Opinion | Can kratom use in Oregon help with the opioid crisis?

Whether advertised on neon-lit signs in gas station windows or brought up in casual conversations, kratom is becoming increasingly prominent in Oregon. While its growth is hard to ignore, its use has, fortunately, not grown to proportions reminiscent of the opioid crisis. To that end, according to the Centers for Disease Control and Prevention, or CDC, Oregon experienced the steepest surge in Fentanyl-related deaths from 2022 to 2023 in the United States. This has led many physicians, myself included, to ask: does kratom have a role in pain management or in addressing the opioid crisis ravaging Oregon’s streets?

Discussion of kratom has infiltrated patient-physician conversations in ways I had never been taught in medical school or residency. But what exactly is kratom? Kratom is an herbal product derived from Mitragyna speciosa — a tree native to Southeast Asia with recorded use as an opioid replacement dating as far back as 1836.

In traditional medicine, kratom was used to increase efficiency or productivity in day-to-day work. Today, it is consumed in various forms, including raw plant matter in capsule or powder form, brewing the leaves for tea or liquid kratom extract. The products are abundant, with many sellers claiming they are a “modern-day miracle” that can provide varying effects, depending on the user’s intention. At low doses (approximately 1-5 grams), kratom acts as a stimulant, while at higher doses (approximately 5-15 grams), it acts more like an opioid like heroin or oxycodone, though less potent. Doses higher than 15 grams are known to be more sedating and potentially toxic.

At this point, it may seem “too good to be true” — perhaps because it is. While patients often use kratom as a last-ditch effort to manage pain or withdrawal symptoms, it lacks standardization, regulation and sufficient evidence. This, in turn, creates a more precarious situation surrounding its use. It is common for physicians to ask patients about prescription and non-prescription medications, including supplements, and frequently kratom is mentioned. However, patients often tell me how much they are using in teaspoons or tablespoons as opposed to grams, leading to unconventional dosing and a higher chance of adverse effects.

Liver toxicity, seizures, development of substance use disorders, cases of neonatal abstinence syndrome and contamination with unintended substances such as salmonella or heavy metals have been reported in the literature thus far. There is also growing controversy as to how and if kratom will be classified by the Drug Enforcement Administration, or DEA, considering its abuse potential and lack of accepted medical use. That being said, many of our most effective medications are littered with adverse effects, so where do we draw the line with kratom?

Currently, the research on kratom is sparse. Most studies focus on its mechanisms of action or rely on self-reported outcomes, which are inherently subjective and often biased by advocates of the product. The gold standard — randomized controlled trials — is conspicuously absent, leaving significant gaps in our understanding of kratom’s long-term efficacy and safety.

That being said, there are case reports and documented patterns of use in patients with opioid use disorder, or OUD, who use kratom to curb cravings for opioids and to help minimize the effects of opioid withdrawal. Further, and perhaps less anticipated by the general public, kratom has also shown benefits in mice models as a treatment model for alcohol use disorder, or AUD, and in methamphetamine use disorder, or MUD. Despite this, the evidence is simply insufficient for physicians, like myself, to recommend kratom for pain, OUD, MUD or AUD.

Meanwhile, fentanyl and other opioids continue to devastate communities in Portland and beyond. The repeal of Measure 110 has made the solution to Portland’s opioid crisis perhaps more tumultuous, and clear solutions remain elusive. Whether through increased resources, safe consumption sites or even kratom, addressing the opioid epidemic demands thoughtful, evidence-based approaches.

Until then, physicians must be able to answer patients’ questions regarding kratom while educating them on the adverse effects and eventually filling them in on the evidence behind the product once available. Ultimately, our clinical decisions should be guided by robust research — a foundation that, for kratom, has yet to be built.

Emma Fenske is a Doctor of Osteopathic Medicine in Oregon.

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This article appears in January 29, 2025.