Kratom for Pain: Can It Fight the Opioid Epidemic?

Learn What Kratom Is, Its Effects, and More

Kratom pills
Joe Raedle/Getty Images

You may have heard about kratom when the U.S. Drug Enforcement Administration (DEA) announced their intent to place two of the herb’s active constituents on its Schedule I drug list as early as September 30, 2016. An herb also known as Mitragyna speciosa, kratom is often used to ease chronic pain and to tame cravings for opioids.

Update: The DEA withdrew its notice of intent and will open an official public comment period lasting until December 1, 2016.

Also including heroin and MDMA, Schedule I drugs are considered to have “no currently accepted medical use and a high potential for abuse.” Two alkaloid compounds called mitragynine and 7-hydroxymitragynine are the kratom constituents set to be classified as Schedule I drugs, making possession or sale of the herb illegal. Kratom would remain on the Schedule I list for at least two years.

Why Do People Use Kratom?

Sourced from a tree native to Southeast Asia, kratom has a long history of use as an herbal remedy in Asia, where it is used by manual laborers for energy and to help ease aches and pains. The herb is said to be a mild stimulant in lower doses and a sedative in higher doses.

While kratom is traditionally used mainly to boost energy or soothe stress, more and more people have started taking it to reduce pain. In many cases, kratom is used to manage chronic pain associated with conditions such as arthritis and fibromyalgia.

Kratom and Opioids: A Promising Alternative?

In recent years, kratom has gained popularity as an alternative to opioid pain medications like hydrocodone (e.g., Vicodin) and oxycodone (e.g., OxyContin). It’s also increasingly used as an herbal approach to alleviating symptoms associated with opioid withdrawal, such as muscle aches and mood disturbance.

A class of medications used for pain relief, opioids reduce the intensity of pain signals reaching the brain. They also lessen the effects of painful stimuli by influencing brain regions involved in regulating emotion.

Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled, according to the Centers for Disease Control and Prevention (CDC). During that time, the number of deaths from prescription opioids has also quadrupled. In addition, more people died from drug overdoses in 2014 than in any other year on record, with more than six out of ten of those deaths involving an opioid.

Many proponents of kratom suggest that the herb could serve as a solution to the opioid epidemic, both by offering another option for pain relief and by aiding those struggling to overcome opioid addiction.

How Does Kratom Work?

It’s thought that mitragynine and 7-hydroxymitragynine may help control pain by attaching to proteins called opioid receptors and, in turn, reducing pain perception. Opioid drugs work in a similar manner.

The Research on Kratom

So far, published research on kratom’s possible benefits as a pain reliever and opioid alternative is very scarce. The available research includes a report published in the International Journal on Drug Policy in 2010, for which scientists surveyed 136 active users of kratom and found that the herb was “described as affordable, easily available and having no serious side effects despite prolonged use.” This report included no testing of kratom’s health effects or potential hazards.

In a more recent report, published in Drug and Alcohol Dependence in 2014, researchers surveyed 293 regular kratom users and determined that more than half had developed severe dependence problems. Symptoms associated with kratom withdrawal included muscle spasms, sleep disruption, anger, and tension.

A mouse-based study published in the Journal of Medicinal Chemistry in 2016 indicates that kratom may not slow breathing to the same extent as other drugs like morphine. Given that deaths due to opioid overdose are usually the result of respiratory depression, the study's finding suggests that further research on the compounds in kratom is warranted.

Side Effects and Safety Concerns

Kratom appears to cause nausea, vomiting, sweating, and dizziness, in some cases.

From January 2010 through December 2015, U.S. poison centers received 660 calls related to kratom exposure, according to the DEA.

The DEA also states that use of kratom can lead to addiction, and that “several cases of psychosis resulting from use of kratom have been reported, where individuals addicted to kratom exhibited psychotic symptoms, including hallucinations, delusion, and confusion.”

Withdrawal symptoms, which are generally perceived to be milder in comparison to opioid drugs, have been reported, such as increased muscle spasms and pain, difficulty sleeping, hot flashes, fever, watery eyes, runny nose, decreased appetite, mood disturbances, and diarrhea.

Although case reports have reported drowsiness, irritability, palpitations, high blood pressure, poor concentration, insomnia, hypothyroidism, seizures, psychosis, hepatitis, and coma in people using kratom, it's unclear how much is solely due to kratom.

Risks appear to be higher when it's taken in concentrated extracts (which have a higher potency), mixed with other psychoactive substances, drugs, or adulterants, or when it's taken by people with alcohol use disorders, a history of heroin abuse, or certain health conditions.

The DEA notes that kratom has been associated with 30 deaths throughout the world, with none appearing to be solely due to kratom. Of the 15 alleged kratom-related deaths that occurred between 2014 and 2016, 14 involved other drugs or illegal substances. A cluster of nine fatal overdoses in Sweden were linked to a product marketed as "Krypton", which was found to be laced with O-desmethyltramadol, an opiate related to tramadol.  

You can learn more about using supplements safely, but keep in mind that herbal products aren’t reviewed by the U.S. Food and Drug Administration before they hit the market. As a result, there’s no guarantee that a supplement will contain the ingredients listed on the label (or that those ingredients will appear in the indicated amounts). Adulteration and contamination with other drugs, herbs, and substances are possible.

Kratom and the DEA Ban

The DEA’s intent to place mitragynine and 7-hydroxymitragynine on its Schedule I drug list has been met with a great deal of backlash. In mid-September, 2016, for instance, protesters held a march and rally at Lafayette Park in Washington, D.C., and presented a petition signed by over 120,000 people opposing the ban.

At the rally, Botanical Education Alliance director Travis Lowin stated that the DEA “has failed Americans in its efforts to combat the opioid epidemic, and targeting kratom will make the situation worse.”

According to those opposing the ban, placing kratom's alklaoids on the Schedule I drug list would also stifle further research on the compounds.

Final Thoughts

There aren't many herbs that are as promising as kratom to manage pain. It would be a shame to see research on this herb stifled due to a ban.

Living with pain isn't easy. If you live with pain, you may already be all too familiar with the profound effect it can have on your quality of life and ability to enjoy the things you love.

Some pain clinics are exploring complementary approaches, in conjunction with pain treatment, to manage or cope with pain. For example, mindfulness (and other mind-body practices) may help some people remain pain-controlled despite the challenges of everyday life. Chronic pain is complex, and it's a matter of finding what's right for you.


Adkins JE, Boyer EW, McCurdy CR. Mitragyna speciosa, a psychoactive tree from Southeast Asia with opioid activity. Curr Top Med Chem. 2011;11(9):1165-75.

Prozialeck WC, Jivan JK, Andurkar SV. Pharmacology of kratom: an emerging botanical agent with stimulant, analgesic and opioid-like effects. J Am Osteopath Assoc. 2012 Dec;112(12):792-9.

Singh D, Müller CP, Vicknasingam BK. Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug Alcohol Depend. 2014 Jun 1;139:132-7.

Váradi A, Marrone GF, Palmer TC, et al. Mitragynine/Corynantheidine Pseudoindoxyls As Opioid Analgesics with Mu Agonism and Delta Antagonism, Which Do Not Recruit β-Arrestin-2. J Med Chem. 2016 Sep 2.

Vicknasingam B, Narayanan S, Beng GT, Mansor SM. The informal use of ketum (Mitragyna speciosa) for opioid withdrawal in the northern states of peninsular Malaysia and implications for drug substitution therapy. Int J Drug Policy. 2010 Jul;21(4):283-8.

Disclaimer: The information contained on this site is intended for educational purposes only and is not a substitute for advice, diagnosis or treatment by a licensed physician. It is not meant to cover all possible precautions, drug interactions, circumstances or adverse effects. You should seek prompt medical care for any health issues and consult your doctor before using alternative medicine or making a change to your regimen.

Continue Reading