February 5, 2021

"Herbal Alternative?"

In recent years, some people have been turning to kratom in an attempt to control withdrawal symptoms and cravings caused by addiction to opioids and other substances. Some companies market kratom products as a “natural substitute for opium,” but are now receiving warning letters from the Federal Drug Administration (FDA) for making unsubstantiated claims. Seeking a natural or alternative treatment to pharmaceuticals may be of interest to some people with restless legs syndrome, but there is no scientific evidence that kratom is an effective or safe alternative treatment.

The ongoing debate regarding the risks and benefits of kratom centers around reports of its stimulating effects, increased alertness, physical energy, and talkativeness at low doses, as well as its supposed sedative effects at high doses. The chemical substances, mitragynine and 7-a- hydroxymitragynine, found in the kratom leaf, interact with opioid receptors in the brain, causing sedation, pleasure and decreased pain when consumed in large amounts. Instances of psychosis with symptoms of hallucinations, delusions and confusion have also been reported. Because kratom acts on the brain in ways that are like the effects of morphine, it exposes users to the risks of addiction, abuse and dependence, according to the FDA.

Kratom – a tropical tree native to Southeast Asia – may appeal to those who are seeking an herbal alternative to traditional medical treatment. Opium is similarly considered as an “herbal” product since it is made from poppy flowers. The leaf of a kratom tree is usually chewed, brewed or crushed into powder. In the US, kratom tends to be sold in a processed form (e.g., pills, capsules or extracts). However, there is no uniformity of strength, and similar mg doses from different sources may contain vastly different amounts of active drug, making it difficult to know how much a person is actually taking.

Also, processed kratom is not regulated by the FDA and may contain other harmful substances. In 2019, the FDA conducted laboratory testing of 30 different kratom products from a variety of sources and found significant levels of lead and nickel at concentrations that exceed safe exposure for oral, daily drug intake. Long-term use could lead to heavy metal poisoning, including nervous system or kidney damage, anemia, high blood pressure and/or increased risk of certain cancers.

Although kratom remains a legal substance, it is not legally marketed in the US as a drug or dietary supplement. The FDA warns the public not to use kratom, and the Drug Enforcement Administration (DEA) has listed kratom as a Drug and Chemical of Concern. Some of the negative side effects as reported by the DEA include nausea, itching, sweating, dry mouth, constipation, increased urination, tachycardia (increased heart rate), vomiting, drowsiness and loss of appetite. Former FDA Commissioner, Scott Gottlieb, stated, “at a time when we face an opioid epidemic of devastating proportions, manufacturers should not be allowed to mislead consumers into believing kratom products are a ‘safe’ alternative to prescription opioids.” Using products with unproven claims may prevent those addicted to opioids from seeking safer, more effective treatments, such as methadone and buprenorphine. The FDA prioritizes reducing the rate of Americans who are addicted to opioids by promoting more widespread innovation and access to opioid addiction treatments, continues to warn against the use of kratom and encourages more research to better understand kratom’s safety profile and long-term health effects.

If you are considering kratom and are experiencing any change in RLS symptoms or are thinking about pursuing any new treatment or supplement, consult with your doctor prior to initiating a change to your current treatment plan.

This article has been reviewed and approved by the RLS Foundation Scientific and Medical Advisory Board. This is offered for information purposes only and should not be considered a substitute for the advice of a healthcare provider. The RLS Foundation does not endorse or sponsor any products or services.