Kratom Overdose: Symptoms, Risks, and Treatment

Kratom is a psychoactive substance made from the kratom leaves of a tropical tree native to Southeast Asia. This herbal supplement is sold as regular kratom powder, capsules, and liquid extracts through some smoke shops, gas stations, and kratom companies, with people reporting uses such as mood enhancement and stimulant effects at low doses. As kratom exposures reported to poison control centers and concerns about kratom toxicity have increased, questions about kratom poisoning, accidental overdose, and public health have become more important.

What Is Kratom and Why Do People Use It?

Kratom is an herbal substance made from the leaves of the Mitragyna speciosa tree, which grows naturally in Southeast Asia. Its main active compounds, mitragynine and 7-hydroxymitragynine, interact with opioid receptors in the brain and can produce stimulant-like effects at lower amounts and sedating, opioid-like effects at higher amounts. People may use kratom to increase energy, improve mood, manage pain, relax, or reduce opioid withdrawal symptoms. Kratom is available as powders, capsules, teas, extracts, and concentrated products that can vary widely in strength. Regular or high-dose use may lead to tolerance, dependence, withdrawal, and addiction, while concentrated products or combining kratom with other substances may increase the risk of serious side effects and kratom overdose.

Signs and Symptoms of a Kratom Overdose

• Extreme Drowsiness or Sedation
• Confusion or Agitation
• Rapid Heart Rate
• High Blood Pressure
• Nausea, Vomiting, or stomach pain
• Seizures
• Difficulty Breathing
• Loss of Consciousness
• Coma

How Kratom Affects the Brain and Body

Kratom contains active compounds called mitragynine and 7-hydroxymitragynine that interact with opioid receptors in the brain. Kratom may produce stimulant-like effects at lower amounts and sedating or opioid-like effects at higher amounts.

These effects can influence mood, alertness, pain perception, heart rate, and breathing. Repeated use can also contribute to tolerance, physical dependence, withdrawal symptoms, and addiction.

Potential Benefits and Risks of Kratom Use

Some people use kratom for pain, energy, mood, or relief from opioid withdrawal symptoms, although kratom is not FDA-approved to treat any medical condition.

Potential reported benefits include:

• Pain Relief
• Increased Energy
• Mood Effects
• Relaxation
• Relief of Opioid Withdrawal Symptoms

Potential risks include:

• Dependence and Addiction
• Withdrawal Symptoms
• Nausea and Vomiting
• Seizures
• Liver Problems
• Drug Interactions
• Kratom Overdose
• Death in Severe Cases

What Is a Kratom Overdose?

A kratom overdose occurs when kratom causes toxic effects that threaten a person’s health or life. The risk can increase with concentrated products, large amounts, repeated dosing, or combining kratom with opioids, alcohol, sedatives, or other substances.

Severe kratom overdose symptoms can include seizures, extreme sedation, difficulty breathing, loss of consciousness, and coma. Unlike an opioid overdose, kratom poisoning does not always follow the same slowed or suppressed breathing pattern. Anyone showing severe symptoms after using kratom needs immediate medical attention.

How Much Kratom Can Cause an Overdose?

There is no established amount of kratom that causes an overdose in every person. Product strength, alkaloid concentration, tolerance, body size, health conditions, and other substances can all influence overdose risk. Taking more kratom, especially stronger extracts or repeated doses, may increase toxicity risk.

Kratom extracts and concentrated products may contain much higher levels of active compounds than traditional kratom leaf products. This variation makes it difficult to establish a single toxic or lethal dose.

Prevalence of Kratom Overdoses

Kratom-related poison center reports have increased in the United States as kratom products have become more widely available. In 2016 and 2017, kratom was linked to 152 deaths. Serious cases can involve seizures, respiratory problems, hospitalization, and death, although many severe and fatal cases involve kratom combined with other substances. Polysubstance use accounted for 87% of kratom-related deaths in 2016-2017. Overdose data can be difficult to measure because kratom products vary in strength and some cases involve multiple drugs. Poison center reports, emergency department data, and toxicology findings continue to provide information about kratom-related health risks, including overdose deaths. Florida recorded 533 multi-substance overdoses involving kratom.

Effects and Risks of a Kratom Overdose

Short-Term:

• Nausea and Vomiting
• Confusion and Agitation
• Rapid Heart Rate
• High Blood Pressure
• Severe Sedation
• Seizures
• Breathing Problems
• Loss of Consciousness
• Coma
• Death in Severe Cases

Long-Term:

• Increased Tolerance
• Physical Dependence
• Withdrawal Symptoms
• Kratom Addiction
• Continued Polysubstance Use
• Recurring Overdose Risk
• Potential Liver Problems
• Declining Mental and Physical Health

Kratom Drug Interactions and Polysubstance Use

Combining kratom with other substances can increase the risk of sedation, seizures, breathing problems, loss of consciousness, and overdose. Higher-risk combinations include opioids such as fentanyl, heroin, oxycodone, and hydrocodone; benzodiazepines such as alprazolam and diazepam; alcohol; sleep medications; and other central nervous system depressants. In many severe cases, kratom was not the only substance involved.

Kratom may also interact with stimulants, antidepressants, and other prescription medications, creating risks such as increased heart rate, high blood pressure, agitation, or serotonin toxicity in some circumstances. People should tell healthcare providers about all kratom products, prescription drugs, over-the-counter medications, supplements, alcohol, and other substances they use.

Risk Factors for Kratom Overdose

Several factors can increase the likelihood of a kratom overdose. Product potency and polysubstance use are especially important because kratom products can contain different concentrations of active compounds.

• Using High Doses or Repeated Doses
• Using Concentrated Kratom Extracts
• Using Products High in 7-Hydroxymitragynine
• Combining Kratom With Opioids
• Combining Kratom With Alcohol or Benzodiazepines
• Taking Multiple Sedating Substances
• Having Low Kratom Tolerance
• Returning to Use After a Period of Abstinence
• Having a History of Substance Use Disorder
• Using Products With Uncertain Potency or Contents

Can Kratom Overdose Cause Respiratory Depression or Death?

Yes. Kratom’s active compounds interact with opioid receptors, and severe toxicity can involve respiratory depression, profound sedation, seizures, coma, and other life-threatening effects. The danger may increase with concentrated products or when kratom is combined with opioids, alcohol, benzodiazepines, or other central nervous system depressants. Deaths involving kratom have been reported, although many cases also involve other substances, and some tracking has become more formal, including Florida requiring medical examiners to record kratom-related deaths since 2020. Any person who has slow or difficult breathing, cannot be awakened, experiences a seizure, or loses consciousness after taking kratom needs emergency medical care, because in severe cases kratom kill can be a real risk.

What to Do If You Suspect a Kratom Overdose

Call 911 immediately if a person has severe breathing problems, seizures, loss of consciousness, or cannot be awakened after using kratom. Stay with the person, and if they are unconscious, place them on their side to help prevent choking, follow instructions from emergency personnel, and provide responders with information about the kratom product, estimated amount, and any other substances taken. Naloxone may reverse opioid-like respiratory depression in some cases, but emergency medical care is still necessary because kratom can produce unpredictable effects. Kratom toxicity can sometimes lead to hypoxia 12 to 24 hours after ingestion, so delayed breathing complications still require emergency evaluation. Naloxone may help naloxone reverse opioid-like breathing suppression when opioid exposure is possible. Do not delay emergency care while waiting to see whether symptoms improve.

How to Prevent a Kratom Overdose

Avoiding kratom is the most reliable way to prevent a kratom overdose. People who continue using kratom should understand that concentrated extracts, high-7-hydroxymitragynine products, uncertain product strength, and combining substances can increase the risk of serious toxicity. Avoid mixing kratom with opioids, alcohol, benzodiazepines, sleep medications, or other sedating drugs. People who struggle to reduce or stop kratom use should speak with a healthcare or addiction treatment professional rather than attempting to manage escalating use alone.

Kratom Addiction and Co-Occurring Mental Health Disorders

Kratom addiction may occur alongside alcohol use disorder and misuse of opioids, benzodiazepines, stimulants, cannabis, or prescription medications. Some people begin using kratom to manage opioid withdrawal or reduce other drug use, but repeated use can mean needing more over time to get the same effects, which may signal rising tolerance, dependence, withdrawal, and compulsive use.

Co-occurring mental health conditions may include major depressive disorder, generalized anxiety disorder, post-traumatic stress disorder (PTSD), bipolar disorder, attention-deficit/hyperactivity disorder (ADHD), and other mood or anxiety disorders. When substance use and mental health symptoms occur together, dual diagnosis treatment can address both conditions as part of the same treatment plan.

Benefits of Stopping Kratom Use

Stopping kratom can reduce risks associated with ongoing use and help a person address dependence or addiction. Potential benefits may include:

• Reduced Overdose Risk
• Lower Risk of Harmful Drug Interactions
• Reduced Tolerance and Dependence
• Freedom From Repeated Kratom Use
• Improved Sleep Over Time
• More Stable Mood and Energy
• Improved Daily Functioning
• Better Management of Co-Occurring Substance Use
• Opportunity to Address Underlying Mental Health Symptoms

When to Seek Help

Seek emergency help immediately for difficulty breathing, seizures, severe confusion, loss of consciousness, or inability to wake after kratom use. These symptoms can indicate a serious kratom overdose and should not be managed at home. Professional addiction treatment may be appropriate when a person cannot control kratom use, needs increasing amounts, experiences withdrawal, continues despite harmful consequences, or repeatedly mixes kratom with other substances. Early treatment can address kratom use along with co-occurring substance use and mental health conditions.

Kratom Overdose and Addiction Treatment Options

• Emergency Medical Care: Medical teams can monitor breathing, heart function, seizures, consciousness, and other complications of a kratom overdose.
• Withdrawal Management: Clinical support can help manage withdrawal symptoms and monitor physical and mental health after regular kratom use stops.
• Residential Treatment: A structured residential setting provides 24-hour support for people with significant kratom addiction, polysubstance use, or co-occurring mental health needs.
• Outpatient Treatment: Outpatient programs allow people to receive addiction treatment while continuing to live at home when clinically appropriate.
• Behavioral Therapy: Cognitive behavioral therapy and other evidence-based approaches can address cravings, triggers, coping skills, and behaviors connected to substance use.
• Dual Diagnosis Treatment: Integrated care addresses kratom addiction and conditions such as anxiety, depression, PTSD, bipolar disorder, or ADHD together.
• Relapse Prevention: Ongoing therapy, support groups, recovery planning, and healthy coping strategies can help reduce the risk of returning to kratom or other substance use.

Does Insurance Cover Treatment?

Many health insurance plans cover substance use and mental health treatment, including care for kratom addiction. Coverage may include withdrawal management, residential or outpatient treatment, therapy, and dual diagnosis care. Exact benefits depend on the plan, medical necessity, provider network, and policy terms.

Conclusion

A suspected kratom overdose can become a medical emergency, especially when slow or shallow breathing, slowed breathing, severe adverse effects, or other signs of kratom poisoning occur. Chronic kratom use can lead to kratom dependence, muscle aches and other withdrawal symptoms, while substance misuse, underlying medical conditions, and combining substances may create an increased risk of fatal overdoses and reported deaths.

Although kratom is not federally classified as a controlled substance by the Drug Enforcement Administration, its chemical compounds can act at some of the same receptors involved in opioid effects. Understanding kratom-related deaths, kratom’s potential risks, and available disorder treatment can help people recognize when professional care is needed to treat withdrawal symptoms and address ongoing use.