There is growing concern about the safety of consuming Kratom (mitragynine), a supplement derived from the leaves of a tree native to several South Asian nations. It is primarily consumed as tea or by chewing whole leaves, but it is used in a variety of products which include drinks, pills, powders, and leaves, and may be brewed as tea.  In its marketing it has been sold as an energy booster, relaxant, and pain reliever. It is commonly available in smoke shops and gas stations, and thus it has a wide exposure to young people. Since 2008 Kratom use has been on the rise in the United States and several other nations. It is sold in health food shops and even in dedicated Kratom stores. In the U.S., its use has been recreational for its euphoric effects and for self-treatment of opioid withdrawal. In high doses Kratom has opioid-like effects.

It is currently listed as an unscheduled drug by the U.S. Drug Enforcement Administration (DEA) and is currently under investigation. The DEA has now listed it a “drug of concern” as it may have been involved in over 150 overdose related deaths. Of note, Kratom is currently banned by six states and the District of Columbia and at least 18 other states have some form of regulation.

Neurocritical care practitioners need to be aware of its association with several serious neurologic symptoms, as these patients may be seen in the ICU. Clinical manifestations associated with Kratom include agitation, drowsiness, confusion, seizures, tremors, vertigo, syncope, coma, hallucinations, ataxia, headache, slurred speech, and muscle weakness as reported in a release of the FDA (FDA, 2025). There has also been a report of a spontaneous intracranial hemorrhage from our center after regular Kratom use. In this case, the patient ingested it orally (Regan and Papadakos, 2021).  The most common presentation was seizures. What is highly important is these seizures may be triggered after single-substance exposure in 6.1-9.6% of users in the US. Reports from Southeast Asia have been reported as high as 17.5% (Bahu and Boyer, 2021).

The vast majority of patients presenting with Kratom induced seizures have no prior history of epilepsy.(Burke et al, 2021)  The seizure effects of mitragynine which has structural similarity to yohimbine which is thought to cause seizures through impairment of gamma-aminobutyric acid. We need to educate ourselves in this drug and its availability and use in our community. Its effects may not only present as seizures but may also mimic stroke and many neuromuscular disorders. We must educate our staff to specifically ask about Kratom use in our patients. At this time Kratom clinical testing is not rapidly available in most centers, it is a send out test and may have a turnaround time of 5-10 days. We must also screen patients admitted to our units about use of this drug in interviews with patients and families in that they may not be aware of the adverse effects of this drug. Its use crosses all socioeconomic and age groups and should be part of our regular screening process.

As a profession involved in neurological disease, we should be vocal in having this drug banded by our state and federal authorities. In August the Health and Human Services Secretary Robert F Kennedy Jr. announced plans for a crackdown on Kratom. We need to follow progress in addressing this drug and its affects on health.