Can kratom be used to reduce harm from opiates?

Kratom Should Not Be Used as a Harm Reduction Strategy for Opiates

Kratom is not recommended as a harm reduction strategy for opiates due to its own significant risks, including addiction potential, adverse effects, and lack of FDA approval or clinical trial evidence supporting this use. 1

What is Kratom?

• Kratom (Mitragyna speciosa) contains over 40 alkaloids, with mitragynine and 7-hydroxymitragynine being the main psychoactive compounds that act on opioid receptors 2
• It has opioid-like and stimulant properties, affecting mu, delta, and kappa opioid receptors as well as adrenergic, serotonergic, and dopaminergic pathways 2
• Some users report using kratom for pain relief (48%), anxiety/depression (22%), energy/focus (10%), and to reduce opioid use or relieve withdrawal (10%) 3

Safety Concerns

• The Society for Perioperative Assessment and Quality Improvement (SPAQI) explicitly recommends discontinuing kratom use and warns against its use due to potential serious adverse effects 1
• Kratom has been associated with physical and psychological dependence, with some individuals experiencing classic opioid withdrawal symptoms upon cessation 2
• Serious adverse effects linked to kratom include liver toxicity, seizures, and death 2
• Kratom may interact with other medications through modulation of cytochrome P450, P-glycoprotein, and uridine diphosphate glucuronosyltransferase enzymes 2
• There are numerous cases where individuals have been unable to stop using kratom, indicating its addictive potential 4, 5

Lack of Clinical Evidence

• There are no published human pharmacologic, pharmacokinetic, or drug interaction studies on kratom that would allow full understanding of its therapeutic potential and risks 4
• No controlled human clinical trials have been conducted to establish kratom's safety and efficacy as an opioid substitute 6
• The FDA has issued public health warnings about kratom and maintains there is no evidence to indicate it is safe or effective for any medical use 6
• Existing animal studies show heterogeneous methodology and findings, with concerns about interspecies variability and human translatability 6

Opioid Management Recommendations

Instead of kratom, evidence-based approaches for opioid management include:

• Multimodal pain management strategies to reduce opioid use, including acetaminophen, NSAIDs, and gabapentinoids when not contraindicated 1
• Nonopioid therapies are preferred for chronic pain due to opioids' small short-term benefits, uncertain long-term benefits, and potential for serious harms 1
• For those with opioid dependence, FDA-approved medications like methadone and buprenorphine should be considered rather than unregulated alternatives 2
• Opioid stewardship programs within healthcare institutions to minimize risk of opioid-related harm 1

Conclusion

While some users report benefits from kratom for pain management and opioid withdrawal, the lack of clinical trials, significant safety concerns, and explicit warnings from medical societies make it impossible to recommend kratom as a harm reduction strategy for opiates. Healthcare providers should instead focus on evidence-based approaches for pain management and opioid use disorder treatment.