Is kratom being adulterated with other drugs?

Both legality proponents and prohibitionists claim that kratom sold in the Western marketplace by some nefarious vendors is adulterated with other drugs such as fentanyl, cocaine, and methamphetamine.

But where is the evidence of this? There are confirmed cases in the scientific literature and media that we examine below of kratom being adulterated with O-desmethyltramadol, morphine, hydrocodone, phenylethylamine, tianeptine, cough syrup, manganese, and a study that examined the possibility of purposefully elevated 7-hydroxymitragynine (a kratom alkaloid that occurs in barely detectable amounts in plain leaf kratom).

Published reports about patients having possible kratom-involved toxicities or side effects have been lacking in basic information, as pointed out in a 2023 review by a team from the National Institute on Drug Abuse (NIDA). Out of 52 case reports/case series reviewed in Feldman et al 2023, and 67 patients examined, there were only five instances where kratom products were tested.

We’ve seen very little to suggest fentanyl, cocaine, or methamphetamine has been found in kratom. Patients claim they took kratom alone sometimes test positive for illicit substances, which could suggest adulteration, but could also suggest the patient may be lying to conceal illegal activities.

Why would kratom be adulterated?

On the one hand, vendors selling a legal, effective product would have no incentive to put themselves at risk by adulterating kratom with illegal substances that are more expensive than the kratom itself.

On the other hand, due to lack of adequate enforcement of manufacturing regulations, the dietary supplements industry has dealt with bad actors adulterating their products for decades.

Vendors willing to take the risk might have an incentive to sell opioid- or novel psychoactive substance-adulterated kratom and brand it as higher quality, and retain customers who are opioid dependent and/or chasing a high. Substances like hydrocodone and morphine are full opioid agonists, while kratom alkaloids like mitragynine are only partial opioid agonists. Full opioid agonists cause stronger euphoric effects and a carry a higher risk of dependency. Legal, unregulated, novel psychoactive substances like tianeptine, an antidepressant, and phenibut, a depressant with anxiolytic effects, have been suspected kratom adulterants for their stronger effects.

A national ban on kratom would almost certainly make the adulteration problem worse, as lack of regulation enforcement in a grey market would turn into no regulations to enforce in a black market. Fentanyl has been found in many illicit substances – not only opioids but in cocaine as well- directly leading to more overdose deaths

Kratom expert and medicinal chemist at University of Florida, Christopher McCurdy, talked about the adulteration problem in both kratom and the dietary supplements industry as a whole in an interview with Kratom Science:

We have seen the adulteration of kratom products in the marketplace. Not from things that we’ve purchased but by emergency room physicians that have contacted us stating that they had someone admitted that swore they were only on kratom, and did not take illicit substances, but their tox panels lit up for different substance uses. So we said, fine, if you can get a hold of their material that they ingested and send it to us – most of the time it wasn’t possible to get the materials. There was one material that we found that had morphine in it, and why someone would take an incredibly more expensive pharmaceutical product and put it into a plant material… To think about it this way, if you’re a new person into the market and you’re trying to establish yourself, you either put out high quality expensive well-tested products, or you put a product that’s potentially going to pack a little bit more of a punch than the other competitors, and somebody will get on it. 

And that’s a big reason why the whole herbal supplement industry and the whole dietary supplement industry is scary. Quite frankly, there’s regulations there but there’s not enough people to enforce the regulations. A lot of products that are being sold – I try to speak to this as an entire industry, not just kratom – there’s stuff that’s adulterated all the time. We hear about it with Viagra being present in some herbal products, and we hear about herbal products being sold that don’t even have the plant material that they say is on the package! So it’s an unfortunate scenario that someone would do that.

We have tested two separate products from two states incredibly far from each other. One had morphine, as I said. The other one had hydrocodone present. So it’s just kind of frightening from that aspect. We have not, thankfully, seen fentanyl in anything, but it wouldn’t surprise me as fentanyl seems to be appearing in everything from marijuana to oxycodone pills and heroin, trying to increase those product “bangs” if you will.

I still call it a wild wild west market, because it is. Until we get some real standardization in place and some real controls on what products are being sold and what kind of guarantees we’re giving to consumers buying this product… I’ve said it for years. I want to buy something that I’m signing up to take, right? If I buy a gallon of milk at the store I expect it to have all the things and the benefits that I want from the milk and not have other crap in it. 

Going forward…

Obviously, new regulations as well as enforcement of current regulations on the kratom industry would provide further assurances to prevent adulteration. But kratom advocates and industry lobbyists should not make adulteration claims without evidence. Medical professionals should make greater effort to acquire kratom products for testing from patients who are experiencing strange side effects or toxicities. Information on kratom products found to contain any substance, legal or illegal, other than kratom, should be made public immediately for the safety of kratom consumers.

We encourage readers to share further evidence of kratom adulteration in the comments section below.

Evidence Of Adulteration

2011 May, Sweden
O-desmethyltramadol

“A drug and alcohol withdrawal rehabilitation centre requested an analysis for ‘Krypton’ in urine of a former opiate-addictive woman”. “LC-MS/MS detected the ‘Kratom’ alkaloids…and approximately 9mg/L O-desmethyltramadol, but no tramadol and N-desmethyltramadol.” “Consumption of a “Krypton” product spiked with O-desmethyltramadol could explain our findings and the patient’s clinical picture” (Arndt et al, 2011).

2011 May, Sweden
O-desmethyltramadol

“We present nine cases of intoxication, occurring in a period of less than one year, where both mitragynine and O-desmethyltramadol were detected in the postmortem blood samples” (Kronstrand et al, 2011).

2015 September, Thailand
cough syrup, Coca Cola, and ice in “4×100” cocktail

A cocktail popular with young people in Thailand “named after its four main ingredients — kratom leaves, cough syrup, Coca-Cola and ice” (Na Thalang, 2015).

2016 December, USA
elevated 7-hydroxymiragynine

“We purchased several commercially available Kratom analogs for analysis”. “We found multiple commercial Kratom products to have concentrations of 7-hydroxymitragynine that are substantially higher than those found in raw M. speciosa leaves” (Lydecker et al, 2016).

Dr. Christopher McCurdy, who co-authored this study, told Kratom Science:

We purchased a bunch of products and we analyzed them…we found the 7-hydroxymitragynine content to be pretty much all over the place. Some very very low-level, some very very high-level, some that we never-even-thought-possible high levels, and so the immediate thing that comes to mind is, well, somebody’s got to be adding material here. But when we looked at it a little bit closer, even after we published it, what you could see is that every time that 7-hydroxy levels went up, the mitragynine levels were much farther down. So that, to us, started to indicate this potential hypothesis that, well, maybe mitragynine is being metabolized in the air, or by light, or by heat, or whatever it is, and we don’t know the answer to that yet. We’re certainly working on those projects, but if that’s what’s happening, that could explain why you see such large levels, right? 

This product is harvested from a tree, it’s dried out in the hot sun, in some cases on the wet floor of the jungles where it’s harvested and then it’s ground up in a grinder that could cause a lot of friction and heat in that process. They’re out in the hot sun. Then they are packed into containers and shipped across the globe to the US. They’re not refrigerated or, what they call “reefers” to make sure that a proper environment is maintained for a food product. 

So it’s no surprise that those early products that we were testing were all over the place, and I’m happy to say it agrees with a lot of things that are going on in independent testing labs, that we’ve seen those levels of 7-hydroxy come way down in many of the dried products that are being distributed in the US. 

2019 November, USA
phenylethylamine

“A 54-year-old fitness instructor who used an online purchased kratom product regularly for one year developed stimulatory effects and suffered a large hemorrhagic stroke with a close temporal relationship to ingestion of a different kratom product from the one he regularly used. A collaborative investigation by medical toxicologists, a regional poison center, the state public health laboratory, and public health officials determined that his new kratom product was adulterated with phenylethylamine” (Nacca et al, 2019).

2022 February, USA
tianeptine

From a Real World Evidence report from user satsugene on Reddit:

The moderators have received credible, consistent, and separate reports from multiple consumers (two with extensive follow-ups) who have encountered specific kratom products that are believed to either contain no kratom, or contain other compounds, most likely Tianeptine, an atypical tricyclic anti-depressant that is MOR active, used in parts of Europe but not in the US (illegal in MI and AL).

Note: Tests in this case were not conducted but it seems likely that tianeptine and phenibut, two legal substances, have been used to adulterate kratom or sold as kratom extracts.

2022 May, USA, Ultra Organics Kratom
manganese

In a study by Virginia Commonwealth University, random kratom products were purchased in shops near the university in Richmond, Virginia. Ultra Organics Kratom drinks were found to have toxic levels of manganese. A different non-kratom product contained phenibut which was not indicated on the label. “Three samples were found to have manganese levels exceeding the tolerable upper intake level of 11 mg/day. These samples were produced by the same manufacturer and purchased in the same tobacco store, highlighting the need for stricter quality control and regulation within the kratom industry. Overexposure to manganese can lead to ‘manganism’, which produces Parkinsonian symptoms including dystonia, tremors, and facial muscle spasms” (Fleming et al, 2022).

2022 June, USA
hydrocodone, morphine

Case report: “A 21-year-old African-American woman with a history of occasional headaches and self-treatment with internet-purchased kratom presented to the emergency department with the chief symptoms of nausea, vomiting, and left flank pain”. “Hydrocodone, morphine, and mitragynine were identified in a sample of kratom leaves provided by the patient” (LeSaint et al, 2022).

References

• Arndt, T., Claussen, U., Güssregen, B., Schröfel, S., Stürzer, B., Werle, A., & Wolf, G. (2011). Kratom alkaloids and O-desmethyltramadol in urine of a “Krypton” herbal mixture consumer. Forensic science international, 208(1-3), 47–52. https://doi.org/10.1016/j.forsciint.2010.10.025
• Feldman, J.D., Schriefer, D., Smith, K.E. et al. Omissions, Ambiguities, and Underuse of Causal Assessment Tools: a Systematic Review of Case Reports on Patients Who Use Kratom. Curr Addict Rep (2023). https://doi.org/10.1007/s40429-023-00466-7
• Kronstrand, R., Roman, M., Thelander, G., & Eriksson, A. (2011). Unintentional fatal intoxications with mitragynine and O-desmethyltramadol from the herbal blend Krypton. Journal of analytical toxicology, 35(4), 242–247. https://doi.org/10.1093/anatox/35.4.242
• LeSaint, K. T., Yin, S., Sharma, A., Avery, B. A., McCurdy, C. R., & Waksman, J. C. (2022). Acute Renal Insufficiency Associated With Consumption of Hydrocodone- and Morphine-Adulterated Kratom (Mitragyna Speciosa). The Journal of emergency medicine, 63(1), e28–e30. https://doi.org/10.1016/j.jemermed.2022.02.004
• Lydecker, A. G., Sharma, A., McCurdy, C. R., Avery, B. A., Babu, K. M., & Boyer, E. W. (2016). Suspected Adulteration of Commercial Kratom Products with 7-Hydroxymitragynine. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 12(4), 341–349. https://doi.org/10.1007/s13181-016-0588-y
• Na Thalang, J. (2015, Sept. 6). The curse and cure of kratom. Bangkok Post. https://www.bangkokpost.com/thailand/special-reports/681964/the-curse-and-cure-of-kratom
• Nacca, N., Schult, R. F., Li, L., Spink, D. C., Ginsberg, G., Navarette, K., & Marraffa, J. (2020). Kratom Adulterated with Phenylethylamine and Associated Intracerebral Hemorrhage: Linking Toxicologists and Public Health Officials to Identify Dangerous Adulterants. Journal of medical toxicology : official journal of the American College of Medical Toxicology, 16(1), 71–74. https://doi.org/10.1007/s13181-019-00741-y