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Kratom is a dose-dependent substance that acts as a stimulant at low doses and an opioid at higher doses

High-potency extracts, including concentrated 7-hydroxymitragynine products, are driving increased hospitalizations

Standard urine drug screens do not detect Kratom, creating a major assessment blind spot

Nurses must ask targeted history questions about herbal teas, powders, energy supplements, and brand names

“Toss and wash” ingestion carries serious airway and aspiration risks due to thick, hydrophobic powder residue

Kratom toxicity can present in three primary ways: opioid-like respiratory depression, stimulant-induced agitation, or seizures

Seizure risk is increased due to Kratom’s adrenergic effects and its inhibition of key liver enzymes that metabolize many medications

“The wobbles” is a critical slang term indicating neurotoxicity and increased seizure risk

Long-term use may cause hepatotoxicity, jaundice, pruritus, hyperpigmentation, and dental changes

Kratom withdrawal is severe and often leads to patients leaving against medical advice if not treated aggressively

Best practice withdrawal management includes buprenorphine, clonidine, and gabapentin

Chronic Kratom use creates cross-tolerance, complicating anesthesia and post-operative pain control

Nurses must approach assessment without judgment to reduce stigma and improve disclosure

Legal status does not equal safety, and Kratom represents a growing clinical and public health concern

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