Kratom is a substance derived from a tropical evergreen tree native to southeast Asia that is related to the coffee tree. It has been used in traditional folk medicine there since at least the 18th century. However, over the past decade its worldwide popularity as a recreational and therapeutic drug has surged. Kratom associated toxicity has increased 10-fold in the USA in the past few years.
In February 2018, the Director of the FDA, Scott Gottlieb MD condemned its use. He cited 3 dimensional molecular studies that identified opioid and stimulant chemical activity. His concerns were for the potential for abuse, addiction and death associated with the use of kratom. He stated, “There is no evidence that kratom is safe or effective in treating any medical condition”. As of 2018 there is virtually nothing in the scientific literature supporting its utility as a medical treatment.
Kratom, via the internet and without any substantiating evidence has been cited as useful in treating chronic pain and opioid withdrawal symptoms. Anecdotal evidence does not equate with sound science; however, there is growing global use of this drug. While there is no evidence of its utility therapeutically, there is growing evidence of its dangers. The FDA to date, has associated at least 44 deaths in the USA to kratom use.
Specifically, the concern is with users combining kratom with other “brain” drugs such as opioids, benzodiazepines and loperamide. The FDA has already issued stern warnings regarding combining opioids, benzodiazepines and loperamide and these are highly studied drugs that have been in use for many years. Kratom has undergone none of this scrutiny.
A major concern is how the drug gets to the market. There exist no standards for purity, packaging and there have been some serious Salmonella infections associated with its use here in the USA. I have a patient who was drinking a kratom product sold for canine use to help him with his opioid withdrawal symptoms. (he said it did not work)
The FDA warning states: “Kratom should not be used to treat medical conditions, nor should it be used as an alternative to prescription opioids. There is no evidence that kratom is safe or effective for any medical condition. Any claims that Kratom is benign because “it is just a plant” are shortsighted and dangerous. There exist serious health threats with the use of Kratom including addiction and death.