Kratom: What to Know

As clinicians and patients scramble for opioid analgesic alternatives and ways to blunt opioid withdrawal, kratom (also known as mitragynine) use among desperate patients has surged. What should practitioners know?

• Kratom is not part of the usual standard test for urine screens
• At low doses, kratom blocks reuptake of norepinephrine, serotonin, and dopamine, like combinations of contemporary antidepressants do
• It inhibits or induces cytochrome enzymes so there’s a large chance of drug interactions
• As you raise the dose of kratom, it has opioid agonist properties; it’s actually a partial opioid agonist
• It’s not technically an opiate (because by definition, an opiate is a drug that’s derived from a poppy plant) but it does have opioid pharmacology and it does affect the opiate receptors, so it’s basically a naturally occurring nonopium derived opioid narcotic
• Some states have outlawed it; some countries have outlawed it
• In some states you can find it in gas stations, right next to the CBD lollipops