Kratom Conundrum: What is kratom, and which drug schedule does it belong to?
DOWNLOADKratom is a naturally occurring substance found in the leaves of a tropical tree, Mitragyna speciosa, native to Southeast Asia and parts of Africa. In the same genetic family as coffee, kratom produces a stimulant effect in low doses and an opioid-like effect in higher doses.¹
Traditionally, kratom was used by brewing tea or chewing on the leaves.² Now, kratom users also consume the drug as a pill, an edible food product, or as a liquid infused with kratom extract.³
Recent research has suggested that the drug could have potentially addictive qualities, might worsen preexisting mental health concerns, and (when used in excess) can lead to overdose and death.⁴
Other studies have found that the drug has a low potential for addiction when compared to opioids, like morphine.⁵ The United States Food and Drug Administration (FDA) has not approved kratom for medical use.⁶
Despite the side effects, clinicians are studying the potential therapeutic aspects of kratom. A user survey shows that kratom can be used to treat opioid addiction, pain relief, anxiety, and depression.⁷
Bodily Effects of Kratom
Kratom contains two active chemical components: mitragynine and 7-hydroxymitragynine. In low doses, kratom produces a stimulant effect, causing users to feel more alert and energetic. In higher doses, the drug acts as an analgesic, providing pain relief and inciting euphoria.⁸
A report published in Pharmacotherapy on the toxicities associated with kratom showed that users most often experienced agitation, tachycardia, drowsiness, vomiting, and confusion.⁹ The same study also found that people who used kratom in high doses for extended periods of time can have serious complications such as seizures, withdrawal, hallucinations, respiratory depression, coma, and cardiac or respiratory arrest.¹⁰ There is also research that suggests kratom can worsen pre-existing mental health conditions like psychosis.¹¹ Many of the side effects are dose dependent.¹²
Kratom usage data shows there have been overdoses and deaths related to kratom.¹³ However, it should be noted that in most of those cases, kratom was used in combination with other substances like alcohol or an opioid.¹⁴ Compared to opioids, the risk of a fatal overdose from kratom is 1000 times lower.¹⁵
Addiction and Abuse Potential
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) does not include specific diagnostic criteria for kratom substance use disorder or addiction.¹⁶ However, based on the criteria for other substance use disorders and addiction, kratom users may experience mild to moderate withdrawal symptoms. Other substances that produce similar symptoms include caffeine¹⁷ and nicotine.¹⁸
A 2021 study reviewed kratom’s abuse potential compared to the eight factors of drug and substance abuse outlined by the Controlled Substances Act. The study found that there is currently a limited public health concern relating to kratom abuse.¹⁹
Scheduling History
The FDA has asserted that kratom does not have any useful medicinal properties. Thus, in 2017, the Drug Enforcement Administration (DEA) released a statement of intent to classify kratom as a schedule I drug,²⁰ alongside drugs like heroin and methamphetamine. However, after research found that the FDA had insufficient evidence to support its claim, the Department of Health and Human Services and the DEA retracted their intent to schedule.²¹ Kratom is not scheduled under the Controlled Substances Act.²²
Notable Southern Legislation from the 2025 Session
States are taking note of the discussions surrounding kratom, and several have begun to enact legislation to regulate the drug. This session, Mississippi has passed two bills (MS H.B. 1077 and MS H.B. 1896) to prohibit the sale of kratom to persons under 21 years of age and to impose a 15 percent excise tax, respectively. Virginia has enacted similar age restrictions this session (VA H.B. 2195 and VA S.B. 1376), and North Carolina has a comparable bill in committee (NC H.B. 468).
Oklahoma, Tennessee, and Texas are seeking to ban kratom in their states. Oklahoma’s Uniform Controlled Dangerous Substances Act (OK S.B.860), should it pass the House, will classify kratom as a schedule I drug.
Tennesse’s H.J.R.0147 supports a ban on the sale of kratom within the state. Texas’s TX S.B. 1868 groups kratom with certain hallucinogens and prohibits the use and distribution of the drug.
Conversely, Arkansas is working to declassify kratom as a schedule I drug and begin regulating its sale and distribution (AR S.B.534). Other states are following suit. Georgia (GA H.B.757), Louisiana (LA H.B. 253), and Missouri (MO H.B. 1037) have put forth legislation to regulate kratom as opposed to criminalizing it.
References
1. United States Drug Enforcement Administration. (2019). Kratom. Dea.gov.
https://www.dea.gov/factsheets/kratom
2. Singh, D., Narayanan, S., & Vicknasingam, B. (2016). Traditional and non-traditional uses of Mitragynine (Kratom): A survey of the literature. Brain Research Bulletin, 126, 41–46.
https://doi.org/10.1016/j.brainresbull.2016.05.004
3. Kratom: Unsafe and ineffective. (2024). Mayo Clinic.
https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/kratom/art-20402171
4. Henningfield, J. E., Grundmann, O., Babin, J. K., Fant, R. V., Wang, D. W., & Cone, E. J. (2019). Risk of death associated with kratom use compared to opioids. Preventive Medicine, 128, 105851.
https://doi.org/10.1016/j.ypmed.2019.105851
5. Henningfield, J. E., Grundmann, O., Babin, J. K., Fant, R. V., Wang, D. W., & Cone, E. J. (2019). Risk of death associated with kratom use compared to opioids. Preventive Medicine, 128, 105851.
https://doi.org/10.1016/j.ypmed.2019.105851
6. Office of the Commissioner. (2019). FDA and Kratom. U.S. Food and Drug Administration.
https://www.fda.gov/news-events/public-health-focus/fda-and-kratom
7. Natural Herb Kratom May Have Therapeutic Effects And Relatively Low Potential For Abuse Or Harm, According To A User Survey. (n.d.). Www.hopkinsmedicine.org.
https://www.hopkinsmedicine.org/news/newsroom/news-releases/2020/02/natural-herb-kratom-may-havetherapeutic-effects-and-relatively-low-potential-for-abuse-or-harm-according-to-a-user-survey
8. Eastlack SC, Cornett EM, Kaye AD. Kratom-Pharmacology, Clinical Implications, and Outlook: A Comprehensive Review. Pain Ther. 2020 Jun;9(1):55-69. doi: 10.1007/s40122-020-00151-x. Epub 2020 Jan 28. PMID: 31994019; PMCID: PMC7203303.
9. Eggleston, W., Stoppacher, R., Suen, K., Marraffa, J. M., & Nelson, L. S. (2019). Kratom Use and Toxicities in the United States. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 39(7), 775–777.
https://doi.org/10.1002/phar.2280
10. Eggleston, W., Stoppacher, R., Suen, K., Marraffa, J. M., & Nelson, L. S. (2019). Kratom Use and Toxicities in the United States. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 39(7), 775–777.
https://doi.org/10.1002/phar.2280
11. Nunez, M. B., Dhingra, A., Dhingra, M., Kossack, R., & Dhingra, M. (2022). Kratom’s rising role in the potential exacerbation of mental health disorders: A case report and review of the literature. Psychiatry Research Case Reports, 1(2), 100069.
https://doi.org/10.1016/j.psycr.2022.100069
12. Grundmann, O., Hendrickson, R. G., & Greenberg, M. I. (2022). Kratom: History, pharmacology, current user trends, adverse health effects and potential benefits. Disease-a-Month, 101442.
https://doi.org/10.1016/j.disamonth.2022.101442
13. Henningfield, J. E., Grundmann, O., Babin, J. K., Fant, R. V., Wang, D. W., & Cone, E. J. (2019). Risk of death associated with kratom use compared to opioids. Preventive Medicine, 128, 105851.
https://doi.org/10.1016/j.ypmed.2019.105851
14. National Institute on Drug Abuse (2019). Kratom DrugFacts. Bethesda, MD: National Institutes of Health. Available from: https://www.drugabuse.gov/publications/drugfacts/kratom. [Google Scholar]
15. Henningfield, J. E., Grundmann, O., Babin, J. K., Fant, R. V., Wang, D. W., & Cone, E. J. (2019). Risk of death associated with kratom use compared to opioids. Preventive Medicine, 128, 105851.
https://doi.org/10.1016/j.ypmed.2019.105851
16. American Psychiatric Association. Substance-related and addictive disorders. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington D.C.: 2013. doi:10.1176/appi.books.9780890425596.dsm16
17. Sajadi-Ernazarova, K. R., & Hamilton, R. J. (2023, August 8). Caffeine Withdrawal. Nih.gov; StatPearls Publishing.
https://www.ncbi.nlm.nih.gov/books/NBK430790/
18. CDC. (2021, July 9). 7 Common Withdrawal Symptoms | Quit Smoking | Tips From Former Smokers | CDC. Www.cdc.gov.
https://www.cdc.gov/tobacco/campaign/tips/quit-smoking/7-common-withdrawal-symptoms/index.html
19. Henningfield, J. E., Wang, D. W., & Huestis, M. A. (2022). Kratom Abuse Potential 2021: An Updated Eight Factor Analysis. Frontiers in Pharmacology, 12.
https://doi.org/10.3389/fphar.2021.775073
20. Drug Enforcement Administration (DEA). Schedules of controlled substances: temporary placement of mitragynine and 7-hydroxymitragynine into Schedule I. Fed Regist. 2016;81(169):59929-59934.
www.gpo.gov/fdsys/pkg/FR-2016-08-31/pdf/2016-20803.pdf. Accessed January 23, 2017.
21. DEA. Withdrawal of notice of intent to temporarily place mitragynine and 7-hydroxymitragynine into Schedule I. Fed Regist. 2016;81(198):70652-70654.
www.gpo.gov/fdsys/pkg/FR-2016-10-13/pdf/2016-24659.pdf. Accessed January 23, 2017.
22. Drug Enforcement Administration. (2019). Kratom.