If you have rheumatoid arthritis (RA), you may have heard about kratom — an herbal supplement touted as a natural way to increase energy, enhance mood, relieve pain, treat opioid withdrawal, and more.
At first glance, kratom may sound like a natural way to help manage rheumatoid arthritis symptoms like fatigue or mental health issues that can occur with traditional RA treatments. However, researchers still have much more to learn about the substance’s potential short- and long-term health effects. Some research has shown that kratom can have negative side effects, including seizures, high blood pressure, withdrawal symptoms, and even death.
Do not try kratom or other supplements without first consulting a doctor. There are several known safety issues associated with kratom use, and U.S. and international agencies have noted that kratom may cause serious harm.
Importantly, there are no large-scale scientific studies that have found kratom to be effective or safe for people with RA or in combination with disease-modifying antirheumatic drug (DMARD) therapy.
Here is what you need to know about kratom, including what it is, how some people believe it can be helpful for RA, and its potential health risks.
Native to the Philippines, New Guinea, and parts of Southeast Asia like Malaysia and Thailand, kratom is an herbal extract derived from a species of tree called the Mitragyna speciosa. It can be used in various ways depending on its form.
Dried kratom and whole kratom leaves can be chewed, brewed, or swallowed to feel its effects. The extract can be made into a liquid that is often marketed to treat or stop muscle pain, cramps, diarrhea, and panic attacks. It’s also sometimes billed as an appetite suppressant.
While kratom’s exact interactions with the body remain unknown, it has been shown to reduce pain by blocking signals from the brain before they can be transmitted. The drug contains two psychoactive (mind-affecting) substances called alkaloids: mitragynine and 7-hydroxymitragynine. Though kratom is not an opiate itself, these ingredients act on the body’s opioid receptors — parts of the nervous system that cause feelings of pain relief or pleasure. Exactly how kratom triggers these receptors is currently unknown.
How kratom affects a person depends on the dose they take. Studies have found that low doses can have a stimulating effect, increasing energy, alertness, and sociability. Higher doses of kratom, meanwhile, can produce opioidlike side effects and can act as a sedative, leaving users feeling relaxed, tired, and quieter than usual.
Significantly high doses can reduce chronic pain and induce euphoria. Regardless of dose, users tend to feel the effects of kratom five to 10 minutes after use, and its effects can last for about two to three hours.
In a survey of 2,700 kratom users in the U.S. — conducted by Johns Hopkins Medicine — 91 percent of respondents reported using kratom for pain relief (particularly in the back, knees, and shoulders). Additionally, 67 percent reported taking kratom to help alleviate anxiety, and 65 percent said they used it to manage depression.
In line with this survey, much of the research on self-reported kratom ingestion mentions taking the drug to ease pain. Animal studies have also suggested that the mitragynine in kratom may reduce anxiety by lowering the levels of stress hormones in the body.
Some people try kratom as an alternative to opioid painkillers. Research from 2019 indicates that up to 40 percent of people with RA take opioid-based drugs. Although opioids can be effective in managing pain, they pose a risk of addiction and, if abused, can be fatal. Kratom can have opioidlike effects when used and may be safer, in some regards, than opioids — one review assessed the risk of overdose death from opioids to be more than 1,000 times greater than the risk of death from kratom.
Although kratom may pose a lower risk of death compared to opioid misuse, do not take it without first consulting your rheumatologist or health care team. Your doctor is best suited to evaluate the overall safety of the drug and its potential impacts on your health and your RA treatment plan.
It’s important to note that just because a substance may be marketed as a natural alternative supplement doesn’t mean it’s safe. The U.S. Dietary Supplement Health and Education Act of 1994 requires manufacturers of dietary supplements sold in the United States to verify the safety of a product prior to marketing.
However, unlike medications, supplements such as kratom do not require approval from the U.S. Food and Drug Administration (FDA) to determine safety and effectiveness before being marketed. Furthermore, in order to restrict or remove a supplement from the market, the FDA must first provide evidence proving that a product is unsafe, essentially taking a reactive rather than proactive approach to supplement safety.
At present, the FDA has not approved kratom for medical use, and it’s not regulated in any way. The U.S. Drug Enforcement Administration lists kratom as a drug of concern, meaning it has the potential to be abused. The National Institute on Drug Abuse has conducted studies on the safety and efficacy of kratom and found reports of rare but serious side effects — including cardiovascular, respiratory, psychiatric, and gastrointestinal issues.
Side effects of kratom can vary drastically depending on a variety of factors, including the person taking the drug and their medical history, the strength and dose of the kratom taken, and the form of consumption. Potential mental, physical, and nervous system issues from kratom can include:
Kratom also presents the potential for abuse, including kratom dependence, addiction, and withdrawal symptoms.
Kratom’s side effects can vary based not just on the amount of the drug taken but also on its strength. This can be difficult to measure, as the amount of active ingredients in kratom varies significantly from plant to plant, making dosage more of an educated guess than a strict guideline. A 2-gram dose from a single kratom plant may be significantly stronger or weaker than a dose of the same size from a different plant.
The lack of FDA regulation makes accurately dosing kratom even more difficult, as those taking the supplement will have virtually no way of knowing the strength or concentration of their kratom’s active ingredients.
Without proper dosing or regulation, kratom can lead to a host of complications. According to Mayo Clinic, 1,800 reports were made to poison control centers in the U.S. from 2011 through 2017 involving exposure to or use of kratom. The resulting outcomes included serious health issues, including high blood pressure, opioid withdrawal symptoms, seizures, and even death. Lack of kratom regulation also increases the risk of drug contamination, with kratom products often containing contaminants like heavy metals and bacteria, which can cause additional side effects and health issues.
While some countries still use kratom as a form of alternative medicine, there is little evidence to prove whether kratom has long-term positive or negative health effects on users. More research is necessary to determine the greater impact of kratom use.
Some myRAteam members have said that using kratom has significantly improved their quality of life with RA. One encouraged another user to try kratom tea, saying, “It works wonders. I have been suffering for 21 years. Now, I take Cimzia, marijuana, and kratom, and I am finally getting the pain relief I need.” Another wrote of their experience, “I feel great on days I take my kratom, but on off days, it is rough.”
Others have used kratom for its arthritis pain-relieving effects, and some expressed wariness of its potential risks. As one member shared, “I have tried it. It does work for a few hours and definitely enhances the mood. But ... I am scared, too. I won’t take it more than twice a week, as I am afraid of addiction. Sometimes it can make me a bit nauseous and can constipate me, but not badly. Overall, though, a definite positive. Especially for the pain.”
Another member warned others away from kratom: “I tried it about a year ago. The first week was OK, then the second week, I needed more. It seemed very addictive. All it did was get me high and mask the pain. I decided I didn’t want to go through life stoned all the time and slobbering on myself. I stopped taking it. Traditional meds take the pain away, not mask it. Things like kratom don’t slow down the damage to your bones and internal organs. I suggest sticking to traditional meds.”
Living with rheumatoid arthritis can be a challenge — but you do not have to go it alone. On myRAteam, you can share your story, ask questions, offer support and advice, and connect with members from around the world who understand life with RA.
Have something to add to the conversation? Share your story or thoughts in the comments below or by posting on myRAteam.