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Kratom – an alternative to opioids??

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You may have heard of this herbal folk medicine as a “new” or “non-opioid” treatment for pain. It is relatively new to the U.S., but has been getting more accessible and more popular here. Kratom is a tree native to Southeast Asia, in the same family as the coffee tree, and has been used for centuries in that part of the world. The tree became known to the western world in 1839.

Kratom acts as a stimulant at low doses, and a sedative and pain medicine at higher doses. It has been used in folk medicine to treat restless leg syndrome, diarrhea, and opioid addiction. It is also used recreationally and socially. The leaves are harvested and taken orally, either fresh or dried.

The active ingredients of kratom appear to be two substances called mitragynine and 7-hydroxymitragynine. Both substances have effects similar to opioids (by stimulating the mu opioid receptor, if you want to get technical), although there may be less risk of addiction and respiratory depression than with opioids, and may possibly have effects similar to antidepressant SSRIs. Kratom also contains a substance called rhynchophylline, which acts similarly to ketamine, a type of anesthetic (an NMDA receptor antagonist).

The effects of kratom in the stimulant phase are increased alertness, increased motivation, a happier mood. People feel more talkative and sociable. At higher doses, the sedative phase causes increased calm, reduced pain perception and improved pain tolerance, and sleepiness. Unfortunately, the effects can change from the stimulant phase to the sedative phase with very little warning, which can be dangerous. The dose required for one phase vs the other depends on the person, the potency of the kratom, and what other substances are being used, including prescribed medications.

The possible side effects of kratom include itching, sweating, nausea/vomiting, and constipation. Insomnia and high blood pressure and heart rate have been reported. Seizure and psychosis are possible effects, thought to be more likely when high doses of kratom are used frequently. Kratom can change the way your body clears other medications, which can lead to toxicity of those medications. Addiction is certainly a possibility, but seems to be less likely than with opioids. The same is true of respiratory depression, the adverse effect of opioids that causes death. In fact, there have been no deaths reported from kratom alone, but several deaths when it is mixed with other substances.

This leads to another concern – the question of what is really in the package marked kratom. Unscrupulous people have mislabeled less expensive herbs as kratom, or have mixed in opioids such as hydrocodone and morphine, or other substances, which has resulted in death. There is no regulation of the potency of a batch of kratom, so it can be much stronger or weaker than anticipated.

There has been very little research on the long-term effects or safety of kratom. Kratom is illegal or controlled in several countries, including Australia, Sweden, Denmark, Poland, Malaysia, Myanmar and Thailand. It is illegal in several U.S. states: Alabama, Arkansas, Indiana, Tennessee, Vermont and Wisconsin. The DEA considered classifying kratom as a Schedule I drug in August 2016, the same classification as heroin, cocaine and marijuana, but decided to gather more information first, after a public outcry.

At this point, there is much we don’t know about kratom. We do know that it does act as an opioid, with all the potential risks and benefits that implies. We know that it has other effects as well. We know that it can potentially interact in a negative way with other medications, drugs, and alcohol. We know that what is labelled as kratom may or may not be pure kratom.

Is kratom an alternative to opioids? It may be...but there are still a lot of questions.


At North Shore Pain Management we provide advanced, evidence based, multidisciplinary and cost effective pain management. Our goal is to improve your ability to return to the activities you have been missing as well as provide a meaningful reduction in pain.

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