Kratom Is Supposed to Relieve Pain and Anxiety. Why Is It Under Scrutiny?

Fact checked by Nick Blackmer

Key Takeaways

• Kratom is an herbal substance sold in different forms ranging from leaf powders to concentrated liquid shots.

• Users claim that, depending on the dose, kratom can boost energy, ease pain, and cause an opioid-like sedative effect.

• The long-term safety of kratom isn’t well understood, and the substance has been linked to several deaths in recent years.

Kratom, an herb with opioid-like effects, is surging in popularity as users claim it can improve health and mood.

But recently, a spate of lawsuits allege that the substance is to blame for several deaths. Last week, the family of a woman who died after taking kratom was awarded $11 million in a wrongful death lawsuit against the company that sold the product.

The Food and Drug Administration (FDA) hasn’t approved kratom for any medical use. While the substance isn’t regulated by federal agencies, half a dozen states have banned kratom products, as have cities including San Diego and Denver. The Drug Enforcement Administration (DEA) has also listed kratom as a “drug and chemical of concern.”

Elsewhere in the country, however, kratom products are found in gas stations, smoke shops, and online.

Kratom sellers tout certain strains as beneficial for boosting energy and mood. At low doses, it can act as a stimulant. People also often take kratom to relieve pain and anxiety, or even to treat opioid and other drug addictions or dependence.

However, there have been very few studies of the effects of kratom on humans, and it’s too soon to know how the risks and benefits of the substance balance, according to Christopher McCurdy, PhD, FAAPS, a professor of medicinal chemistry and Director of the University of Florida Translational Drug Development Core.

“There’s just so much we don’t know, and that’s the hard part. It’s a similar fight that we’re having on the scientific side with cannabis. The human usage is so far out in front of where the science is,” McCurdy told Verywell. “Individuals are out there saying, ‘This is the greatest thing since sliced bread,’ and you have the other side of the group where they’re saying, ‘This is incredibly dangerous and addictive.’ Quite frankly, we don’t have science to back up either one of those statements.”

Related: Is Kratom Addictive?

Kratom Comes in Many Forms

Kratom comes from the leaves of a tree native to Southeast Asia, where it has been used in herbal medicine for centuries. Traditionally, people chew or smoke the leaves or steep them in tea.

In the U.S., kratom commonly comes as a powder sold on its own or in capsules to be taken by mouth. Some manufacturers extract the most potent elements of the plant and sell it as a concentrated liquid shot or capsule.

Just as there is variety in the alcohol content in alcoholic beverages, kratom products can have a range of chemical concentrations and doses, McCurdy said. Teas and powders made from the natural leaf material are akin to beer, whereas extracts and concentrates are much more potent, like Everclear.

While kratom proponents may consider the herb to be a “dietary supplement,” McCurdy said most kratom products are so manipulated they stray far from the plant-based material.

Related: Herbal Supplements to Avoid Before Surgery

Kratom Has Potential to Be an Opioid or an Opioid Use Treatment

Traditional opioids—like morphine, heroin, or fentanyl—interact only with the opioid receptors in our body. One of the main compounds in kratom, called 7-hydroxymitragynine, is particularly active at opioid receptors. The FDA therefore considers components of kratom to be opioids, and says the drug has high potential for abuse.

But many other alkaloids in kratom interact with several different receptors, including those that deal with hormones that regulate heart rate, blood pressure, breathing, and mood.

McCurdy said that people often associate the sedative or euphoric feelings of high doses of kratom with opioids. However, Poison Control Center’s data and his team’s research indicate that those higher doses may actually produce a stimulant-like overdose effect, much like one might experience with cocaine or methamphetamines.

“You don’t see a true outward opioid-like effect when someone takes it, no matter what sort of dose they’re taking,” McCurdy said. “The overall pharmacology is very complex. That’s why I don’t consider kratom itself to be an opioid—it’s too complicated even for us to understand as scientists.”

Some case studies indicate that kratom may have mechanisms similar to opioid withdrawal treatments like clonidine. That could mean that kratom, if used correctly, could indeed help treat opioid dependence.

“It’s a very interesting parallel. I’m not saying it’s exactly the same, but it’s similar. So it’s not too surprising that people claim that it helps them stay off of prescription opioids because it’s helping to treat their pain, but it’s also helping to sort of mitigate any withdrawals they’re having,” McCurdy said.

Still, the unknowns far outweigh the knowns, especially when it comes to the long-term effects of kratom use in humans.

The National Institute on Drug Abuse (NIDA) has funded at least 50 active kratom research studies so far.

“Five or six years ago, when I would talk to addiction treatment physicians, they were hearing about patients of theirs that were starting to use kratom to get off of opioids and were pretty successful in doing it, but in the last couple of years, they have started to talk about patients that are coming to them, trying to get off of kratom and not being able to do it very well,” McCurdy said.

Related: Types of Opioids Used for Chronic Pain Relief

Increased Deaths Associated With Kratom

In 2011, poison control received 13 calls nationwide about kratom exposure. In 2017, that number soared to 682. More than half of those cases involved a serious medical outcome, such as seizure, respiratory distress, and slow heart rate.

In 2016 DEA sought to classify kratom as a Schedule I controlled drug, a class of substances with no currently accepted medical use and a high potential for abuse. But the agency later withdrew its notice of intent after receiving strong backlash.

The American Kratom Association, which advocates on behalf of kratom users in the U.S., disputes the claim that kratom is a dangerous substance and said its abuse potential is on par with unscheduled substances, like caffeine. Nearly all cases of death associated with kratom products involved other drugs or contaminants, according to the NIDA.

“The American Kratom Association recognizes that every effort should be made to keep kratom risks low, and protect consumers from adulterated and contaminated kratom products,” the organization said in a statement.

“With appropriate FDA consumer regulation, we can maximize the potential for kratom to be responsibly used for the improvement of health and well-being of individuals and public health in America.”

Read Next: Benefits and Risks of Opioids for Chronic Pain

What This Means For You

If you are seeking medicinal support for chronic pain or substance use disorder, talk to a medical professional about whether kratom is useful and safe for you.