Introduction and background

Kratom (Mitragyna speciosa), a tropical tree native to Southeast Asia, has traditionally been used for its stimulant and analgesic properties [1]. In recent years, it has gained popularity in the West as an alternative treatment for anxiety, pain, and opioid withdrawal due to its active alkaloids, mitragynine and 7-hydroxymitragynine, which interact with opioid receptors [1-3].

Despite its increasing use, kratom remains poorly understood in clinical practice, particularly with respect to its pharmacology, safety profile, and toxicity. The growing availability of kratom through online retailers and over-the-counter products has heightened the need for a better understanding of its pharmacologic effects, adverse events, and potential risks [3]. Improved knowledge of these factors is essential to inform evidence-based clinical practice, regulatory policies, and public health initiatives [4].

Given the increasing prevalence of kratom use and the absence of standardized detection and management guidelines, this narrative review synthesizes current clinical, toxicologic, pharmacologic, and epidemiologic evidence regarding kratom toxicity and its implications for acute care. Particular emphasis is placed on respiratory depression, variable responsiveness to naloxone, delayed or recurrent respiratory depression, and practical considerations for patient monitoring and disposition. In addition, this review discusses the evolving regulatory landscape and highlights implications for patient care and public health policy.