Kratom is one of the newer psychoactive substances derived from natural elements and used for pain relief. It’s an unscheduled opioid receptor agonist, and while banned by the Food and Drug Administration (FDA), it is widely available and not very expensive. You may see storefront signs touting kratom products in your community with claims to treat pain, cure opioid addiction, or manage opioid withdrawal.

In addition to the actions of the substance itself, a big concern is that “Using products with unsubstantiated claims may prevent those addicted to opioids from seeking treatments that have been demonstrated to be safe and effective” (FDA, 2019). As nurses, we must remain educated, share our knowledge, and be alert for use of kratom and other products with unsupported claims and significant health risks.  

Here’s what you need to know (O’Malley, 2018):

1. Kratom (Mitragyna speciose) is a tropical tree native to Southeast Asia, the Philippines, and New Guinea.
2. There are no FDA-approved uses for kratom.
3. Kratom is often marketed as a dietary supplement.
4. The forms of kratom include leaves, pills, capsules, powder and tea.
5. Other names for kratom include Mitragyna speciosa, mitragynine extract, biak-biak, cratom, gratom, ithang, kakuam, katawn, kedemba, ketum, krathom, krton, mambog, madat, Maeng da leaf, nauclea, Nauclea speciosa or thang.
6. Small doses of kratom produce stimulatory effects like cocaine or amphetamines.
7. Large doses of kratom are associated with sedative-narcotic effects similar to opioids.
8. Repeated use of kratom can cause hypertension, renal toxicity, impaired cognitive function and behavior, and liver injury.
9. Withdrawal symptoms include tremor, anorexia, weight loss, decreased libido, insomnia, muscle spasms and pain, fever, diarrhea, and psychosis.
10. Kratom may be added to other products without identification in the labeling.
11. The lack of regulatory controls, production standardization, and sale of products contaminated with potentially toxic and infectious substances contribute to the danger associated with this product.

It’s important for us to educate patients that "legal" and "available" do not imply safety. Claims that kratom is a natural substitute for opioids are unproven. Share these facts, keep up on the latest evidence, and report any adverse reactions to the FDA MedWatch program. 

References:
O’Malley, P. (2018). Think Kratom Is a Safe Opioid Substitute? Think Again!: History, Evidence, and Possible Future for Mitragyna speciose. Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, 32(5). doi: 10.1097/NUR.0000000000000392
 
U.S. Food & Drug Administration. (2019). FDA issues warnings to companies selling illegal, unapproved kratom drug products marketed for opioid cessation, pain treatment and other medical uses. Retrieved from https://www.fda.gov/news-events/press-announcements/fda-issues-warnings-companies-selling-illegal-unapproved-kratom-drug-products-marketed-opioid