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Kratom & Liver Damage: About Liver Toxicity & What to Do

Kratom-related hepatotoxicity can lead to hospitalization. Although there are few reports of liver failure from kratom abuse, it is becoming more common in the US as more people struggle with this substance.

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Kratom is sold online as an herbal supplement that can help treat opioid addiction, depression, anxiety, and chronic pain. However, this is an unregulated substance that can become addictive. It can lead to various problems, including liver damage and failure.

Is Kratom Addictive?

Kratom is an opioid-like substance derived from a tree native to Southeast Asia. Although this substance is not illegal in the United States and is often sold online, it is becoming a drug of abuse for many people, particularly people who try to use it to overcome opioid addiction. This has led to several counties and states banning kratom.

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The drug is sold as an extract, pill, capsule, or powder. Although fewer than 1 percent of people in the US use kratom, as many as 10.3 percent of people who struggle with opioid addiction use kratom, often in an attempt to overcome their addiction to opioids and safely withdraw from the drugs.

However, tapering without medical supervision may not result in ending substance abuse. Instead, it may lead to ongoing or even increasing drug abuse.

Unfortunately, many people who take kratom develop a tolerance, as they do with opioids. They then begin abusing larger amounts to experience the same effects. This can cause serious physical harm, including to the liver.

How Does the Liver Metabolize Kratom?

The liver is the main organ responsible for metabolizing drugs and alcohol through the body. Once drugs are digested and the chemicals are shifted to the liver, these chemicals are broken down further into metabolites and slowly released into the blood.

For substances like prescription medications, using the liver’s metabolic function can help drugs release into the body at a specific pace, with few side effects. But with unregulated chemicals like kratom, it is difficult to understand safety around the dose.

One of the most serious problems with kratom is the lack of regulation. Although many containers say that there are specific dosing sizes, there is no way to know for sure. This is because kratom is sold as a dietary supplement and is therefore not subject to any legal regulation in the US.

Additionally, many additives in kratom supplements might cause liver damage. Sometimes, these may not be listed on the ingredients, or they could be incidental chemicals found in the manufacturing process that should not be there. Toxins are processed through the liver like supplements, vitamins, and prescription medications.

What Is Kratom Liver Toxicity or Hepatotoxicity?

Kratom is associated with several serious health problems, like heart damage and liver toxicity. Chronic use of kratom can cause liver damage. It often starts with symptoms like these:

  • Fatigue
  • Fever
  • Nausea
  • Itchy skin
  • Dark urine after jaundice

Acute liver toxicity, or hepatotoxicity, typically sets in between one and eight weeks after regular use of kratom tablets, capsule, or powder. Severe liver toxicity can cause liver failure, as well as kidney failure and bone marrow damage. Although this is a rare condition, there have been about a dozen reports of serious liver damage due to kratom.

It is possible to recover from kratom liver toxicity. A study of eight people hospitalized for kratom-related hepatotoxicity found that all of them recovered, but this is still a very dangerous condition to experience. Without medical treatment, liver damage can lead to jaundice, organ failure, and death.

Signs of Kratom Abuse

Signs of kratom intoxication include alertness, high physical energy, and talkativeness. These effects are typically considered the opposite of opioid intoxication, which often causes relaxation and sedation. Unlike opioids, however, at high doses kratom can cause psychosis.

Other health effects associated with kratom abuse include the following:

  • Nausea
  • Itching
  • Sweating
  • Constipation
  • Dry mouth
  • Loss of appetite
  • Increased urination
  • Hallucinations
  • Seizures

It is possible to overdose on kratom as well, although this typically occurs in combination with other drugs. Data from the National Poison Data System, collected between 2011 and 2017, found 11 deaths associated with kratom exposure; nine of those involved other drugs including benzodiazepines, opioids like fentanyl, and cocaine. In 2017, the Food and Drug Administration (FDA) found that there were 44 deaths associated with kratom, with at least one involving just kratom and no other substance abuse.

Although kratom is becoming a popular substance to self-medicate depression, anxiety, chronic pain, and opioid use disorder, it is unregulated and not approved for any sort of use in the US.

Substance abuse involving kratom is becoming increasingly common, which means that reports of hepatotoxicity from kratom are also increasing. If you are trying to overcome opioid use disorder, find a rehabilitation program instead that specializes in managing opioid withdrawal.

Frequently Asked Questions (FAQs)

Does kratom cause liver issues?

Yes, kratom can cause serious liver damage and failure. Hepatotoxicity can also cause other organs to fail, including the kidneys.

Can kratom cause cirrhosis of the liver?

Although there are few reports of kratom-associated hepatotoxicity, this drug can cause symptoms similar to cirrhosis, which includes jaundice, or the yellowing of the skin and eyes as the liver is no longer able to process toxins.

Updated February 7, 2024
  1. Kratom DrugFacts. (April 2019). National Institute on Drug Abuse (NIDA).
  2. Kratom Use Rare, but More Common Among People With Opioid Use Disorder. (April 2021). New York University.
  3. Drug Metabolism. (October 2020). Merck Manuals, Consumer Version.
  4. Kratom-Induced Liver Injury: A Case Series and Clinical Implications. (April 2021). Cureus.
  5. LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. (April 2020). National Institute of Diabetes and Digestive and Kidney Diseases.
  6. Kratom-Related Liver Injuries on the Rise in the US. (November 2019). The Liver Meeting.
  7. Kratom. (April 2020). United States Drug Enforcement Administration (DEA).
  8. What Is Kratom? The Popular Herbal Supplement Has Caught Flak From the FDA. (October 2019). NBC News.
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