From the Guidelines
Kratom is not safe for use due to its potential for serious adverse effects, including opioid-like addiction and withdrawal, as well as hepatotoxicity. The use of kratom is not recommended by the Society for Perioperative Assessment and Quality Improvement (SPAQI) due to these potential risks, as stated in their 2021 consensus statement published in the Mayo Clinic Proceedings 1. According to this study, kratom has opioid agonist properties and should be tapered due to the potential for withdrawal, with the FDA warning against its use.
Some of the key concerns with kratom use include:
- Opioid-like addiction and withdrawal
- Hepatotoxicity
- Potential for serious adverse effects, such as liver damage and respiratory depression
- Unpredictable dosing due to varying potency of kratom products
- Risk of contamination with harmful substances or bacteria
Given these risks, it is recommended that kratom be discontinued if possible, especially in patients undergoing surgery or with pre-existing health conditions, as advised by the SPAQI consensus statement 1. Patients considering using kratom should consult with a healthcare provider first to discuss the potential risks and benefits, as well as alternative treatment options.
From the Research
Safety Concerns
- Kratom use has been associated with various adverse effects, including addiction, withdrawal, and toxicity 2, 3, 4, 5.
- The lack of controlled, standardized studies limits the understanding of kratom's safety and clinical utility 2.
- Kratom-related adverse drug reactions, such as seizures, respiratory depression, and coma, have been reported to the US Food and Drug Administration Adverse Event Reporting System 3.
- Kratom use has been linked to an increased risk of accidental death, with 63-fold greater than expected reports of kratom-related accidental death 3.
Mental Health Effects
- Kratom use has been found to have both positive and negative effects on mental health, including enhanced mood and relief from anxiety, as well as withdrawal symptoms and addiction 6, 4.
- Kratom may have potential as a harm reduction tool, particularly as a substitute for opioids among people who are addicted 6.
- However, kratom use disorder and opioid-like withdrawal symptoms have been reported, particularly with daily, high-dose use 4.
Toxicities and Fatalities
- Kratom use has been associated with significant toxicities, including agitation, tachycardia, drowsiness, vomiting, and confusion 5.
- Serious effects, such as seizure, withdrawal, hallucinations, respiratory depression, coma, and cardiac or respiratory arrest, have also been reported 5.
- Kratom has been listed as a cause or contributing factor in fatalities, highlighting the potential public health threat posed by its availability as an herbal supplement 5.