Kratom is Not Safe for Pain Management or Opioid Addiction Treatment
Kratom should be discontinued and is not recommended for use in pain management or opioid addiction treatment due to significant safety concerns and lack of clinical evidence supporting its efficacy. 1
Safety Concerns with Kratom
Kratom (Mitragyna speciosa) contains multiple alkaloids with opioid-like and stimulant properties, primarily mitragynine and 7-hydroxymitragynine, which act on mu-opioid receptors and other neurological pathways 2. Despite its increasing popularity, kratom poses several serious health risks:
- FDA Warning: The FDA has explicitly warned against kratom use 1
- Withdrawal Syndrome: Chronic use can lead to physical dependence and withdrawal symptoms similar to opioids 2
- Neurological Effects: Seizures have been reported with chronic use 2
- Hepatotoxicity: Multiple case reports document liver injury associated with kratom use 3
- Death: Fatalities have been linked to kratom, particularly when combined with other substances 2
Perioperative Considerations
The Society for Perioperative Assessment and Quality Improvement (SPAQI) explicitly states that kratom should be discontinued and does not recommend its use as a supplement 1. This recommendation is based on kratom's:
- Opioid and stimulant-like properties
- Potential for withdrawal syndrome with regular use
- Risk of neurological effects including seizures
- FDA warnings against its use
Alternatives for Pain Management
For patients seeking pain management options, several evidence-based alternatives exist:
For Neuropathic Pain:
- First-line options: Pregabalin, duloxetine, or gabapentin 1
- Second-line options: Tricyclic antidepressants like amitriptyline 1
- Topical options: Capsaicin 8% patch for patients who prefer non-oral treatments 1
For Chronic Pain:
- Non-opioid analgesics (NSAIDs, acetaminophen)
- Physical therapy and exercise
- Cognitive behavioral therapy
- Multimodal pain management approaches
Alternatives for Opioid Addiction Treatment
For patients seeking opioid addiction treatment, FDA-approved medications include:
- Buprenorphine: Partial opioid agonist with ceiling effect on respiratory depression 4
- Methadone: Full opioid agonist for maintenance therapy 1
- Naltrexone: Opioid antagonist for preventing relapse
These medications should be administered under medical supervision as part of a comprehensive treatment program that includes counseling and behavioral therapy 1.
Why Patients Turn to Kratom
Patients often turn to kratom for several reasons:
- Self-management of pain when conventional treatments fail 5
- Self-treatment of opioid withdrawal symptoms 6
- Lower cost compared to prescription medications 6
- Legal availability and easy access online 5
Important Considerations for Providers
When encountering patients using kratom:
- Screen for kratom use: Many patients may not volunteer this information
- Educate about risks: Inform patients about documented adverse effects
- Monitor liver function: Consider kratom as a potential cause of unexplained liver injury 3
- Assess for withdrawal: Patients stopping kratom may experience withdrawal symptoms requiring management
- Provide evidence-based alternatives: Direct patients toward proven treatments for pain or addiction
Conclusion
While preliminary research suggests potential applications for kratom in treating pain and substance use disorders 7, the lack of controlled clinical trials, standardized formulations, and significant safety concerns make it unsuitable for clinical use. Healthcare providers should discourage kratom use and instead guide patients toward evidence-based treatments for pain management and opioid addiction.