The following is a summary of an article published on the NIH Library of Medicine, and the full article can be read here.

Kratom (Mitragyna speciosa) is a tropical tree native to Southeast Asia. Its leaves have been used traditionally for centuries and are now consumed worldwide in forms like teas, powders, and capsules. In the U.S., interest has grown rapidly, especially among people looking for natural approaches to energy, mood, discomfort, or to manage opioid withdrawal. With that growth, clinicians have also reported some abuse cases of dependence, adverse effects, and toxicity. NCBI+1

This article offers a clear, science-based overview of what kratom is, what its main active compounds do, and what current medical literature says about potential risks.

The two key compounds to know

Kratom contains multiple alkaloids, but two are especially important:

• Mitragynine – the most prevalent alkaloid.

• 7-hydroxymitragynine (7-OH) – present in smaller amounts but is more pharmacologically active. NCBI

Mitragynine is metabolized in the liver into 7-OH, which is believed to contribute strongly to kratom’s more opioid-like effects. The estimated half-life of mitragynine is about 3 hours, though real-world effects can vary based on product type and individual metabolism. NCBI+1

How kratom may act in the body

Kratom’s effects are often described as stimulant-like at lower amounts and opioid-like at higher amounts, though the exact experience can vary widely across people and products. NCBI

Researchers have also noted a potentially meaningful difference between classic opioids and kratom alkaloids: both interact with G-protein coupled receptor pathways, but kratom alkaloids may not activate the beta-arrestin pathway. This is important since the beta-arrestin pathway is responsible for all of the negative side effects associated with opioids. That detail has sparked interest in future therapeutic research, but this is still an evolving area and not necessarily a green light for safety in all products. NCBI

Why product variability matters

One of the biggest safety challenges is inconsistency. Because kratom products may vary widely in alkaloid content and can be adulterated or contaminated, it can be difficult for consumers (and even clinicians) to know what dose or what additional substances someone has been exposed to when researching safety. NCBI+1

This highlights the importance of implementing regulatory structures across the United States to keep kratom safe.

Drug interactions and who should avoid kratom

Medical literature suggests that mitragynine may interact with liver enzyme systems involved in drug metabolism. This raises concern for potential herb-drug interactions, especially with medications affected by UGT pathways (e.g., buprenorphine, ketamine, etc). NCBI

Based on reported risks, clinicians urge additional caution or avoidance among people with:

• liver disease

• neurologic conditions

• heart, lung, or kidney disease

• history of polysubstance use

• pregnancy NCBI+1

This content is for educational purposes only and is not medical advice. Kratom products have not been approved by the U.S. Food and Drug Administration to diagnose, treat, cure, or prevent any disease. If you have questions about kratom use or potential interactions with medications or health conditions, consult a qualified healthcare professional.

References

Sokup B, Pippin MM. Kratom. [Updated 2023 Aug 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK585120/