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Ask the Experts

Kratom for Opioid Withdrawal

by Jeanine Barone  

Q: Can the herbal product kratom help with opioid withdrawal?

A: Anecdotally, people claim that it helps, but its safety is highly questionable, and both the FDA and CDC have strongly warned against using it because the compounds in the supplement essentially make it an opioid itself.

The kratom plant (Mitragyna speciosa) is found in Southeast Asia and parts of Africa. Laborers, farmers, and others have chewed, smoked, or brewed the leaves as a tea for centuries as a stimulant to boost energy levels. Taken in low doses, kratom acts as a stimulant; high doses produce pain relief and euphoria. Nowadays, it’s most common for people to purchase kratom online, as capsules, powder, or tea. It’s estimated that between three and five million people in the U.S. are using kratom, which is often billed as an “opioid alternative.” Because it contains opioid compounds, people often take it to treat chronic pain as well as withdrawal from opioids.

Kratom is marketed as being less addictive and having milder withdrawal symptoms compared with opioids such as oxycodone, hydrocodone, and fentanyl. But the efficacy and, more importantly, safety of kratom are highly controversial. In a report published in 2016 in the CDC’s Morbidity and Mortality Weekly Report (MMWR), researchers noted a ten-fold increase in kratom-related calls to poison control centers from 2010 to 2015, including some for life-threatening side effects. The most severe effects appeared to be associated with taking other drugs along with kratom, including some psychiatric medications. Other reports have linked kratom with adverse effects ranging from hypertension, nausea, constipation, and urinary frequency to liver, kidney, and cardiac damage.

More recently, kratom was associated with 152 overdose deaths—and determined to be a cause of death in 91 cases—in an analysis by CDC researchers published in MMWR in April 2019. The researchers examined data from more than 27,300 fatal overdoses in 32 states and the District of Columbia between July 2016 and December 2017.

A public health advisory released by the FDA in 2017 warned consumers against using kratom or any parts of the plant, noting that deaths had been associated with the use of kratom products. In a statement released in 2018, the agency cited a new analysis by FDA scientists that “clearly revealed” that kratom “isn’t just a plant—it’s an opioid. And it’s an opioid that’s associated with novel risks because of the variability in how it’s being formulated, sold and used recreationally and by those who are seeking to self-medicate for pain or who use kratom to treat opioid withdrawal symptoms.” The agency warned that “claiming that kratom is benign because it’s ‘just a plant’ is shortsighted and dangerous.”

Keep in mind also that since kratom is a dietary supplement, it’s not regulated—and there’s no guarantee of its purity and potency, nor that you’re getting what’s on the label. In some cases, samples of kratom have been found to be adulterated with other drugs, including hydrocodone. In February 2018, the CDC announced that it was investigating a multistate outbreak of Salmonella infections linked to kratom supplements. The agency advised the public not to consume kratom in any form because of the risk of contamination with Salmonella.

As of early 2018, six states—Wisconsin, Tennessee, Vermont, Indiana, Alabama, and Arkansas—and D.C. had enacted bans on kratom, though this is probably hard to enforce since the product is mainly bought and sold online. An effort by the federal Drug Enforcement Agency (DEA) to crack down on kratom in 2016 by proposing to list two of its main psychoactive components as Schedule I drugs—the same class as heroin—was thwarted by a campaign of public commenters claiming that the herb helped them with chronic pain, opioid withdrawal symptoms, or other conditions.

Bottom line: Avoid using kratom for any purpose, especially if you are taking other drugs.

Also see Are Opioids In Your Medicine Cabinet?

Originally published February 2018. Updated April 2019.