Kratom: Risks, Addiction Potential, and Opioid Mechanisms

This AMA episode delves into the short and long-term effects of kratom, a substance derived from the *mitragyna speciosa* tree. Andrew Huberman explains that while low doses of kratom can act as a mild stimulant, higher doses exhibit analgesic and sedative properties, functioning as an opioid in the body. This places kratom squarely within the controversial context of the opioid crisis, as it shares pharmacological similarities with more potent opioids like morphine and hydrocodone, despite being marketed as a supplement. The discussion highlights the significant risk of habit formation and addiction associated with kratom, even though some individuals report using it to taper off other opioids.\n\nA key distinction is drawn between habit-forming and addiction, with addiction defined as the progressive narrowing of pleasure sources or continuing a behavior despite negative consequences. Huberman clarifies kratom's neurochemistry, stating that it primarily binds to the mu-opioid receptor, similar to other opioids, contrary to some claims that it acts differently. A crucial point is the substantial individual variability in response to opioids, with an estimated 10-40% of people being particularly susceptible to their euphoric effects, making them highly vulnerable to addiction. The unregulated nature of kratom supplements, leading to inconsistent alkaloid concentrations, is also identified as a major concern.\n\nThe primary practical recommendation is a strong warning: individuals who have not tried kratom should avoid it entirely due to its addictive potential. For those already using kratom, extreme caution regarding dosage is advised, along with an understanding of its opioid-like effects. If using kratom to transition off more potent opioids, consultation with a physician is essential, coupled with a firm commitment to progressively reduce and eventually cease kratom use. Furthermore, combining kratom with other opioids or alcohol is strongly cautioned against due to the heightened risk of respiratory suppression, a leading cause of opioid-related deaths.\n\nThe episode extends beyond kratom to broader principles of substance use, advocating for a balanced assessment of benefits and risks for any substance, rather than relying on arguments that one substance is merely "less bad" than another. It touches upon the neurobiology of addiction, including the roles of dopamine and serotonin, and explains the mechanism of respiratory suppression by opioids, linking it to the physiological sigh. The discussion underscores the serious public health implications of unregulated substances with high abuse potential and the importance of understanding individual susceptibility to addiction.

Indeed at low dosages, kratom has a mild stimulant effect. However, at higher dosages, it has what's called an analgesic effect, that is a painkilling effect, and it acts as a sedative.

I define addiction more broadly as the progressive narrowing of the things that give you pleasure.

So the general takeaway from all of that is if you can avoid taking kratom, meaning if you haven't taken it already, don't.

It is impossible to get addicted to a substance that you've never consumed.

We don't know how big this subgroup of people is, but we know it's not everyone, but it's somewhere between 10 and 40% of people seem to respond to opioids in a particularly potent way.

So we really have to look at kratom as an opioid, OK. That's just the honest truth.

The idea that substance A is not as bad as substance B. And that making substance A unavailable is just going to send everyone running for substance B. That's a weak argument, frankly.

Opioids, when taken as drugs, suppress physiological sighing and do so during sleep. And lack of adequate respiration, meaning people stop breathing during sleep, is one of the primary reasons why people die when they take opioids.

So my advice would be, if you haven't touched kratom, don't touch it at all, ever.

I always say behavior is first, then nutrition. Then if and only if it's needed, rely on supplementation.