Kratom 2025: Bench to Bedside

Kratom, a drug sold at U.S. gas stations and on the internet, has serious dose-related safety risks and has caused deaths. Kratom alkaloids differ from heroin as they have opioid plus serotonergic, adrenergic, and other effects. Emergency room presentation for OUD is increasing as are reports of kratom associated with polydrug or fentanyl deaths. Physicians, health care providers as well as consumers are not well informed as Kratom is not regulated by the FDA. Scientists are trying to separate the constituents of Mitragyna speciosa Korth leaves to find new medicines. Compared to other options available on the street, kratom is gaining traction. Kratom tea has few adverse effects and low risk of overdose, but kratom extracts in tablets, capsules, liquid shots, or gummies markedly escalate risks. Kratom appears to have a use as a tea or in low-dose leaf use for pain and as a transition from opioid use to opioid use disorders treatment, but labeling and legislation are necessary to protect consumers. Kratom may have other uses in Psychiatry, including treatment for anxiety. One underappreciated but important area is pain medication development, and kratom and its active ingredients may be a new answer. Researchers are trying to identify the most critical psychoactive chemicals in the plant to develop novel medicines with increased efficacy and safety.

Learner Objectives
After participating in this educational activity, the participant should be better able to effectively:
• Identify the historical and indigenous uses of Kratom in pain , sleep, and opioid replacement in disorders.
• Describe the current users of Kratom in the USA and the routes of administration, doses and forms available to consumers.
• Discuss the problematic user, form-routes-doses, and what are the common presentations in the emergency room, addiction clinics and pain practices.
• Suggest legislative solutions to enhance safety, preserve safe leaf use, and the Kratom users conundrum.
• Describe advice for health providers that could be given to patients who use kratom and how to ask patients about use of kratom.

Predicted Outcomes
Predicted changes in practice as a result of participating in this activity may include the improved ability to:
• Develop a strategy to assist patients and their loved ones understand the current use or Kratom, risks and potential.
• Develop a plan to take a history and discover use, attribute the use to a chief complaint and reduce harms.
• Increase competence in recognizing research and evidence-based prohibitions to use and caveats to users.