Characteristics of Adverse Reactions to Kratom and Implementation of Harm Reduction Strategies in a Sample of Ethnobotanical Tea Bar Patrons in Colorado

Background: Kratom is a psychoactive botanical that is increasingly popular in the United States, yet limited research exists to date on its potential risks. Given that kratom is currently unregulated, and a variety of kratom products are widely available on the commercial market, more data are needed to inform consumers about potential adverse reactions to kratom. Methods: 102 participants (mean age=22.34 years, 32.9% women) were recruited from ethnobotanical tea bars in Northern Colorado to complete a survey on kratom use, which included questions pertaining to adverse experiences. Results: Most participants (75.5%) reported experiencing an adverse reaction to kratom at least once in the past, with a wide range of kratom dosages reportedly consumed during these experiences. Adverse reactions were most commonly reported to occur in the context of consuming kratom on an empty stomach, consuming alongside certain foods, lack of hydration, and combining kratom with other substances. Participants employed a variety of strategies in attempt to mitigate adverse reactions, such as drinking water, eating, and resting. Conclusions: Adverse reactions to kratom may be associated with certain contextual factors. Several techniques are reportedly used to mitigate adverse reactions, but the efficacy of these techniques is unknown. More data are needed to understand the causes and consequences of adverse reactions to kratom, and to better understand potential harm reduction strategies for reducing adverse experiences. More research could also shed light on the extent to which kratom dosage and various product formulations (e.g. whole leaf vs. extracts) are predictive of adverse effects.