Kratom: Unsafe and ineffective

If you read health news or visit vitamin stores, you may have heard about kratom, a supplement that is sold as an energy booster, mood enhancer, pain reliever and antidote for opioid withdrawal. However, the truth about kratom is more complicated, and the safety problems related to its use are concerning.

Kratom is an herbal extract that comes from the leaves of an evergreen tree (Mitragyna speciosa) grown in Southeast Asia. Kratom leaves can be chewed, and dry kratom can be swallowed or brewed. Kratom extract can be used to make a liquid product. The liquid form is often marketed as a treatment for muscle pain, or to suppress appetite and stop cramps and diarrhea. Kratom is also sold as a treatment for panic attacks.

Kratom is believed to act on opioid receptors. At low doses, kratom acts as a stimulant, making users feel more energetic. At higher doses, it reduces pain and may bring on euphoria. At very high doses, it acts as a sedative, making users quiet and perhaps sleepy. Some people who practice Asian traditional medicine consider kratom to be a substitute for opium.

Some people take kratom to avoid the symptoms of opioid withdrawal and because kratom may be bought more easily than prescription drugs.

Kratom is also used at music festivals and in other recreational settings. People who use kratom for relaxation report that because it is plant-based, it is natural and safe. However, the amount of active ingredient in kratom plants can vary greatly, making it difficult to gauge the effect of a given dose. Depending on what is in the plant and the health of the user, taking kratom may be very dangerous. Claims about the benefits of kratom can't be rated because reliable evidence is lacking.

Side effects and safety concerns

Although people who take kratom believe in its value, researchers who have studied kratom think its side effects and safety problems more than offset any potential benefits. Poison control centers in the United States received about 1,800 reports involving use of kratom from 2011 through 2017, including reports of death. About half of these exposures resulted in serious negative outcomes such as seizures and high blood pressure. Five of the seven infants who were reported to have been exposed to kratom went through withdrawal. Kratom has been classified as possibly unsafe when taken orally.

Kratom has a number of known side effects, including:

• Weight loss
• Dry mouth
• Chills, nausea and vomiting
• Changes in urine and constipation
• Liver damage
• Muscle pain

Kratom also affects the mind and nervous system:

• Dizziness
• Drowsiness
• Hallucinations and delusion
• Depression and delusion
• Breathing suppression
• Seizure, coma and death

Kratom takes effect after five to 10 minutes, and its effects last two to five hours. The effects of kratom become stronger as the quantity taken increases. In animals, kratom appears to be more potent than morphine. Exposure to kratom has been reported in an infant who was breastfed by a mother taking kratom.

Many of the problems that occur with pain medications happen when these drugs are used at high doses or over a long period of time. It's not known exactly what level of kratom is toxic in people, but as with pain medications and recreational drugs, it is possible to overdose on kratom.

Research shows little promise

At one time, some researchers believed that kratom might be a safe alternative to opioids and other prescription pain medications. However, studies on the effects of kratom have identified many safety concerns and no clear benefits.

Kratom has been reported to cause abnormal brain function when taken with prescription medicines. When this happens, you may experience a severe headache, lose your ability to communicate or become confused.

In a study testing kratom as a treatment for symptoms of opioid withdrawal, people who took kratom for more than six months reported withdrawal symptoms similar to those that occur after opioid use. Too, people who use kratom may begin craving it and require treatments given for opioid addiction, such as naloxone (Narcan) and buprenorphine (Buprenex).

Kratom also adversely affects infant development. When kratom is used during pregnancy, the baby may be born with symptoms of withdrawal that require treatment.

In addition, substances that are made from kratom may be contaminated with salmonella bacteria. As of April 2018, more than 130 people in 38 states became ill with Salmonella after taking kratom. Salmonella poisoning may be fatal, and the U.S. Food and Drug Administration has linked more than 35 deaths to Salmonella-tainted kratom. Salmonella contamination has no obvious signs, so the best way to avoid becoming ill is to avoid products that may contain it.

Kratom is not currently regulated in the United States, and federal agencies are taking action to combat false claims about kratom. In the meantime, your safest option is to work with your doctor to find other treatment options.