- Kratom is an herbal leaf from an evergreen tropical tree that is used as a stimulant, mood enhancer or sedative.
- As kratom use increases among young people, Doctors should routinely ask patients about their kratom use, researchers say.
- Up to One third of Kratom users experience an unwanted side effect, which may include Cardiac arrest, liver damage, brain hemorrhage or seizures.
- In some cases, kratom consumption has resulted in deaths due to overdose.
A new research commentary suggests that doctors should routinely ask their patients about their kratom use.
The authors argue that physicians should view kratom in the same way as other recreational drugs such as cannabis, cocaine, methamphetamines, and heroin.
“We believe it is time for physicians to commit to asking about kratom because of its effects, safety profile, wide availability, and largely unregulated status,” researchers from the University of New Mexico School of Medicine and WorkIt Health wrote on August 12 in Annals of Internal Medicine.
Tildabeth Doscher, MD, clinical assistant professor of family medicine at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, who was not involved in the commentary, agreed.
“Kratom is definitely something I see in my practice because it is a substance that people become physically and psychologically dependent on,” Doscher told Healthline.
Kratom is a herbal leaf from Mitragyna spp.a tropical evergreen tree in the coffee family. The tree is native to Thailand, Indonesia, Myanmar, Malaysia and other Southeast Asian countries.
People use the leaves or extracts from the leaves as a stimulant, mood enhancer or sedative.
“Kratom acts as a stimulant at low doses, but as an opioid at higher doses,” explained Dr. Natalie Klag, assistant professor of psychiatry in the department of psychiatry and behavioral health at Ohio State University’s Wexner Medical Center and College of Medicine. Klag was not involved in drafting the new commentary.
Kratom is available at tobacco, vape, and natural product stores, among others. It comes in a variety of forms and can be smoked, vaporized, drunk, or swallowed in capsule form.
An estimated 1.9 million Americans ages 12 or older will have used kratom in 2022, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). However, the authors of the new commentary said this was “likely an underestimate.”
According to SAMHSA, kratom use was highest among young adults ages 18 to 25, followed by adults ages 26 and older and adolescents ages 12 to 17.
Kratom is also used to relieve chronic pain, treat anxiety and depression, or reduce the symptoms of opioid withdrawal, such as when quitting heroin or morphine.
There is little evidence to support the use of kratom for these purposes, and the drug is not approved for medical use.
Although kratom is widely available in the United States, it is considered a “drug of concern” by the Drug Enforcement Agency (DEA).
According to the
However, according to the Congressional Research Service, kratom remains unregulated in most states except Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin. In several of these states, lawmakers have introduced bills that would allow the sale of kratom products.
In Tennessee, the kratom ban only applies to synthetic versions of the drug, not the plant itself.
“The easy availability (of kratom) conveys a misleading level of safety,” Klag told Healthline, “and can often cause people to delay seeking medical treatment when their use gets out of control.”
In the research commentary, the authors wrote that up to a third of kratom users experience unwanted side effects.
A 2022 study links kratom use to several adverse events, including:
- Cardiac arrest
- irregular heart rhythm
- Liver and kidney damage
- Brain hemorrhage
- Visual disturbances
- Seizures
- Aphasia (speech disorder)
- Neonatal abstinence syndrome (when a baby is exposed to a drug in the womb)
- Death
Kratom products have also been found to contain dangerous contaminants such as toxic metals and Salmonellawrite the authors of the new commentary.
According to the
According to Klag, kratom use can even make it difficult to obtain medications for other substance-related disorders.
“Naltrexone, a drug commonly used for opioid and alcohol abuse, if taken by someone using kratom, would cause significant withdrawal symptoms,” she said.
“Kratom has also been shown to have significant interactions with psychotropic drugs such as Seroquel,” she added.
There is little research on whether kratom is addictive or causes dependence.
However, “kratom has been classified as a highly addictive substance in numerous studies,” the commentary’s authors wrote, “with reports of tolerance, dependence, and withdrawal symptoms characterized by hostility, irritability, emotional lability, and delusions.”
Kratom withdrawal is associated with psychiatric disorders such as:
- Nervousness and restlessness
- Irritability and anger
- violent and intrusive thoughts
- Hallucinations
- increased anxiety
- depression
A case report from 2010, published in European addiction research A 44-year-old man who had consumed Kratom experienced the following withdrawal symptoms:
- Fear
- Unrest
- tremor
- Sweat
- Cravings
One year 2016
Despite this evidence, kratom use disorder is not listed in the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition), the authors of the commentary emphasize.
However, a survey found that 12.3% of kratom users had a use disorder, the authors said.
In her practice, Doscher treats patients with symptoms of kratom use disorder. “At high doses, kratom acts like an opioid – people go into withdrawal symptoms,” she says. “I have people who are addicted to kratom and I prescribe them buprenorphine as if they were taking fentanyl, methadone, etc.”
Although there is no standard treatment for kratom use disorder, some research suggests that buprenorphine may be an effective treatment. This prescription medication is used to treat opioid use disorder.
Doscher has found that kratom addiction is easier to treat than opioid addiction. “I’ve never had to treat anyone with a kratom addiction with methadone,” she said.
Methadone is another prescription medication used to treat opioid addiction.
Given the risks of kratom use, the authors of the commentary write that “physicians need more education and better tools to counsel and assess patients regarding their kratom use.”
Klag agreed. “Doctors need to be better educated about how kratom works, how it is consumed, the effects of stopping it, and the potential interactions with other medications and medical complications it can cause,” she said.
Doscher believes that doctors’ education should begin as early in their careers as possible. “The opportunity to teach doctors (about kratom) is slim,” she said. “The bigger opportunity would be to educate medical students.”
Doscher, who provides treatment for drug addicts and trains general practitioners in drug addiction treatment, believes the question doctors ask their patients should be more general: “Are you even taking anything that hasn’t been prescribed for you?”
“Substance abuse treatment should be much more widespread,” she noted. Additionally, “people need to understand that if they don’t have control over their use of a substance, it’s a problem.”
Klag believes that doctors need to be aware of the risks of kratom, but also stresses that they need to have open conversations with their patients.
“Patients need to feel comfortable giving us this information so we can counsel and educate them in a safe environment,” she said. “Otherwise they will be receiving information from unreliable sources.”
A group of physicians wrote in a commentary that doctors should routinely ask their patients about their use of the herbal medicine kratom, just as they ask about their use of cannabis, cocaine and other recreational drugs.
Kratom is an herbal leaf from a tropical evergreen tree native to Southeast Asia. It has stimulating or sedative effects depending on the dose. Some people use it to treat anxiety and depression, chronic pain, or opioid withdrawal symptoms, although there is little evidence to support these uses.
Kratom consumption poses many health risks, including cardiac arrest, kidney or liver damage, brain hemorrhages, and seizures. Some people have also died from a kratom overdose.
