A list of baseless claims that kratom causes hallucinations

In October 2018 we covered a sensationalist news story out of Florida where the director of a for-profit rehabilitation center claimed that kratom caused hallucinations (Scripps Media, 2018). Multiple news stories, press releases by government agencies, and even peer-reviewed published studies have made this claim, all without a shred of hard evidence.

The most comprehensive studies we have on kratom and psychosis/hallucinations did not find evidence that these symptoms are caused by kratom ingestion or long-term use.

A study of 150 regular kratom users in Malaysia found that while 4% displayed mild psychotic symptoms, “heavy and prolonged kratom use was not significantly associated with the occurrence of psychotic symptoms in regular kratom users”. In other substances with psycho-stimulant elements, the study points out, a significant link has been found. “In comparison, studies have reported a prevalence of methamphetamine-induced psychosis of 36.5%” (Leong Bin Abdullah et al., 2019).

We don’t pretend to understand all the motivations to make the claim that kratom causes hallucinations without hard evidence. Once prominent government agencies like DEA and FDA begin to make baseless claims, news and medical website writers will trust these authorities enough to repeat these claims without digging for evidence.

Worse, scientists and doctors in peer-reviewed journals repeat these claims without digging for evidence. Some doctors proclaim Kratom as a cause of hallucinations (or other effects) in case reports despite not having conducted a detailed investigation into the patient’s medical history, considering other factors that might have lead to a mental health episode, or testing for the presence of other drugs.

This is part of the construction of a “Reefer Madness” style groupthink around a substance. News companies love drug horror fiction stories because fear sells. For-profit rehab centers and some government agencies are driven by the funds they’ll acquire from kratom prohibition. But even well-meaning scientists and doctors sometimes fail to give these serious issues serious examination, and would rather adhere to flimsy claims to reach a foregone conclusion.

Here is just a small list of the hundreds of claims that kratom causes hallucinations:

• 2014-2021 FDA Import Alert 54-15 championed by Natural Products Association CEO Daniel Fabricant when he worked in FDA claims kratom causes hallucinations. There is no evidence cited.
• 2017 An early study co-authored by the pioneering kratom researcher Dr. Christopher McCurdy looked at kratom and salvia divinorum (which does cause hallucinations). The study did not claim kratom caused hallucinations (Babu et al., 2008). Years later, however, an articled titled “Is Kratom the New ‘Legal High’ on the Block?” would source Babu, 2008 in its claim that “those who overdose on Kratom can experience seizures, psychosis, coma, hallucination” (Chang-Chien et al., 2017).
• 2018 DEA claims kratom causes hallucinations on the website GetSmartAboutDrugs.gov. The article cites no source for this claim.
• 2018 Two vague case reports of men with a history of opiate use disorder (OUD) and both suffering from (apparently temporary) mental health episodes, at least one due to lack of sleep. They were also taking kratom. No drug testing was reported to determine whether other drugs had been present, and of course a kratom sample was not tested for possible adulteration. Other than OUD, the reports included no discussion of mental health histories. (Bestha, 2018)
• 2018 A Virginia Department of Forensic Science study lists “hallucination” in the abstract as one of kratom’s effects. The article cites no source for this claim (Wright, 2019).
• 2019 A review of the National Poison Data System by Eggleston et al. claimed 4.8% of 935 kratom exposure calls claimed hallucinations as a side effect. Though Eggleston et al. included only cases where callers claimed to be taking kratom only, there’s no evidence the callers were not also taking illegal hallucinogens and did not want to incriminate themselves, no evidence the kratom was adulterated, and no blood or urine samples to test for the presence of other drugs. We’re also uncertain of what the National Poison Data System defines as hallucination, and uncertain about the exact nature of the conversation. A critique by Grundmann et al. (2019) took issue with conclusions drawn by Eggleston et. al. given the review’s “significant methodological limitations” and pointed out that “The authors do not acknowledge that their data and methods prevent determining causal relationships between kratom and adverse outcomes.”
• 2019 University of Utah Health claims “Because it affects the nervous system and brain, health problems associated with Kratom include… hallucinations”. The article cites no source for this claim.
• 2020 Healthline.com claims “Kratom contains almost as many alkaloids as opium and hallucinogenic mushrooms.” and “Even low doses can cause severe side effects like hallucinations.” The article cites no source for this claim (Stevens, 2020).
• 2020 The DEA’s one-page Drug Fact Sheet on kratom twice claims kratom causes hallucinations. The article cites no source for this claim.
• 2021 Verywellmind.com, a mental health website in partnership with the Cleveland Clinic lists hallucinations as one of kratom’s “potential health effects”. The article cites no source for this claim (Wong, 2021).
• 2021 A case report (Sangani, 2021) was published of a woman with multiple health complications. It listed “hallucinations” as one of the associated effects of “kratom overdose”. The source for this claim was another case report that did not mention hallucinations at all (Aggarwal, 2017).
• 2021 American Addiction Centers, a for-profit nationwide rehabilitation clinic, claims “Symptoms of kratom-induced psychosis may include hallucinations”. It cites the DEA as its source but not a specific document. (Lautieri, 2021).
• 2021 Partnership to End Addiction, formerly known as Partnership for a Drug Free America, claims “Psychotic symptoms (hallucinations, delusion, and confusion) have been reported at high doses.” The article cites the DEA page GetSmartAboutDrugs.gov (Drug Enforcement Administration, 2018).

References

• Aggarwal, G., Robertson, E., McKinlay, J., & Walter, E. (2018). Death from Kratom toxicity and the possible role of intralipid. Journal of the Intensive Care Society, 19(1), 61–63. https://doi.org/10.1177/1751143717712652
• 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
• Bestha D. (2018). Kratom and the opioid crisis. Innovations in clinical neuroscience, 15(5-6), 11.
• Leong Bin Abdullah, M., 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
• 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.
• Drug Enforcement Administration. (2018, February 9). Kratom: 5 questions and answers. https://www.getsmartaboutdrugs.gov/content/quick-facts-kratom
• Drug Enforcement Administration. (2020). Drug fact sheet: Kratom. https://www.dea.gov/sites/default/files/2020-06/Kratom-2020.pdf
• 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
• Food and Drug Administration. (2014-2021). Import Alert 54-15. https://www.accessdata.fda.gov/cms_ia/importalert_1137.html
• 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
• Lautieri, A. (2021, May 5). Does kratom get you high? American Addiction Centers. https://americanaddictioncenters.org/kratom/does-it-get-you-high
• Partnership to End Addiction. (2021). Kratom. https://drugfree.org/drugs/kratom/
• 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
• Scripps Media. (2018). Is Kratom a deadly drug or a life-changing supplement? https://www.fox4now.com/news/local-news/is-kratom-a-deadly-drug-or-a-supplement
• Stevens, C.J. (2020, June 3). Kratom: Is it safe? Healthline. https://www.healthline.com/health/food-nutrition/is-kratom-safe
• University of Utah Health. (2019, April 1). Concerns about kratom. https://healthcare.utah.edu/healthfeed/postings/2019/04/kratom.php
• Wong, C. (2021, June 24). What to know about kratom use. Verywellmind. https://www.verywellmind.com/kratom-for-pain-management-4089380
• 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