What Is Kratom—Really?

Kratom (Mitragyna speciosa) is a plant with opioid-like properties.

Traditionally, it has been used for:

• Pain relief

• Mood enhancement

• Mitigation of opioid withdrawal

Its active compounds interact with opioid receptors, which explains both its appeal—and its risk profile.

But the modern version of kratom is not the traditional version.

Today’s market includes:

• High-potency extracts

• Semisynthetic derivatives (notably 7-hydroxymitragynine)

• Concentrated liquid formulations marketed as “energy” products

This evolution matters. Because potency has changed faster than understanding.

The Data: A 1,200% Increase

From 2015 to 2025, reports to U.S. poison centers involving kratom increased from 258 to 3,434.

That is a 1,200% increase.

Across the full dataset:

• 14,449 total exposure reports were documented

• 2025 represented the highest level on record

• A sharp surge occurred in the most recent year

These are not isolated events. They represent a trend line moving in one direction. Up.

The Real Risk: It’s Not Kratom Alone

Here is the critical finding most people miss:

Kratom by itself is not the primary driver of severe outcomes. Kratom combined with other substances is.

Multi-Substance Use Changes Everything

• 38% of all exposures involved multiple substances

• These cases had:

  • Higher hospitalization rates (44–56%)

  • Higher rates of serious outcomes (57–66%)

• 79% of all deaths involved multiple substances

The most common co-exposures:

• Alcohol

• Opioids

• Benzodiazepines

• Stimulants

• Antidepressants

This is not a coincidence. It is pharmacology.

Additive effects on the central nervous system increase:

• Respiratory depression

• Sedation

• Cardiovascular instability

And with newer high-potency products, that risk compounds.

Who Is Using Kratom?

The demographic profile is shifting.

• Historically: young adult males (20–39)

• Increasingly: adults 40–59

• Males still represent the majority of cases

This matters clinically. Because it challenges the assumption that kratom use is limited to a narrow population. It is expanding.

Why People Use It

The most common driver?

Intentional use.

• 56% of single-substance cases

• 49% of multi-substance cases

But beneath that:

• Pain management

• Self-treatment of anxiety or depression

• Attempts to manage opioid withdrawal

In multi-substance exposures:

• 23% involved suspected suicide attempts

This is where the conversation changes. Kratom is not just a substance issue. It is a behavioral and mental health signal.

The Clinical Reality

From a frontline perspective, kratom occupies a difficult space:

• Not fully regulated

• Widely available

• Perceived as “natural”

• Poorly understood by many clinicians

Patients often do not disclose use unless asked directly.

And when they do, it is often embedded in a larger pattern:

• Polypharmacy

• Self-medication

• Underlying psychiatric comorbidity

The data supports this:

• ~⅓ of users meet criteria for another substance use disorder

• ~⅔ report using kratom for mood-related symptoms

This is not a supplement problem. It is a system problem.

The Illusion of Safety

The most dangerous assumption surrounding kratom is this:

If it’s plant-based, it must be safe.

That assumption no longer holds. The shift to:

• Concentrated extracts

• Semisynthetic compounds

High-dose formulations has fundamentally altered the risk profile. The label says kratom. The pharmacology may say something else entirely.

What This Means for Practice

If you work in clinical care—especially emergency or acute care—this matters.

Ask Directly - Patients rarely volunteer kratom use. You have to ask.

Think Poly-Substance

Kratom alone is not the full story. Look for:

• Alcohol

• Benzodiazepines

• Opioids

• Antidepressants

Watch for Mental Health Signals

Kratom use often coexists with:

• Anxiety

• Depression

• Substance use disorders

Recognize the Pattern

Frequent users are not always seeking euphoria. Many are trying to:

• Function

• Cope

• Replace something else

The Bottom Line

Kratom is not new. But its context is.

• Use is increasing

• Potency is increasing

• Risk is increasing—especially with other substances

And most importantly:

The patient using kratom is rarely just using kratom.

Final Perspective

This is where clinical medicine must move beyond labels. Kratom is not simply:

• “good” or “bad”

• “natural” or “dangerous”

It is a signal of:

• unmet pain

• unmanaged mental health

• gaps in care

If we reduce it to a substance, we miss the patient. And if we miss the patient, we miss the point of medicine entirely.

Author: R.E. Hengsterman, MSN, MA, M.E., RN

Registered nurse, night-shift administrator, and author of The Shift Worker’s Paradox

Nursewhowrites.com

For educational purposes only. Not medical advice.

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This article follows NurseWhoWrites editorial guidelines emphasizing evidence-based practice, transparent sourcing, and real-world clinical experience.

Sources: Towers, E. B., Thomas, Y. T., Holstege, C. P., & Farah, R. (2026). Increases in kratom-related reports to poison centers—National Poison Data System, United States, 2015–2025. Morbidity and Mortality Weekly Report, 75(11), 139–145. https://doi.org/10.15585/mmwr.mm7511a1