What Is Kratom? The Plant, the Evidence and the Dutch and EU Legal Position

Kratom arrives in the smartshop with a lot of vocabulary attached: red, green, white, Maeng Da, extract, "enhanced". Underneath all of it is one tree and three plain questions. What is it, what does it actually do, and where does it stand in Dutch law? Let's start with the leaf and work outwards to the shelf.

Kratom is the leaf of Mitragyna speciosa, a tropical tree in the coffee family from Southeast Asia. People there have chewed the leaves or brewed them as tea for generations, traditionally to get through long working days. The main alkaloids, mitragynine and 7-hydroxymitragynine, act on opioid receptors, which is why low amounts are described as stimulating, higher amounts as sedating, and why dependence is a recognised concern.

Controlled human research is still scarce. The US National Center for Complementary and Integrative Health (NCCIH) says kratom hasn't been shown to be safe and effective for any medical use. A 2022 report published in the EFSA Journal concluded that the risk can't be properly quantified yet, mostly because kratom products vary so much in what's in them.

The Dutch legal picture has two layers, an Opium Act layer and a food-law layer, and neither answers the question alone. The legal section near the end sets out both, dated 8 October 2026.

Five things worth knowing before you reach the shelf

• A plant, not a single substance: kratom leaf contains dozens of alkaloids in varying proportions. Mitragynine is usually the main one; 7-hydroxymitragynine is normally a small fraction.
• The claims are bigger than the evidence: pain relief, energy and mood are the claims you'll see most. Human evidence is a few small or short trials, many surveys and a lot of case reports. None of it amounts to a proven treatment.
• Dependence is real: surveys of regular users in Malaysia and clinical case reports describe tolerance, craving and withdrawal. Several reviews and the EFSA report say the same.
• "Kratom" on a label isn't a specification: leaf powder, concentrated extracts and products enriched with 7-hydroxymitragynine can be quite different things.
• Law differs by place: the Netherlands and other European countries handle kratom differently, and the Dutch position has two layers (see the legal section).

One tree, two names, a long history

Mitragyna speciosa grows across Southeast Asia, and "kratom" is its Thai name; in Malaysia it's often called ketum. The EU Drugs Agency's (EUDA) drug profile describes how people traditionally chew fresh leaves or make them into a tea, and notes that the leaves contain over 40 related alkaloids plus flavonoids and other plant compounds (EUDA kratom drug profile, archived copy dated 1 January 2026). The NCCIH summary says the same thing in plainer words: in Southeast Asia, people historically chewed the leaves or made tea from them to fight fatigue and boost productivity, and used it for pain and diarrhoea as a substitute for opium (NCCIH: kratom, last reviewed April 2022).

That's a long record of use, and a genuinely interesting one. Traditional use meant leaves, chewed or brewed by people who often did so every day, and those are the people the dependence surveys later studied. A modern capsule or gummy is a different thing, and the history doesn't tell us what it does or how risky it is.

Why people buy it, and what the claims rest on

In the smartshop world, kratom is usually bought for one of three reasons: energy and focus at lower amounts, relaxation at higher ones, or as a self-managed way to deal with pain or opioid withdrawal. Here's what the human evidence looks like for each.

Pain. One small randomised, placebo-controlled study from Malaysia tested a kratom decoction in 26 men who had used kratom daily for about six years. In a cold-water hand test, the time before they pulled their hand out increased about an hour after kratom, but not after the placebo (Vicknasingam et al., 2020, Yale Journal of Biology and Medicine). That's a real finding, but it's a laboratory pain-tolerance test in experienced daily users, not a trial in people with pain conditions. The authors themselves call for more rigorous research.

General safety and tolerability. A 2026 randomised, double-blind trial gave dried kratom leaf powder to 116 healthy adult volunteers who hadn't used kratom recently (49 got kratom, 67 got placebo), with single doses and then 15 days of daily doses. No serious adverse events were reported, and the most common effects were dizziness, nausea and feeling relaxed, followed by headache and raised alanine aminotransferase (a liver enzyme) with repeated doses. The authors conclude it was well tolerated and showed no meaningful abuse potential or withdrawal in that setting (Huestis et al., 2026, Therapeutic Drug Monitoring). It's the largest controlled study of its kind so far, and a useful one. It was also industry-funded (by NP Pharma, according to the paper), ran for 15 days, and used one characterised leaf product, so it can't tell us about months of daily use or about extracts.

The "no meaningful abuse potential" line deserves a second look. A companion paper from the same trial found that subjective drug effects rose with dose and were statistically significant against placebo only at the highest single dose, then faded with repeated dosing, with no clinically meaningful withdrawal (Coe et al., 2026, Drug Testing and Analysis). That's one industry-funded trial reported in several papers, not several independent trials. And in a small double-blind pilot of 40 recreational polydrug users with opioid experience, who took single doses of 1 to 12 g of leaf (about eight people per dose level), "drug liking" and "high" ratings rose at 12 g, and vomiting, sleepiness and nausea were common (Reissig et al., 2026, Journal of Clinical Psychopharmacology).

Opioid withdrawal. Some people use kratom this way. NCCIH's position is that kratom has not been shown to be safe and effective for it or for any other medical use. If you're trying to come off opioids, that's a conversation for a doctor, who can offer treatments with actual evidence behind them.

Mood and energy. A 2024 meta-analysis of 36 studies found a very small positive association between kratom use and negative mental-health indicators and no clear link with positive ones (Yang et al., 2024, European Addiction Research). Most included studies were observational surveys, so they can't show cause and effect in either direction. Controlled evidence on focus is a single small study: eight healthy volunteers received placebo and single doses of purified mitragynine (not leaf), and at the lowest dose, 5 mg, their ratings of arousal and attention and their accuracy on a sustained-attention task went up, while the highest dose (40 mg, tested in a second group of seven) raised ratings of amnesia (Prevete et al., 2025, Psychopharmacology). It was exploratory and single-blind, covered only 15 people, and didn't correct for testing many outcomes, so it's a hint rather than a result. Beyond that, we didn't find a controlled study on mood, focus or gaming performance, and wanting to feel more alert isn't the same as a demonstrated benefit.

A 2024 scoping review of recent kratom research summed up the overall picture as a "dearth of reliable data" on prevalence and on objective measures of risk and safety (Vicknasingam et al., 2024, Current Opinion in Psychiatry).

Two alkaloids and a plot twist

Two alkaloids do most of the talking. Mitragynine is the most abundant in the leaf. 7-hydroxymitragynine is much rarer in the leaf, but it's a more potent opioid-receptor agonist. EUDA's profile gives the typical picture: total alkaloids in dried leaf of roughly 0.5 to 1.5%, with mitragynine up to about two-thirds of that in Thai varieties and 7-hydroxymitragynine up to about 2% of it. Leaf composition also depends on variety, plant age, environment and harvest time.

Here's the twist. In laboratory work on mouse and human liver preparations, mitragynine was converted into 7-hydroxymitragynine by CYP3A enzymes, and in mice that metabolite seemed to account for much of the opioid-receptor-mediated pain relief (Kruegel et al., 2019, ACS Central Science). Those are animal and lab findings. They help explain why the two alkaloids can't be treated as separate stories, and why a product that's rich in 7-hydroxymitragynine is a different proposition from a leaf with trace amounts.

That's the real reason "format" matters. A powder made from ground leaf, a concentrated extract, and a product with added or enriched 7-hydroxymitragynine can all be sold under the word kratom, but they aren't the same exposure. The evidence on what's actually in products:

• The US Food and Drug Administration warned consumers in July 2025 about products containing added or enhanced 7-hydroxymitragynine, sold as tablets, gummies, drink mixes and shots. It separates these from the naturally occurring trace amounts in leaf, and states that 7-hydroxymitragynine isn't approved for any medical use (FDA consumer update, 29 July 2025). That's US regulatory language, not a statement about Dutch or EU law.
• Laboratory testing has found 7-hydroxymitragynine at levels much higher than leaf in some US-market products sold as kratom (Lydecker et al., 2016, Journal of Medical Toxicology; Brown et al., 2026, Journal of AOAC International). Those authors argue that such products are not simply kratom extracts. Neither study surveyed Dutch shops.
• A 2026 mass-spectrometry study of 38 commercial products found substantial variability in alkaloid composition between products, with 7-hydroxymitragynine and mitragynine pseudoindoxyl (another alkaloid) found in several tablet and capsule formulations. It also warned that routine screening methods can misidentify 7-hydroxymitragynine (Sheehan et al., 2026, Journal of the American Society for Mass Spectrometry).
• Adulteration with other drugs has happened too. EUDA's profile describes "Krypton" products sold in Germany and Sweden that contained caffeine and synthetic O-desmethyltramadol.

The takeaway: "kratom" tells you the plant, not what's in the pack.

Dependence and withdrawal

The most direct evidence comes from surveys of people who use kratom regularly. In a cross-sectional survey of 293 regular users in Malaysia, more than half of those using it for over six months showed severe dependence problems on the questionnaire used, and users who drank three or more glasses a day had higher odds of severe dependence, withdrawal symptoms and craving. Commonly reported withdrawal symptoms included muscle spasms and pain, sleep difficulty, watery eyes and nose, restlessness and tension (Singh et al., 2014, Drug and Alcohol Dependence). The sample was regular users in one country, using a traditional beverage, so it doesn't predict what happens to any one person elsewhere.

A systematic review of the literature, paired with the authors' own clinical cases, concluded that chronic use can lead to dependence, tolerance and withdrawal on stopping, and that clinicians are seeing more withdrawal presentations (Stanciu et al., 2019, Journal of Psychoactive Drugs). NCCIH lists addiction and withdrawal symptoms among the concerns, and the Dutch drug-information service DRUGSinfo, run by the Trimbos Institute, describes kratom as addictive, with daily use leading to tolerance and withdrawal symptoms (DRUGSinfo: kratom, no update date shown on the page).

How common dependence is depends on who you ask. In a 2017 online survey of 2,798 mostly US users, 59% used kratom daily, but 56 people (2%) met DSM-5 criteria for a moderate or severe past-year use disorder, and about a third reported adverse effects that were mostly mild and short-lived (Garcia-Romeu et al., 2020, Drug and Alcohol Dependence). In a smaller online sample of 129 US adults who had ever used regularly, 29.5% met past-year use-disorder criteria, with tolerance and withdrawal the main features and withdrawal described as moderate (Smith et al., 2022, Journal of Addiction Medicine). Both are self-selected online samples, so neither gives a true rate. WHO's expert committee on drug dependence, in a 2021 pre-review, says limited epidemiological evidence indicates withdrawal is usually mild (WHO ECDD: kratom).

The healthy-volunteer trial above reported no meaningful withdrawal after 15 days, which fits with dependence building up with heavier, longer use. Exactly where the line sits will vary between people and products. If you notice that you're using more to get the same effect, struggling to stop, or feeling unwell when you skip it, that's the moment to talk to a GP or an addiction-care service. It's a common pattern with substances that act on opioid receptors, and there's no shame in asking.

Kratom and your medicine cabinet

In test-tube experiments with human liver and intestinal preparations, mitragynine slowed down two enzymes that help the body process many medicines: CYP3A (a time-dependent inhibitor) and CYP2D6 (a strong competitive inhibitor). A model built on those results predicted that a 2 g kratom dose could raise exposure to midazolam (a CYP3A-processed sedative) about 5.7-fold (Tanna et al., 2021, Journal of Pharmacology and Experimental Therapeutics). A later clinical study has now measured it: in 12 healthy adults, a 2 g dose of kratom tea raised midazolam exposure (AUC) about 1.4-fold (1.39) and its peak level 1.5-fold, while dextromethorphan, which relies on CYP2D6, was unchanged (Tanna et al., 2023, Clinical Pharmacology & Therapeutics). So the interaction is real, but far smaller than the model predicted. It was one low dose of one product on a single occasion, so it can't tell us what higher or repeated doses do, or how other medicines behave. The practical point is that medicines processed by these enzymes could behave differently alongside kratom, which is exactly why a pharmacist should see the actual product.

EUDA's profile notes reports of serious interactions between kratom and other drugs, and the Dutch DRUGSinfo page warns about combining it with depressants such as alcohol, benzodiazepines and oxycodone (risk of breathing problems), and about serotonin-related risks when combined with some stimulant drugs. NCCIH says more research is needed on interactions. Our guide to supplement and drug interactions covers how to ask a pharmacist about this in general.

Reported harms, and why case reports are hard to read

NCCIH lists reported effects from mild (nausea, constipation, dizziness) to serious (seizures, high blood pressure, liver problems), and says fatal overdoses from kratom alone appear to be extremely rare, while combinations with other drugs carry greater risk.

The most detailed European risk review is a 2022 report from EFSA's European Food Risk Assessment Fellowship Programme, published in the EFSA Journal (Papadi, Bakhiya and Hirsch-Ernst; a fellowship report, not an official EFSA scientific opinion). It reviewed animal and human data on oral kratom and concluded that consumption can cause adverse neurological effects including addiction and withdrawal, and can also affect organs including the liver and kidneys. It also says that large numbers of case reports describe intoxication, liver injury, seizures, coma, cardiovascular effects and some deaths. The report stresses that the risk can't be pinned down because product composition varies, dose-response information is thin and long-term data are limited, so it couldn't set a health-based guidance value (Papadi et al., 2022, EFSA Journal).

Two more recent systematic reviews show how hard case reports are to interpret:

• A 2026 systematic review of kratom and liver injury found 32 reported cases across 31 studies. Many involved other substances or conditions, and only 7 cases gave complete information on exposure. Most patients recovered after stopping, and four went on to liver transplantation. The authors say the association is plausible but needs better research (Calicdan et al., 2026, Journal of Addiction Medicine).
• A 2025 systematic review of kratom and seizures found 20 patients across 11 publications, but only one patient had a urine test confirming mitragynine, so the authors concluded there wasn't enough evidence to say kratom causes seizures (Turla et al., 2025, Frontiers in Pharmacology).

Put together: there are credible reports of harm, and the controlled data that would show how often it happens and at what exposure is missing. If you've got liver disease, take regular medication, drink heavily, are pregnant or breastfeeding, or have a history of problems with opioids or other substances, speak to a clinician or pharmacist before you try anything.

Two laws, one plant: kratom in the Netherlands and Europe (8 October 2026)

Is kratom legal? It depends on the country, and in the Netherlands the answer comes in two parts. This section was read on 8 October 2026; laws change, so check current rules before you rely on it, and this is not legal advice.

Opium Act. Kratom, mitragynine and 7-hydroxymitragynine aren't on the Dutch Opium Act lists. DRUGSinfo says so directly ("Kratom staat niet in de Opiumwet en is dus legaal") and adds that it falls under the Commodities Act (Warenwet) and can't be marketed for human consumption. We found no Dutch government proposal to put kratom or its alkaloids on the lists. One loose end remains: the minister sent Parliament a draft decision on 31 March 2026 amending Opium Act lists I and IA, but the summary page doesn't name the substances and we couldn't open the annexes, so we can't confirm that it's unrelated to kratom (Rijksoverheid, 31 March 2026).

Food law. On 24 June 2025, the Dutch College van Beroep voor het bedrijfsleven (the trade and industry appeals tribunal) ruled on an appeal about a 1,100 kg shipment of "Mitragyna speciosa dried leaves powder" that had been detained and refused entry into the EU. The only point still contested on appeal was whether kratom is excluded from "food" as a narcotic or psychotropic substance under the UN drug treaties. The tribunal held that it isn't, because kratom isn't listed in those treaties, so kratom counts as a food. The authorities' position that kratom is an unauthorised novel food came from the ministry and the lower court (Rechtbank Rotterdam) and wasn't contested on appeal. Under EU Regulation 2015/2283, only authorised novel foods on the Union list can be marketed as such (ECLI:NL:CBB:2025:340, 24 June 2025, case 24/93).

What that means in practice is hard to state tidily. Being outside the Opium Act lists means kratom isn't treated as a controlled drug under that law. The tribunal's reasoning, though, was about a commercial import of leaf powder. We found no ruling on retail smartshop sales, capsules, extracts or gummies, and no Dutch policy statement on them either, so we can't say how that reasoning applies to a product on a shelf. DRUGSinfo says kratom is sold in smartshops as powder, capsules and gummies. The NVWA (the Dutch food and consumer product safety authority) handles novel-food questions, and is the place to ask about a specific product.

Elsewhere in Europe. Kratom isn't controlled at EU level. EUDA's profile reports that kratom, mitragynine or 7-hydroxymitragynine are controlled in at least 12 of the countries it monitors, naming Denmark, Estonia, France, Italy, Latvia, Lithuania, Poland, Portugal, Romania, Finland, Sweden and Turkey. That's a snapshot from an archived copy of the EUDA profile, which describes some other things in older terms, so treat it as a pointer rather than a current legal table. If you're travelling or ordering from another country, check that country's official rules first. A product sold legally in one place can be a customs problem in another.

A shop-window glossary

Shelf labels can sound like a secret code. Here's a decoder, with the gaps marked.

• Term: Leaf powder; What it usually means: Dried, ground leaf, usually sold by weight; What it leaves out: Alkaloid content per gram, which varies by batch and origin
• Term: Capsules; What it usually means: Powder or extract in a shell, sold by the pack; What it leaves out: Whether the number on the box is leaf, extract or mitragynine
• Term: Extract; What it usually means: A concentrated preparation; What it leaves out: How it was made, what it's concentrated from, and what's in it
• Term: "Enhanced" or 7-OH products; What it usually means: Products with added or concentrated 7-hydroxymitragynine, according to FDA's usage; What it leaves out: They aren't the same as leaf, whatever the brand name says
• Term: Extract multiples ("10x", "15x"); What it usually means: Usually read as a concentration factor; What it leaves out: No source we found says what the multiple is measured against, so it's best not to read a meaning into it
• Term: Vein colour or strain name (red, green, white, Maeng Da, Bali); What it usually means: Sales labels, often drawn from vein or powder colour; What it leaves out: No controlled or blinded human study has tested whether these predict effects. In a survey of 644 users, people reported different effects for red, green and white, but lab tests of six products from one vendor found no significant difference in mitragynine or total alkaloids between the colours (Huisman et al., 2023, IJERPH). They aren't a specification
• Term: "Lab tested"; What it usually means: A claim of some testing; What it leaves out: Which lab, which batch, which compounds, and whether a certificate is available

What to take from all this

Kratom is a real plant with real pharmacology, a long history of traditional use and a thin body of controlled human research. It's worth understanding properly, and the picture that emerges is a mixed one: regular use can lead to dependence, product composition varies a lot, kratom can raise the levels of some medicines, and case reports of liver and other harm exist even if they're hard to interpret. It isn't a harmless herbal pick-me-up, and the products on a shelf aren't all the same thing.

If you're thinking about buying kratom, the useful questions are about the product in front of you rather than the colour on the label: what's in it, how is it measured, is there a batch certificate, what else are you taking, and is it legal where you live? Our guide to how to read supplement labels is a good general starting point for those first questions.

If you're worried about your own use or a friend's, a GP (huisarts) is a sensible first call in the Netherlands, and DRUGSinfo offers independent information. If someone is hard to wake, breathing slowly or unusually, or has a seizure, call 112.

Update note, 14 October 2026: we corrected the medicine-interaction passage, which called the midazolam figure a model prediction (a 2023 clinical study has since measured it); added the one small controlled study on focus, further abuse-potential results and other dependence surveys; and reworded the vein-colour line, which said there was no human evidence (there are surveys, but no controlled or blinded study).

Written by Smart Supplements with AI assistance from the sources linked in the text. It has not been reviewed by a clinician.

Last updated: 14 October 2026

This article is for informational purposes only and is not intended as medical advice. Always consult a healthcare professional before starting any new supplement, especially if you take prescription medication.