Is Taking Kratom with Other Substances Safe?

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Kratom is an herbal substance that is enjoying increased popularity in the U.S. and beyond for its purported value in relieving pain, increasing energy (in low doses), and acting as an opioid-like sedative (in high doses).

Because it is a natural substance, many assume kratom is safe, but some research shows that it can be dangerous to take, especially in combination with many medications.

If you or someone you care about struggles with dependence on Kratom or are taking it along with another substance, Guardian Recovery can help. We will work with you to develop an individualized and effective program to help you recover from addiction and get you on the road to long-term recovery. We believe in the benefits of a full curriculum of clinical care, beginning with medical detoxification, transitioning into a higher level of treatment, and concluding with personalized aftercare planning. Contact us today to learn more about our treatment options in your area.

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What is Kratom Used For?

Kratom is derived from a tree in the coffee family, which is found in Thailand and other Southeast Asian countries.

In its native lands, its leaves have been traditionally used to fight fatigue or increase productivity. They’ve also been used during religious ceremonies to treat pain, coughing, and diarrhea. 

Other uses that have not been proven scientifically include:

  • Anxiety and depression
  • Opioid use disorder
  • Opioid withdrawal

How is Kratom Taken?

Kratom is used in multiple ways in Southeast Asia. People chew on the leaves or brew them into tea. Kratom can also be smoked or vaporized.

In the West, it is mostly marketed in gel capsules, powders, or extracts and sold over the internet, in specialty shops, and in gas stations.

Kratom can also be processed into a powder, which is sometimes swallowed with a beverage, known as the “toss and wash” method. It is also added to smoothies, cocktails, caffeinated drinks, and cough syrup.

Is Kratom Popular in the U.S.?

According to the U.S. Drug Enforcement Agency (DEA), the use (and misuse) of kratom has increased substantially in recent years. That claim is supported by the National Survey on Drug Use and Health, which reported that an estimated 1.7 million Americans aged 12 and older used kratom in 2021.

What is Kratom’s Effect on the Body?

At low doses, kratom increases alertness, physical energy, and talkativeness. At high doses, it brings about sedation. Its opioid-like effects make dependence possible. Those who become addicted can experience hallucinations, delusion, confusion, nausea, itching, sweating, dry mouth, constipation, increased urination, and loss of appetite. Long-term use can cause anorexia, weight loss, and insomnia.

The U.S. Food and Drug Administration (FDA) warns against using kratom due to the risk of serious adverse events, including liver toxicity, seizures, and substance use disorder (SUD). In rare cases, deaths have been associated with kratom use in combination with other drugs.

Is Kratom Legal?

Kratom and kratom-based products are currently legal and accessible in many areas throughout the U.S. However, several states have imposed regulations on the substance, and five states have outright banned its sale. 

Those states are:

  • Alabama
  • Arizona
  • Indiana
  • Rhode Island
  • Wisconsin

The U.S. Drug Enforcement Agency (DEA) lists kratom as a “drug of concern” but has yet to list it on the U.S. schedule of controlled substances. The schedule is a list developed under the Controlled Substances Act. It organizes all substances regulated by existing federal law based on their medical use, potential for abuse, safety, and potential for developing dependence.  Substances are classified in one of five categories (schedules) as follows:

Schedule I — substances or chemicals with no currently accepted medical use and a high potential for abuse. Examples include heroin, lysergic acid diethylamide (LSD), marijuana (cannabis), 3,4-methylenedioxymethamphetamine (ecstasy), methaqualone (quaaludes), and peyote.

Schedule II — drugs with a high potential for abuse, where use can lead to severe psychological or physical dependence. These drugs are also considered dangerous. Examples include combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin), cocaine, methamphetamine, methadone, hydromorphone (Dilaudid), meperidine (Demerol), oxycodone (OxyContin), fentanyl, Dexedrine, Adderall, and Ritalin.

Schedule III — drugs with a moderate to low potential for physical and psychological dependence. The chance for abuse is less than for Schedule I and Schedule II drugs but more than for Schedule IV. Schedule III drugs include products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine), ketamine, anabolic steroids, and testosterone.

Schedule IV — drugs with a low potential for abuse and low risk of dependence. Some examples are Xanax, Soma, Darvon, Darvocet, Valium, Ativan, Talwin, Ambien, and Tramadol.

Schedule V — drugs have a lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. Schedule V drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. They include cough preparations with less than 200 milligrams of codeine per 100 milliliters (Robitussin AC), Lomotil, Motofen, Lyrica, and Parepectolin.

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Is Kratom Safe?

The long-term effects of kratom use are not well understood. While more research is necessary to determine scientifically if kratom is safe and/or effective in treating the conditions people say it does, cases of kratom-related SUD and death associated with the substance have also been observed. 

In cases of kratom misuse, individuals met criteria for SUD, including:

  • Using kratom for longer than intended.
  • Using more kratom than intended.
  • Having cravings for kratom.
  • Continuing to use kratom despite adverse consequences (either physically or in their personal life).
  • Needing more kratom to produce the same effect (tolerance).
  • Experiencing withdrawal symptoms when kratom use was stopped (physical dependence).

The FDA has also found cases involving neonatal abstinence syndrome, in which newborns experienced withdrawal signs such as jitteriness, irritability, and muscle stiffness following prolonged exposure to kratom before birth.

There have also been reports that long-term use of large doses of kratom may cause serious liver problems in some people.

What Are the Side Effects of Using Kratom?

Kratom use has been proven to produce adverse side effects, including:

  • Agitation
  • Tachycardia
  • Drowsiness
  • Vomiting
  • Confusion

More severe effects such as hepatotoxicity (liver damage), cardiotoxicity (heart damage), respiratory depression, seizure, neonatal abstinence syndrome, hypothyroidism (underactive thyroid), and fatalities have also been confirmed. Usually, these side effects were found in people using Kratom along with another substance, making it unclear to what extent either substance contributed to the problems.

Can Kratom Cure Opioid Addiction?

Kratom leaves contain compounds that interact with opioid receptors in the brain, potentially easing withdrawal symptoms and cravings experienced by individuals addicted to opioids. Users often report using kratom for its stimulant effects at low doses and its opioid-like effects at higher doses, especially to self-manage opioid withdrawal symptoms and to reduce opioid cravings.

Despite anecdotal evidence suggesting kratom’s effectiveness in managing opioid withdrawal and dependence, scientific research on kratom’s efficacy and safety is still limited. The compounds found in kratom act on the brain’s opioid receptors, but they don’t offer the same high level of euphoria or the same degree of risk of respiratory depression (a common cause of overdose in opioid use) that traditional opioids do. This has led some to believe that kratom could potentially offer a less harmful alternative to opioids and could be used as a step-down treatment to ease withdrawal symptoms.

Risks of Kratom Use for Opioid Dependence

There are also concerns about the variability in the strength and purity of kratom products, which are not regulated in many parts of the world. This variability can significantly affect both the efficacy and safety of using kratom for opioid withdrawal or as a substitute for opioids.

Additionally, there are reported side effects associated with kratom use, including nausea, vomiting, constipation, sleep issues, and even more severe issues like liver damage, dependence, and withdrawal symptoms from kratom itself. The potential for abuse and addiction to kratom is another significant concern, as it suggests that while kratom may offer some relief from opioid addiction, it could also pose its own risk of dependence.

Given these uncertainties, the recommendation for individuals struggling with opioid dependence is to seek the help of experienced and licensed healthcare professionals. Medical professionals can offer evidence-based treatments for opioid addiction, such as medication-assisted treatment (MAT) using FDA-approved medications like buprenorphine, methadone, and naltrexone, combined with counseling and behavioral therapies. These treatments have been studied extensively and have been shown to be effective in helping individuals recover from opioid addiction, reduce opioid overdose rates, and improve social and health outcomes.

Does Kratom Interact with Other Substances?

It is generally unsafe to take Kratom alongside more than 260 substances, including alcohol, depressants like barbiturates and benzodiazepines (benzos), antidepressants, including MAO inhibitors and SSRIs, opiates, and stimulants.

Kratom either increases the effect of the substance (agonistic interaction), decreases it (antagonistic interaction), or slows the body’s ability to eliminate the substance (metabolic competitor), meaning it stays in the body longer than it is supposed to.

Other medications reported to interact with kratom include:

  • Modafinil (Provigil) is a medication that promotes wakefulness in people with narcolepsy. Taking kratom along with modafinil might increase the risk of seizures.
  • Medications that are changed or broken down by the liver. Kratom might change how quickly the liver breaks down these medications. This could alter the effects and side effects of these medications.
  • Quetiapine (Seroquel) is used to treat schizophrenia, bipolar disorder, and other mental health conditions. Kratom may slow down the rate at which the body breaks down quetiapine, increasing effects and side effects.
  • Sedatives and kratom both cause sleepiness and slowed breathing. Taking them together might cause breathing problems or excessive drowsiness.
  • Naltrexone is prescribed to treat alcohol and opioid use disorders. Combining it with kratom might lead to withdrawal.
  • Venlafaxine (Effexor) is an antidepressant. Taking kratom with venlafaxine may reduce how quickly the body breaks down the antidepressant, leading to increased effects and side effects.

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Reviewed professionally for accuracy by:

Ryan Soave


Ryan Soave brings deep experience as a Licensed Mental Health Counselor, certified trauma therapist, program developer, and research consultant for Huberman Lab at Stanford University Department of Neurobiology. Post-graduation from Wake Forest University, Ryan quickly discovered his acumen for the business world. After almost a decade of successful entrepreneurship and world traveling, he encountered a wave of personal and spiritual challenges; he felt a calling for something more. Ryan returned to school and completed his Master’s Degree in Mental Health Counseling. When he started working with those suffering from addiction and PTSD, he found his passion. He has never looked back.

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Cayla Clark

Cayla Clark grew up in Santa Barbara, CA and graduated from UCLA with a degree in playwriting. Since then she has been writing on addiction recovery and psychology full-time, and has found a home as part of the Guardian Recovery team.

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