Kratom: An Opioid-like Herbal Supplement Pediatricians Should Know About

Kratom is a legal, widely-available herbal supplement with opioid-like properties increasingly used by those with opioid dependence to self-treat opioid withdrawal. Kratom binds to opioid receptors and can induce withdrawal, dependence, and toxicity. Classification of Kratom as an opioid is controversial. The search for non-opioid alternatives for the treatment of opioid dependence has intensified in the current opioid epidemic. Kratom is heavily advertised as one such safe non-opiate alternative and has been used by pregnant women with chronic opioid use resulting in neonatal abstinence syndrome. Kratom cannot be detected on routine toxicology screening. As kratom use becomes more widespread, pediatric populations will likely be impacted and pediatricians should familiarize themselves with its pharmacology and adverse effects to appropriately counsel parents and care for kratom-exposed patients. This article reviews kratom’s pharmacology, uses, potential benefits as a therapeutic, and risks for pediatric patients.