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While kratom or its related compounds have not been approved by the U.S. Food and Drug Administration as safe and effective for any medical use, people report using kratom products to alleviate drug withdrawal symptoms and cravings (particularly for opioids), to alleviate pain and to help manage mental health problems.3,4,11,12,13,14,15,16 (See Why do people use kratom?) NIDA is particularly interested in studying how kratom use may impact opioid use, which continues to drive the drug overdose epidemic in the United States.
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People typically use kratom by swallowing raw plant matter in capsule or powder form, mixing kratom powder into food or drinks, brewing the leaves as a tea, or taking liquid kratom extract.1 People who use kratom report both stimulant-like effects (increased energy, alertness and rapid heart rate) and effects that are similar to opioids and sedatives (relaxation, pain relief and confusion).10,17 Studies and case reports have also indicated rare adverse effects may be associated with kratom or individual kratom compounds.1,9 (See How does kratom affect the body?; Is kratom safe?)
Anthropologists report that kratom has been used in Southeast Asia for hundreds of years as a multi-purpose remedy in traditional medicine, to increase alertness and energy while working and during social gatherings.18 While estimates of the scope of kratom use in the United States vary,19 the expansion of kratom vendors and increasing case reports suggest kratom use has become more common over the past two decades.20
Researchers are still learning how kratom and kratom compounds affect the body, as well as how short- and long-term kratom use may impact health. While evidence is quickly evolving, early studies have revealed important information about how the drug works.
Kratom leaves contain many chemical compounds (known as bioactive alkaloids) that influence the body. The most well-studied kratom-related compounds are mitragynine and 7-hydroxymitragynine. Mitragynine is found in kratom leaves and breaks down into 7-hydroxymitragynine in the body when digested.22, 27 Both activate mu-opioid receptors (specific molecular structures on the surface of nerve cells), but the resulting effects only partially compare to those of opioids like heroin or oxycodone.28
To help inform kratom policy and health decision-making around kratom use, NIDA conducts and supports research on how kratom compounds work in the brain, as well as research on kratom use patterns, health effects, therapeutic uses and drug interactions. Because many people who use kratom also report using or previously using opioids and experiencing opioid use disorder, 2, 3 NIDA is particularly interested in studying how kratom use may impact opioid use, which has driven the drug overdose epidemic in the United States. Early studies have found that some people report using kratom to ease craving and withdrawal symptoms associated with other substances, including opioids and stimulants.5, 11, 13, 14, 15, 16
NIDA and the NIH HEAL (Helping to End Addiction Long-termSM) Initiative are supporting several studies evaluating kratom and related compounds as potential treatments for chronic pain and for opioid withdrawal and opioid use disorder. One of these projects (also supported by the National Center for Advancing Translational Sciences and National Institute of Neurological Disorders and Stroke) includes efforts to help develop new medications, including kratom-derived products, as potential treatments for opioid use disorder.
NIDA also supports preclinical research to better understand how multiple kratom compounds produce complex pharmacological and behavioral effects, to evaluate kratom as a potential therapy for opioid use disorder and to investigate the chemistry and biology of kratom-derived compounds for their use as therapeutic drugs and as research tools. (See Could kratom be used as medicine?)
Among people aged 12 or older in 2021, an estimated 0.6% (or about 1.7 million people) reported using kratom in the past 12 months (2021 DT 8.22).*Source: 2021 National Survey on Drug Use and Health*
*The COVID-19 pandemic had an impact on data collection for the 2021 National Survey on Drug Use and Health (NSDUH). For more information, please see the 2021 NSDUH Frequently Asked Questions from the Substance Abuse and Mental Health Services Administration.
NIDA conducts and supports research to better understand the diverse reasons people use kratom.3 Kratom has been used in its native Southeast Asia for centuries to produce opioid- and stimulant-like effects, including increased energy and relaxation.18 (See How does kratom affect the body?)
In recent years, studies suggest people across the globe use kratom for these and many other reasons.1, 3, 4 Researchers have found that people report using kratom to alleviate pain, to address symptoms of mental health conditions like anxiety and depression, to help stop or reduce opioid or other substance use and to manage withdrawal symptoms and cravings related to opioids and other drugs. Most report multiple reasons for using kratom.3, 11, 32
While research is underway to explore possible therapeutic benefits (see Could kratom be used as medicine?), kratom products have not been demonstrated to be safe and effective for any medical condition. Of note, safe and effective medications are approved to help control withdrawal symptoms and cravings associated with opioid use disorder, as well as other substance use disorders. Learn more about pain treatment from the NIH Pain Consortium and about mental health treatment from the National Institute of Mental Health.
U.S. and international agencies have expressed concern that kratom products may cause serious harm.1 There are no uses for kratom approved by the U.S. Food and Drug Administration (FDA), and the FDA has warned consumers not to use kratom products because of potential adverse effects.
The FDA, the U.S. Centers for Disease Control and Prevention and NIDA support and conduct research to measure and better understand the short- and long-term safety risks of kratom use and inform policy around kratom regulation.
Very little research is available on kratom use before, during and after pregnancy. A 2021 report suggests that many cases of kratom use during pregnancy likely also involve the use of other substances, and the effects of kratom alone on pregnancy are difficult to determine without further research. The same report identified at least five cases of opioid-like neonatal abstinence syndrome in infants born to women who regularly used kratom but not opioids. The infants in these cases all responded well to standard treatments given to infants experiencing neonatal abstinence syndrome related to opioids.37
Studies suggest people may experience mild to moderate withdrawal symptoms when they stop regular kratom use,41, 42 but more research is needed to understand to what extent people develop substance use disorder symptoms related to kratom.1, 3, 9
Preliminary data from anonymous surveys of people who use kratom suggest a minority of people report experiencing kratom-related withdrawal symptoms and a smaller minority report experiencing substance use disorder symptoms related to kratom use.3
NIDA and other institutes at NIH support and conduct research to evaluate potential medicinal uses for kratom and kratom compounds. While kratom has not been proven safe or effective for any medical purpose, kratom has been used in traditional medicine in some countries,1, 18 and many people who use kratom report doing so to self-medicate for pain, anxiety, depression, substance use disorders and substance withdrawal.1, 3, 11 Studies in animal models suggest kratom and related compounds potentially have other therapeutic properties, such as antidepressant and pain-relieving properties, that may warrant further study.1, 48
Of particular interest to NIDA, early studies suggest kratom and kratom compounds warrant further study as experimental treatments for substance use disorders, specifically opioid use disorder.9, 48 Such treatments are urgently needed to help curb the drug overdose epidemic in the United States. NIDA and its partners conduct and support research evaluating kratom and related compounds as potential treatments for chronic pain and for opioid withdrawal and opioid use disorder. Learn more: How is NIDA advancing research on kratom?
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