Moving Us Closer To Osler
A Miller Coulson Academy of Clinical Excellence Initiative

Kratom—the opioid-like herbal drug your patients may be using  


Kratom use is on the rise. It is important to ask patients about use in a nonjudgmental manner. 

I first met “G” almost seven years ago in primary care clinic when she was hospitalized after an unintentional opioid overdose. She was 60 years old and required ICU-level care. 


At the time of her overdose, she was using kratom to self-treat chronic pain from osteoarthritis of her knees and fibromyalgia, in addition to her prescribed oxycodone and tramadol. Prior to her overdose, she’d never told a doctor about her kratom use.


At our first visit, she told me she’d stopped using kratom and declined buprenorphine. We simplified her medications and focused on managing her pain safely. However, after several months of regular visits and building trust, she admitted that she’d been unable to stop using kratom due to rebound pain and withdrawal symptoms. We made the shared-decision at that time to stop all opioids (both kratom and prescribed tramadol) and switch to sublingual buprenorphine-naloxone. She experienced great improvement in her pain and continues to do well today. 


Since the early 2000s, use of kratom has been on the rise in the West. There is a growing number of poison control cases associated with it. In 2018, the FDA issued a warning on its addictive potential. Kratom won’t show up on standard drug tests and regular use can lead to physical opioid dependence and opioid use disorder.  


Here are a few things to know:


What is it? 

Kratom is an herbal drug with opioid-like properties. Used for centuries in Southeast Asia, it’s obtained from the leaves of the Mitragyna speciosa tree.  


Why do people use it? 

In the West, kratom is most commonly used as a cheaper and non-prescribed opioid replacement therapy without the need for medical supervision. It can be purchased online or from “legal high” shops as raw leaves, capsules, tablets, and concentrated extracts. People may use it as an alternative to prescription opioids or to self-treat opioid withdrawal. 


How do I know if my patient is using kratom?  

Patients may not disclose kratom use to their provider. First off, ask all patients about non-prescribed medication and herbal supplements in an open-ended and nonjudgmental way. If you just use the term “drugs” or “illegal drugs,” patients may not disclose kratom or other substance use.  


One validated tool is the NIDA Single Question Screening Test for Drug Use, “How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons (for example, because of the experience or feeling it caused)?” 


If your patient reports using kratom: 

1. Ask about quantity and frequency of use. 

2. Ask about withdrawal symptoms (typically opioid-like withdrawal syndrome). 

3. Ask about any harms from kratom use. 

4. You can use DSM-V diagnostic criteria to screen for kratom use disorder 

5. Patients with kratom dependence can be treated with buprenorphine (commonly known by brand-name Suboxone), which is life-saving medication for opioid use disorder.  











This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.