{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T11:02:48Z","timestamp":1784890968293,"version":"3.55.0"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,7,24]]},"DOI":"10.7759\/cureus.113280","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T10:40:41Z","timestamp":1784889641000},"source":"Crossref","is-referenced-by-count":0,"title":["Kratom Toxicity: Pharmacologic Mechanisms, Clinical Risks, and Management Considerations"],"prefix":"10.7759","author":[{"given":"Asis A","family":"Babun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brehyn R","family":"Evans","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ines N","family":"Volic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sierra","family":"Wood","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelson","family":"Knighton","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Lopez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Tufts","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1016\/j.disamonth.2022.101442","article-title":"Kratom: history, pharmacology, current user trends, adverse health effects and potential benefits","volume":"69","author":"Grundmann O","year":"2023","unstructured":"Grundmann O, Hendrickson RG, Greenberg MI. Kratom: history, pharmacology, current user trends, adverse health effects and potential benefits. Dis Mon. 2023, 69:101442. 10.1016\/j.disamonth.2022.101442","journal-title":"Dis Mon"},{"key":"ref2","doi-asserted-by":"publisher","DOI":"10.1021\/jacs.6b00360","article-title":"Synthetic and receptor signaling explorations of the Mitragyna alkaloids: mitragynine as an atypical molecular framework for opioid receptor modulators","volume":"138","author":"Kruegel AC","year":"2016","unstructured":"Kruegel AC, Gassaway MM, Kapoor A, et al.. Synthetic and receptor signaling explorations of the Mitragyna alkaloids: mitragynine as an atypical molecular framework for opioid receptor modulators. J Am Chem Soc. 2016, 138:6754-64. 10.1021\/jacs.6b00360","journal-title":"J Am Chem Soc"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.801855","article-title":"Understanding kratom use: a guide for healthcare providers","volume":"13","author":"Swogger MT","year":"2022","unstructured":"Swogger MT, Smith KE, Garcia-Romeu A, Grundmann O, Veltri CA, Henningfield JE, Busch LY. Understanding kratom use: a guide for healthcare providers. Front Pharmacol. 2022, 13:801855. 10.3389\/fphar.2022.801855","journal-title":"Front Pharmacol"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2024.1403140","article-title":"Kratom safety and toxicology in the public health context: research needs to better inform regulation","volume":"15","author":"Henningfield JE","year":"2024","unstructured":"Henningfield JE, Grundmann O, Huestis MA, Smith KE. Kratom safety and toxicology in the public health context: research needs to better inform regulation. Front Pharmacol. 2024, 15:1403140. 10.3389\/fphar.2024.1403140","journal-title":"Front Pharmacol"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1080\/14786419.2024.2362428","article-title":"Phytochemical analysis of water and ethanol liquid extracts prepared using freshly harvested leaves of Mitragyna speciosa (Korth.)","volume":"39","author":"Karunakaran T","year":"2025","unstructured":"Karunakaran T, Vicknasingam B, Chawarski MC. Phytochemical analysis of water and ethanol liquid extracts prepared using freshly harvested leaves of Mitragyna speciosa (Korth.). Nat Prod Res. 2025, 39:4480-7. 10.1080\/14786419.2024.2362428","journal-title":"Nat Prod Res"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1080\/00952990.2022.2111685","article-title":"Kratom as an opioid alternative: harm, or harm reduction? A systematic review of literature","volume":"48","author":"Stanciu C","year":"2022","unstructured":"Stanciu C, Ahmed S, Gnanasegaram S, Gibson S, Penders T, Grundmann O, McCurdy C. Kratom as an opioid alternative: harm, or harm reduction? A systematic review of literature. Am J Drug Alcohol Abuse. 2022, 48:509-28. 10.1080\/00952990.2022.2111685","journal-title":"Am J Drug Alcohol Abuse"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1124\/jpet.120.000189","article-title":"Pharmacological comparison of mitragynine and 7-hydroxymitragynine: in vitro affinity and efficacy for \u03bc-opioid receptor and opioid-like behavioral effects in rats","volume":"376","author":"Obeng S","year":"2021","unstructured":"Obeng S, Wilkerson JL, Le\u00f3n F, et al.. Pharmacological comparison of mitragynine and 7-hydroxymitragynine: in vitro affinity and efficacy for \u03bc-opioid receptor and opioid-like behavioral effects in rats. J Pharmacol Exp Ther. 2021, 376:410-27. 10.1124\/jpet.120.000189","journal-title":"J Pharmacol Exp Ther"},{"key":"ref8","doi-asserted-by":"publisher","DOI":"10.1097\/ADM.0000000000001417","article-title":"The associations of kratom (mitragynine), opioids, other substances, and sociodemographic variables to drug intoxication-related mortality","volume":"19","author":"Suriaga AA","year":"2025","unstructured":"Suriaga AA, Tappen RM, McCurdy CR, Newman D, Grundmann O, Kelly JF. The associations of kratom (mitragynine), opioids, other substances, and sociodemographic variables to drug intoxication-related mortality. J Addict Med. 2025, 19:306-13. 10.1097\/ADM.0000000000001417","journal-title":"J Addict Med"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6814a2","article-title":"Notes from the field: unintentional drug overdose deaths with kratom detected - 27 states, July 2016-December 2017","volume":"68","author":"Olsen EO","year":"2019","unstructured":"Olsen EO, O'Donnell J, Mattson CL, Schier JG, Wilson N. Notes from the field: unintentional drug overdose deaths with kratom detected - 27 states, July 2016-December 2017. MMWR Morb Mortal Wkly Rep. 2019, 68:326-7. 10.15585\/mmwr.mm6814a2","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1002\/wfs2.1420","article-title":"Kratom: a systematic review of toxicological issues","volume":"4","author":"Kerrigan S","year":"2022","unstructured":"Kerrigan S, Basiliere S. Kratom: a systematic review of toxicological issues. WIREs Forensic Sci. 2022, 4:1420. 10.1002\/wfs2.1420","journal-title":"WIREs Forensic Sci"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1124\/dmd.122.001005","article-title":"Translating kratom-drug interactions: from bedside to bench and back","volume":"51","author":"Tanna RS","year":"2023","unstructured":"Tanna RS, Cech NB, Oberlies NH, Rettie AE, Thummel KE, Paine MF. Translating kratom-drug interactions: from bedside to bench and back. Drug Metab Dispos. 2023, 51:923-35. 10.1124\/dmd.122.001005","journal-title":"Drug Metab Dispos"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.3390\/molecules29050984","article-title":"Human mitragynine and 7-hydroxymitragynine pharmacokinetics after single and multiple daily doses of oral encapsulated dried kratom leaf powder","volume":"29","author":"Huestis MA","year":"2024","unstructured":"Huestis MA, Brett MA, Bothmer J, Atallah R. Human mitragynine and 7-hydroxymitragynine pharmacokinetics after single and multiple daily doses of oral encapsulated dried kratom leaf powder. Molecules. 2024, 29:984. 10.3390\/molecules29050984","journal-title":"Molecules"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.43144","article-title":"The great imitator: a case of accidental kratom overdose","volume":"15","author":"Ahmed S","year":"2023","unstructured":"Ahmed S, Tran QV, McLean M. The great imitator: a case of accidental kratom overdose. Cureus. 2023, 15:e43144. 10.7759\/cureus.43144","journal-title":"Cureus"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.5811\/cpcem.2018.11.40588","article-title":"Kratom (mitragynine) ingestion requiring naloxone reversal","volume":"3","author":"Overbeek DL","year":"2019","unstructured":"Overbeek DL, Abraham J, Munzer BW. Kratom (mitragynine) ingestion requiring naloxone reversal. Clin Pract Cases Emerg Med. 2019, 3:24-6. 10.5811\/cpcem.2018.11.40588","journal-title":"Clin Pract Cases Emerg Med"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpet.2025.103720","article-title":"Mitragynine and 7-hydroxymitragynine: bidirectional effects on breathing in rats","volume":"392","author":"Zuarth Gonzalez JD","year":"2025","unstructured":"Zuarth Gonzalez JD, Ragsdale AK, Mukhopadhyay S, McCurdy CR, McMahon LR, Obeng S, Wilkerson JL. Mitragynine and 7-hydroxymitragynine: bidirectional effects on breathing in rats. J Pharmacol Exp Ther. 2025, 392:103720. 10.1016\/j.jpet.2025.103720","journal-title":"J Pharmacol Exp Ther"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-76119-w","article-title":"Chemical composition and biological effects of kratom (Mitragyna speciosa): in vitro studies with implications for efficacy and drug interactions","volume":"10","author":"Todd DA","year":"2020","unstructured":"Todd DA, Kellogg JJ, Wallace ED, et al.. Chemical composition and biological effects of kratom (Mitragyna speciosa): in vitro studies with implications for efficacy and drug interactions. Sci Rep. 2020, 10:19158. 10.1038\/s41598-020-76119-w","journal-title":"Sci Rep"},{"key":"ref17","unstructured":"Kratom. summary of state laws. (2026). Accessed: July 24, 2026: https:\/\/legislativeanalysis.org\/kratom-summary-of-state-laws\/."},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.1177\/0269881119862530","article-title":"Characteristics of deaths associated with kratom use","volume":"33","author":"Corkery JM","year":"2019","unstructured":"Corkery JM, Streete P, Claridge H, et al.. Characteristics of deaths associated with kratom use. J Psychopharmacol. 2019, 33:1102-23. 10.1177\/0269881119862530","journal-title":"J Psychopharmacol"},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1080\/00952990.2020.1836185","article-title":"A comparative analysis of kratom exposure cases in Thailand and the United States from 2010-2017","volume":"47","author":"Davidson C","year":"2021","unstructured":"Davidson C, Cao D, King T, et al.. A comparative analysis of kratom exposure cases in Thailand and the United States from 2010-2017. Am J Drug Alcohol Abuse. 2021, 47:74-83. 10.1080\/00952990.2020.1836185","journal-title":"Am J Drug Alcohol Abuse"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2023.1332999","article-title":"Presence of kratom in opioid overdose deaths: findings from coroner postmortem toxicological report","volume":"14","author":"Torrico T","year":"2023","unstructured":"Torrico T, Patel K, Nikolov N, Salam MT, Padhy R, Weinstein D. Presence of kratom in opioid overdose deaths: findings from coroner postmortem toxicological report. Front Psychiatry. 2023, 14:1332999. 10.3389\/fpsyt.2023.1332999","journal-title":"Front Psychiatry"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2025.1620601","article-title":"The acute adverse health effects of kratom: an evaluation of case reports","volume":"16","author":"Smallets S","year":"2025","unstructured":"Smallets S, Litvin S, Abele G, Kirsh S, Paustenbach D. The acute adverse health effects of kratom: an evaluation of case reports. Front Pharmacol. 2025, 16:1620601. 10.3389\/fphar.2025.1620601","journal-title":"Front Pharmacol"},{"key":"ref22","doi-asserted-by":"publisher","DOI":"10.1080\/02791072.2018.1562591","article-title":"Legally lethal kratom: a herbal supplement with overdose potential","volume":"51","author":"Palasamudram Shekar S","year":"2019","unstructured":"Palasamudram Shekar S, Rojas EE, D'Angelo CC, Gillenwater SR, Martinez Galvis NP. Legally lethal kratom: a herbal supplement with overdose potential. J Psychoactive Drugs. 2019, 51:28-30. 10.1080\/02791072.2018.1562591","journal-title":"J Psychoactive Drugs"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0000000000000958","article-title":"Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association","volume":"143","author":"Dezfulian C","year":"2021","unstructured":"Dezfulian C, Orkin AM, Maron BA, et al.. Opioid-associated out-of-hospital cardiac arrest: distinctive clinical features and implications for health care and public responses: a scientific statement from the American Heart Association. Circulation. 2021, 143:e836-70. 10.1161\/CIR.0000000000000958","journal-title":"Circulation"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1021\/acscentsci.9b00141","article-title":"7-hydroxymitragynine is an active metabolite of mitragynine and a key mediator of its analgesic effects","volume":"5","author":"Kruegel AC","year":"2019","unstructured":"Kruegel AC, Uprety R, Grinnell SG, et al.. 7-hydroxymitragynine is an active metabolite of mitragynine and a key mediator of its analgesic effects. ACS Cent Sci. 2019, 5:992-1001. 10.1021\/acscentsci.9b00141","journal-title":"ACS Cent Sci"}],"container-title":["Cureus"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cureus.com\/articles\/495110-kratom-toxicity-pharmacologic-mechanisms-clinical-risks-and-management-considerations","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T10:40:43Z","timestamp":1784889643000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cureus.com\/articles\/495110-kratom-toxicity-pharmacologic-mechanisms-clinical-risks-and-management-considerations"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":24,"URL":"https:\/\/doi.org\/10.7759\/cureus.113280","relation":{},"ISSN":["2168-8184"],"issn-type":[{"value":"2168-8184","type":"print"}],"subject":[],"published":{"date-parts":[[2026,7,24]]}}}