given Kratom a Hepatotoxicity Score of C, which they define as “Probable cause of clinically apparent liver injury”¹.
  • Hyperbilirubinemia¹: Typically results from an underlying condition (such as Hepatic Cholestasis), it is the result of too much bilirubin in the blood due to poor liver function. This can cause jaundice, decreased appetite, and lethargy.
  • Tonic-Clonic (Grand Mal) Seizure¹²: These types of seizures are characterized by a loss of consciousness and subsequent involuntary muscle contractions, which may sometimes be violent. The causation between Kratom and T-C seizure is unknown, but there is undoubtedly a correlation between the two.
  • Posterior Reversible Encephalopathy Syndrome (PRES)¹: Typically drug induced (most commonly from methamphetamines), this can result in a severe headache, disorientation, visual disturbances, and aphasia (inability to generate or understand speech). It is commonly due to vasogenic edema, which is a buildup of fluid between brain cells which can lead to many different problems depending where in the brain it occurs.
  • Brain Lesions / Focal Epilepsy¹: Through unknown means, recurrent Petit or Grand Mal seizures have been attributed to Kratom use. Petit Mal are characterized by sudden disorientation and brief loss of consciousness. Grand Mal involve a loss of consciousness and possibly violent involuntary muscle contractions.
  • Tachycardia: Increased heart rate and blood pressure. There are several different types of tachycardia, some more dangerous than others. All types can drastically increase your risk of stroke or heart failure. Symptoms include felling dizzy or lightheaded, heart palpitations, shortness of breath, or chest pain.
  • Torsades de Pointes¹: A distinct form of tachycardia, it presents with a very recognizable ECG signature. May lead to Ventricular Fibrillation, which is life threatening.

In addition, the lack of regulation for products containing Kratom is concerning, as there is no enforcing body in place to monitor the quality, potency, or safety of Kratom being sold. This means that in addition to Mitrgynine and its metabolites, there is no telling what else may be present in Kratom. In 2018, there was a serious outbreak of Salmonella in the US as a direct result of nonexistent regulation measures (see Kratom Contaminants below for more).

Potentially Dangerous Drug Interactions

There are many potential drug-drug interactions which may occur with Kratom. While there has yet to be studies done on drug-drug interactions in Humans, there are many cases where death or serious side effects occurred with Kratom present in the body alongside other drugs. The exact interactions which may have occurred are unclear, but the results are not desirable. Some of these potential drug interactions include, but are not limited to:

  • Zopiclone (Zimovane), Citalopram (Celexa), Lamotrigine (Lamictal)¹: Used in tandem with Karom; resulted in a fatality. Blood levels of the 3 other drugs were well within therapeutic range, indicating no abuse of said drugs. The post mortem levels of Kratom metabolites were quite high, indicating heavy use.
  • Vyvanse¹: In this case, there was no history or risk factors of epilepsy. After using Kratom in tandem with Vyvanse, he started having both tonic-clonic and absence seizures. Upon discontinuing Kratom use, the seizures ceased.
  • Seroquel & Adderall¹: Patient was presenting with multiple symptoms of PRES (see above) after tandem use of prescribed medications and Kratom. CT scan showed results consistent with Vasogenic Edema.
  • Paxil & Lamictal¹: Subject was found unresponsive by his family after a T-C seizure at home. EMS were called but were unable to resuscitate. Subsequent autopsy revealed he had a heart attack, pulmonary embolism and brain hemorrhage before finally succumbing to hypoxia.
  • Modafinil (Provigil)¹: After use with Kratom, the subject suffered a T-C seizure.

Additional complications arise when someone uses Kratom while pregnant. Again, since so little is understood about Kratoms mechanism(s) of action, it is extremely unwise to use it at all, and especially when pregnant. There have been confirmed cases of children being born addicted to Kratom, and experiencing withdrawal immediately after birth¹².

No Legal Regulations

In 1943, the Thai government passed Kratom Act 2486 which made planting of the Kratom tree illegal. Then in 1979, the Thai government also passed the Narcotics Act B.E. 2522 (Amended by Narcotics Act B.E. 2545 in 2002)¹ which made the possession, distribution, and consumption of Kratom illegal.

Beginning in 2014 the FDA posted several notices which made it illegal to import Kratom as a dietary supplement, such as FDA Import Alert 54-15. Invoking the Federal Food, Drug, and Cosmetics Act – Adulteration, Section 402(f)(1)(B)¹ the agency has claimed “The article is subject to refusal of admission pursuant to section 801(a)(3) in that it appears to be a dietary supplement or contains a dietary ingredient that is a new dietary ingredient for which there is inadequate information to provide reasonable assurance that such ingredient does not present a significant or unreasonable risk of illness or injury” with the article in question being a product containing Kratom in this case. This led to 3 seizures of massive stockpiles of Kratom products by US Marshals in 2014¹ and 2016¹² which were valued at over $5.5 million total.

The DEA and Department of Justice did attempt to include Kratom as a Schedule 1 drug in 2016 with 2 Proposed Rules¹. This was met with massive public backlash and this action was delayed pending further research. However, several states have taken it into their hands to make Kratom illegal including Alabama, Arkansas, Indiana, Rhode Island, Vermont, and Wisconson where it is illegal to possess, purchase, or use Kratom. There is also pending state-level legislation which, if unchallenged, will result in Kratom becoming illegal or regulated in the near future. States with currently pending legislation include: Michigan, Ohio, New York, New Jersey, Georgia, Mississippi, Missouri, and Kansas. Several other states have imposed age restriction on purchase, as well as several counties scattered throughout the country making possession illegal¹².

Finally, the FDA has an active program under the MedWatch umbrella to compile reports of Kratom related issues from health care workers or directly from the users themselves. If you would like to report personal adverse reactions to Kratom, you can fill out a MedWatch Volunteer Reporting Form. Until a substantial number of controlled studies on Kratom have been completed, the best way to contribute to and inform policy is to share your experiences.

Contaminated Kratom

In 2018, there was a massive Salmonella outbreak in which Kratom was heavily implicated. There were 199 reported infections in 41 states, and over 70 people were hospitalized. The FDA and CDC performed an investigation, and traced the source to contaminated Kratom powder, tablets, and tea with no common supplier or distributor identified¹

Several companies which sold Kratom products performed voluntary recalls, and on April 2, 2018 the FDA ordered a mandatory recall¹ of any Kratom products supplied by Triangle Pharmanaturals LLC. There were several different strains of Salmonella found, including Salmonella Javiana, Thompson, Okatie, Weltevreden, and Heidelberg¹.

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