Understanding the drug kratom better as an opioid or supplement
DEAR DOCTOR: What, exactly, is kratom? The FDA has apparently called it an opioid, even though it seems to be an herbal supplement. Is it safer than prescription opioids?
DEAR READER: The origin of America’s opioid epidemic stems from the medical community’s desire to control pain: Pain was the enemy and opiates were the cure. But over the years, the addictive potential of these drugs has destroyed multiple lives.
Some consider kratom (Mitragyna speciosa), a tree native to southeast Asia, to have potential in this respect. Kratom has been used in traditional medicine since the 1800s, with the leaves of the tree chewed or made into a tea.
People who have used kratom have reported pain relief, relaxation, improved mood and decreased anxiety. Because of its pain-relieving mechanism and because it works via the opiate receptors, kratom has been considered a potential alternative to traditional opiates, with perhaps even the ability to help wean people off opiates.
We already have some history with the substance,
because kratom has been available in the United States since 2010. Findings from one study suggest that kratom may hold promise against pain and opiate addiction, but we simply don’t have good studies of its effectiveness.
And it may have serious side effects. The substance is cleared from the body through the liver, so if a person has liver problems or is taking medications metabolized by the liver, it may stay in the bloodstream. From 2010 through 2015, 660 calls were made to poison control regarding kratom. Callers complained of rapid pulse rates, agitation, drowsiness, nausea and elevated blood pressure.
Symptoms can be amplified to life-threatening levels when kratom is mixed with alcohol and prescription or illicit drugs, sometimes leading to liver toxicity, seizures and death. That said, the number of deaths from prescribed opiate medications far outnumber the deaths thus far from kratom.
Robert Ashley, M.D., is an internist and assistant professor of medicine at the University of California, Los Angeles.