Kratom-Induced Psychosis Is Rare but Real, Clinicians Warn — U.S. Products May Carry Higher Risk

Why it matters

Primary care clinicians may encounter patients with kratom-related psychotic symptoms but fail to identify kratom use as the cause, particularly since many users view it as a safe, natural supplement.

The big picture

While kratom is widely used in the U.S. for self-managing pain and opioid withdrawal, its psychiatric effects remain poorly understood. A critical gap exists between international data and U.S. clinical reality: American kratom products often contain far higher concentrations of the active alkaloid 7-OH than the leaf tea studied in Southeast Asia, making direct comparisons difficult and potentially misleading.

Key findings

• A Malaysian study of 150 regular kratom users found approximately 4% had mild psychotic symptoms, unrelated to dose or frequency of use
• U.S. kratom products typically contain much higher 7-OH concentrations via potent extracts, compared to trace amounts in traditional Malaysian tea
• Kratom alkaloids interact with dopamine D2 receptors, which may contribute to psychotic symptoms
• A recent case documented kratom-induced Fregoli syndrome, a rare delusional misidentification disorder
• A meta-analysis found a significant association between kratom use and exacerbation of existing psychosis

What they say

Pharmacologic complexity and inconsistent quality control underscore the need for caution when interpreting the kratom-psychosis link, particularly in the United States. — Modesto-Lowe and Patel, Quinnipiac University Health Sciences (2026)

Bottom line

Kratom-induced psychosis is rare but documented, and U.S. clinicians should remain alert given that American kratom products typically contain far higher alkaloid concentrations than those studied in Southeast Asian populations.