Hallucination defined in Johns Hopkins Psychiatry Guide is “a perception without a stimulus” (2017).
Kratom is not classified as a hallucinogen. Hallucinogens are defined by the National Institute on Drug Abuse (NIDA) as “drugs that alter a person’s awareness of their surroundings as well as their own thoughts and feelings” (2019).
However, while the Food and Drug Administration (FDA), Drug Enforcement Agency (DEA), and numerous news organizations have listed “hallucinations” as a potential side effect of kratom, they have not provided references to support this claim. A Google search on private browsing for “kratom” “hallucinations” yields 5.7 million results. The top result is a case report (Cutlip et al, 2021) discussed below. Other front page results include FDA, DEA, and multiple rehabilitation industry sources.
The scientific literature provides limited evidence to support the inclusion of hallucinations as a legitimate side effect of kratom. A Pubmed search for “(kratom) AND (hallucinations)” (this automatically includes related medical subject heading (MeSH) terms) generated seven results:
- Babu et al 2009 examines both kratom and salvia divinorum. It clearly only mentions hallucinations as an effect of salvia divinorum, not kratom.
- However, Chang-Chien et al 2017 listed Babu et al 2009 as a source for this statement: “Those who overdose on Kratom can experience seizures, psychosis, coma, hallucination, paranoia, severe emesis, respiratory depression and in the worst scenarios, death (13,16).” Source #13 is Babu et al 2009. Source #16 is Forrester 2013.
- Forrester 2013 is Texas Department of State Health Services report on kratom-related calls to the Texas Poison Control Center from January 1998 to September 2013. Two of the calls reported hallucinations after kratom ingestion. More information about these two calls is not included in the report. Therefore other factors, such as the misinterpretation of symptoms like blurred vision or visual seizures as hallucinations, the potential for hidden co-ingestion of illicit drugs, and the adulteration of kratom products, must also be considered as possible explanations.
- Three papers: Burillo-Putze et al 2013, Sangani et al 2021, and Wright 2018 simply list hallucinations as a kratom effect without sourcing.
- Eggleston et al 2019 cites 45 reports to National Poison Data System over a seven year period that can’t rule out above listed possibilities for call-in self-reporting. Furthermore, Grundmann et al 2019 critiques Eggleston et al, noting that “the authors do not acknowledge that their data and methods prevent determining causal relationships between kratom and adverse outcomes” and “the contribution of adulteration or contamination to cases was ignored by Eggleston et al”.
The evidence that kratom is a direct cause of psychosis, that may or may not involve hallucinations, is also sparse in the literature. A Pubmed search for “(kratom) AND (psychosis)” (related MeSH terms automatically included) generated 13 results. Ten results either list psychosis as a kratom side effect, or list kratom as one of the substances consumed by a sample group in a broader study of drug use trends.
Three of the results specifically focused on psychosis as an effect of kratom:
- Cutlip et al 2021, “A Case Report of Kratom-Induced Psychosis”, reports on a man whose medical history included “a history of post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), and chronic primary adrenal insufficiency”, “several head injuries”, “a history of addiction to ‘pain relievers'”, “depression”, and reported that prior to admission he “had not slept in seven days”. His medications included 20mg Cymbalta, 15mg hydrocortisone, and 5mg Adderall daily, and 200mg testosterone weekly. The patient drank a shot of liquid kratom a week prior to his hospital admission and decided to stop all other medications. He was then unable to sleep. Cutlip et all concludes that “After speaking with the patient, Kratom was considered the most likely cause of his acute psychosis.” See our podcast episode Kratom Science Journal Club #24 about this case report.
- Leong Bin Abdullah et al 2019 found that out of 150 regular kratom users from Malaysia, six were found to have mild psychotic symptoms. The study concludes, “Although psychotic symptoms could occur among regular kratom users, they were rare and not significantly associated with kratom use characteristics. We found no evidence of elevated psychosis among regular users.”
- Vijeepallam et al 2016 found kratom to be “effective in alleviating positive as well as negative symptoms of psychosis in mouse models” and that kratom “could be utilized for the development of novel antipsychotic drug”.
Anecdotes have been reported online that are similar to Cutlip et al., where symptoms of psychosis occurred after kratom was taken in combination with other drugs, during the discontinuation of medication, or due to insomnia. But it is important to consider that kratom may have played a contributory role in the development of hallucinations and/or psychosis, rather than being the sole cause.
Finally, there has yet to be pharmacological evidence established to suggest the major alkaloids in kratom have hallucinogenic properties.
References
- Babu, K. M., McCurdy, C. R., & Boyer, E. W. (2008). Opioid receptors and legal highs: Salvia divinorum and Kratom. Clinical toxicology (Philadelphia, Pa.), 46(2), 146–152. https://doi.org/10.1080/15563650701241795
- Burillo-Putze, G., López Briz, E., Climent Díaz, B., Munné Mas, P., Nogue Xarau, S., Pinillos, M. A., & Hoffman, R. S. (2013). Drogas emergentes (III): plantas y hongos alucinógenos [Emergent drugs (III): hallucinogenic plants and mushrooms]. Anales del sistema sanitario de Navarra, 36(3), 505–518. https://doi.org/10.4321/s1137-66272013000300015
- Chang-Chien, G. C., Odonkor, C. A., & Amorapanth, P. (2017). Is Kratom the New ‘Legal High’ on the Block?: The Case of an Emerging Opioid Receptor Agonist with Substance Abuse Potential. Pain physician, 20(1), E195–E198.
- Cutlip, H. A., Bushman, E., Thottumari, L., Mogallapu, R., & Ang-Rabanes, M. (2021). A Case Report of Kratom-Induced Psychosis. Cureus, 13(6), e16073. https://doi.org/10.7759/cureus.16073
- Eggleston, W., Stoppacher, R., Suen, K., Marraffa, J. M., & Nelson, L. S. (2019). Kratom Use and Toxicities in the United States. Pharmacotherapy, 39(7), 775–777. https://doi.org/10.1002/phar.2280
- Forrester M. B. (2013). Kratom exposures reported to Texas poison centers. Journal of addictive diseases, 32(4), 396–400. https://doi.org/10.1080/10550887.2013.854153
- Grundmann, O., Brown, P. N., Boyer, E. W., Swogger, M. T., Walsh, Z., Prozialeck, W., Kruegel, A. C., Veltri, C. A., & Dudley, S. (2019). Critique of “Kratom Use and Toxicities in the United States”. Pharmacotherapy, 39(11), 1119–1120. https://doi.org/10.1002/phar.2336
- Johns Hopkins Medicine. (2021). Hallucinations. In Johns Hopkins Psychiatry Guide. Traci Speed, M.D., Ph.D., & Thomas Sedlak, M.D., Ph.D. (Contributors). Retrieved March 29, 2023, from https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_Psychiatry_Guide/787023/all/Hallucinations
- Leong Bin Abdullah, M. F. I., Singh, D., Swogger, M. T., Rahim, A. A., & Vicknasingam, B. (2019). The prevalence of psychotic symptoms in kratom (Mitragyna speciosa Korth.) Users in Malaysia. Asian journal of psychiatry, 43, 197–201. https://doi.org/10.1016/j.ajp.2019.07.008
- NIDA. 2019, April 22. Hallucinogens DrugFacts. Retrieved from http://nida.nih.gov/publications/drugfacts/hallucinogens on 2023, March 29
- Sangani, V., Sunnoqrot, N., Gargis, K., Ranabhotu, A., Mubasher, A., & Pokal, M. (2021). Unusual Presentation of Kratom Overdose With Rhabdomyolysis, Transient Hearing Loss, and Heart Failure. Journal of investigative medicine high impact case reports, 9, 23247096211005069. https://doi.org/10.1177/23247096211005069
- Vijeepallam, K., Pandy, V., Kunasegaran, T., Murugan, D. D., & Naidu, M. (2016). Mitragyna speciosa Leaf Extract Exhibits Antipsychotic-Like Effect with the Potential to Alleviate Positive and Negative Symptoms of Psychosis in Mice. Frontiers in pharmacology, 7, 464. https://doi.org/10.3389/fphar.2016.00464
- Wright T. H. (2018). Suspected Driving Under the Influence Case Involving Mitragynine. Journal of analytical toxicology, 42(7), e65–e68. https://doi.org/10.1093/jat/bky028