Why Does the Food and Drug Administration Need to Ban Kratom?

  • Stephanie ColucciEmail author
  • Sarah Culbreth
  • Emad Alsarraf
  • John Fanikos
Pharmacology Care (J Fanikos, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pharmacology Care


Purpose of Review

Kratom (Mitragyna speciosa) is an herb with no current indication for medical use with potentially addictive properties, yet it is being used in the management of pain, depression, and anxiety. The agent’s pharmacology lends itself for concern regarding recreational misuse (Drugs of Abuse, 2017).

Recent Findings

Kratom’s increasing popularity for use in the USA is reflected by National Poison Data System data that in 2011 there were 13 cases reported to poison control centers while in 2017 there were 682 calls in response to kratom exposure (Kratom exposure in the US linked to serious medical outcomes, 2019; Post et al. in Clin Toxicol. 57:847–54, 2019). Subjects most commonly use kratom for the self-treatment of pain, mood swings, and opioid-related withdrawal symptoms (Grundmann in Drug Alcohol Depend. 176:63–70, 2017). Known serious adverse events include hallucinations, delusions, reduced respiratory drive, and death (Kratom: unsafe and ineffective, 2019). Additional anecdotally reported side effects include hypothyroidism, seizure, hepatotoxicity, coma, and injury to the posterior white matter of the brain (Anwar et al. in MMWR Morb Mortal Wkly Rep. 65:748–9, 2016; Nelsen et al. in J Med Toxicol. 6:424–6, 2010; Sheleg and Collins in J Addict Med. 5:300–1, 2011; Castillo et al. in Proc (Baylor Univ Med Cent). 30:355–7, 2017).


At this time, kratom remains without regulations on a federal level. The substance’s opioid-like pharmacology, ease of use, and lack of demonstrated safety or efficacy justify the need for continued extensive research (Brooks, 2019).


Kratom Mitragyna speciosa 7-Hydroxymitragynine Substance abuse 



The authors wish to thank Dr. Glee Lenoir for reviewing their manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Drugs of Abuse. A DEA Resource Guide and DEA Announces Intent to Schedule Kratom. Updated 2017. Accessed February 12, 2019. Available at:
  2. 2.
    Kratom exposure in the US linked to serious medical outcomes. Published February 21, 2019. Accessed February 21, 2019. Available at:
  3. 3.
    • Post S, Spiller H, Chounthirath T, Smith G. Kratom exposures reported to United States poison control centers: 2011–2017. Clin Toxicol. 2019;57:847–54 Available at: This reference was important for providing significant context for kratom being a substance for misuse. CrossRefGoogle Scholar
  4. 4.
    American Kratom Association. Kratom legality map. Accessed March 9, 2019. Available at:
  5. 5.
    Anwar M, Law R, Schier J. Notes from the field: kratom (mitragyna speciosa) exposures reported to poison centers — United States, 2010–2015. MMWR Morb Mortal Wkly Rep. 2016;65:748–9 Available at: Scholar
  6. 6.
    Boyer EW, Babu KM, Adkins JE, McCurdy CR, Halpern JH. Self-treatment of opioid withdrawal using kratom (Mitragynia speciosa korth). Addiction. 2008;103(6):1048–50 Available at: Scholar
  7. 7.
    • Grundmann O. Patterns of kratom use and health impact in the united states- results from an online survey. Drug Alcohol Depend. 2017;176:63–70. Accessed February 13, 2019. Available at: This reference was important for providing significant context for kratom being a substance for misuse.CrossRefPubMedGoogle Scholar
  8. 8.
    Kratom: unsafe and ineffective. Updated February 23, 2019. Accessed February 25, 2019. Available at:
  9. 9.
    Nelsen JL, Lapoint J, Hodgman MJ, Aldous KM. Seizure and coma following Kratom (Mitragynina speciosa Korth) exposure. J Med Toxicol. 2010;6(4):424–6 Available at: Scholar
  10. 10.
    Sheleg SV, Collins GB. A coincidence of addiction to “Kratom” and severe primary hypothyroidism. J Addict Med. 2011;5(4):300–1 Available at: Scholar
  11. 11.
    Castillo A, Payne JD, Nugent K. Posterior reversible leukoencephalopathy syndrome after kratom ingestion. Proc (Baylor Univ Med Cent). 2017;30(3):355–7 Available at: Scholar
  12. 12.
    Hughes RL. Fatal combination of mitragynine and quetiapine - a case report with discussion of a potential herb-drug interaction. Forensic Sci Med Pathol. 2019;15(1):110–3 Available at: Scholar
  13. 13.
    Aggarwal G, Robertson E, McKinlay J, Walter E. Death from kratom toxicity and the possible role of intralipid. J Intensive Care Soc. 2017;19(1):61–3 Available at: Scholar
  14. 14.
    McIntyre I, Trochta A, Stolberg S, Campman S. Mitragynine ‘Kratom’ related fatality: a case report with postmortem concentrations. J Anal Toxicol. 2015;39(2):152–5 Available at: Scholar
  15. 15.
    Neerman M, Frost R, Deking J. A drug fatality involving kratom. J Forensic Sci. 2013;58(1):S278–9 Available at: Scholar
  16. 16.
    Riverso M, Chang M, Soldevila-Pico C, Lai J, Liu X. Histologic characterization of kratom use-associated liver injury. Gastroenterol Res. 2018;11(1):79–82 Available at: Scholar
  17. 17.
    Kapp FG, Maurer HH, Auwarter V, Winkelmann M, Hermanns-Clausen M. Intrahepatic cholestasis following abuse of powdered kratom (Mitragyna speciosa). J Med Toxicol. 2011;7:227–31 Available at: Scholar
  18. 18.
    Dorman C, Wong M, Khan A. Cholestatic hepatitis from prolonged kratom use: a case report. Hepatology. 2015;61:1086–7 Available at: Scholar
  19. 19.
    Pizarro-Osilla C. Introducing…Kratom. J Emerg Nurs. 2017;43(6):504 Available at: Scholar
  20. 20.
    Galbis-Reig D. A case report of kratom addiction and withdrawal. WMJ. 2016; Accessed February 20, 2019. Available at:
  21. 21.
    Phillip AL. Heroin abstinence: a case report of kratom in the emergency department and beyond. West J Emerg Med. 2019;20:2 Available at: Scholar
  22. 22.
    Tatum WO, Hasan TF, Coonan EE, Smelick CP. Recurrent seizures from chronic kratom use, an atypical herbal opioid. Epilepsy Behav Case Rep. 2018;10:18–20 Available at: Scholar
  23. 23.
    LaBryer L, Sharma R, Chaudhari KS, Talsania M, Scofield RH. Kratom, an emerging drug of abuse, raises prolactin and causes secondary hypogonadism: case report. J Investig Med. 2018;6:1–3 Available at: Scholar
  24. 24.
    Castillo A, Payne JD, Nugent K. Posterior reversible leukoencephalopathy syndrome after kratom injection. Proc (Bayl Univ Med Cent). 2017;30(3):355–7 Available at: Scholar
  25. 25.
    FDA and Kratom. Updated February 15, 2019. Accessed February 20, 2019. Available at:
  26. 26.
    • Statement from FDA Commissioner Scott Gottlieb, M.D., On the agency’s scientific evidence on the presence of opioid compounds in kratom, underscoring its potential for abuse. published February 6, 2018. Accessed February 12, 2019. Available at: This reference was important for providing significant context for kratom being a substance for misuse.
  27. 27.
    FDA Oversees Destruction and Recall of Kratom Products; and Reiterates its Concerns on Risks Associated with this Opioid. Published February 21, 2018. Accessed February 15, 2019. Available at:
  28. 28.
    Withdrawal of notice of intent to temporarily place mitragynine and 7-hydroxymitragynine into schedule I. Published October 13,2016. Accessed February 12, 2019. Available at:
  29. 29.
    Brooks M. FDA warns more kratom makers over illegal sales, false claims. Medscape. Published June 25, 2019. Accessed July 9, 2019. Available at:
  30. 30.
    FDA in Brief. FDA objects to kratom compound intended for use as an alternative to prescription opioids and promoted with unproven claims to treat addiction. Published February 26, 2018. Accessed February 20, 20. Available at:

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Stephanie Colucci
    • 1
    • 2
    Email author
  • Sarah Culbreth
    • 1
  • Emad Alsarraf
    • 1
  • John Fanikos
    • 1
    • 2
  1. 1.Brigham and Women’s HospitalBostonUSA
  2. 2.Massachusetts College of Pharmacy and Health Science UniversityBostonUSA

Personalised recommendations