What is Kratom (Mitragyna speciosa)?

Kratom: Opioid-Like Plant with Significant Health Risks

Kratom should be discontinued and is not recommended for use due to its opioid-like properties and potential for serious adverse effects. 1

What is Kratom?

• Kratom (Mitragyna speciosa) is a plant native to Southeast Asia containing over 40 alkaloids, with mitragynine and 7-hydroxymitragynine being the main psychoactive compounds 2
• These compounds target opioid receptors (mu, delta, and kappa) and affect adrenergic, serotonergic, and dopaminergic pathways 2
• Kratom produces both stimulant-like effects at lower doses and sedative/opioid-like effects at higher doses 3

Medical and Recreational Uses

• Commonly used for:
  • Self-medication for chronic pain conditions 4
  • Managing opioid withdrawal symptoms 2
  • Treating anxiety and depression 5
  • Recreational purposes as a "legal high" 4
• Typical consumption involves 1-3 grams daily, often in powder form encapsulated 5
• An estimated 2.1 million US residents used kratom in 2020 4

Health Risks and Concerns

• The Society for Perioperative Assessment and Quality Improvement (SPAQI) explicitly recommends discontinuing kratom use 1
• Kratom has been associated with serious adverse effects including:
  • Liver toxicity 2
  • Seizures 2
  • Withdrawal syndrome in chronic users 2
  • Potential for physical and psychological dependence 2
  • Death (often in cases involving polysubstance use) 2, 3
• Up to 20% of US kratom users report symptoms consistent with kratom use disorder 4
• Chronic use may lead to neurologic effects including seizures 1

Perioperative Considerations

• The FDA warns against the use of kratom 1
• Patients taking more than 5-15g per day may experience withdrawal syndrome if discontinued abruptly 1
• For surgical patients, SPAQI recommends discontinuing kratom use 1
• Kratom may interact with medications through modulation of cytochrome P450, P-glycoprotein, and uridine diphosphate glucuronosyltransferase enzymes 2

Treatment for Kratom Dependence

• Kratom use disorder and opioid-like withdrawal symptoms are best treated with buprenorphine 4
• Daily, high-dose use may result in kratom use disorder requiring medical intervention 4

Regulatory Status

• In 2016, the US Drug Enforcement Administration attempted to classify kratom as a Schedule I substance but set this plan aside due to public resistance 2
• Different countries have distinctive regulations regarding kratom, with most banning its use due to addiction potential and side effects 6

Kratom presents significant health risks despite its perceived benefits for pain management and opioid withdrawal. Healthcare providers should be aware of its use among patients and discourage its consumption given the lack of standardized quality control, potential for dependence, and serious adverse effects.