APA Guidance: Kratom Opioids Require Clinical Recognition and Dependence Treatment

Why it matters

The American Psychiatric Association published comprehensive guidance educating clinicians that kratom contains opioid compounds (mitragynine and 7-OH) requiring medical recognition and treatment. Only 19% of Americans are aware of kratom risks, but 1.6 million use it annually.

The big picture

Kratom remains widely available despite FDA and DEA concerns about opioid activity. FDA proposed restricting 7-OH products but the DEA has not acted. Kratom-related fatal overdoses have increased from 0.5% of all opioid deaths in 2016 to 2% in 2022. Mental health professionals need updated knowledge to identify and treat kratom use disorder.

Key findings

• FDA definitively classified 7-OH as an opioid; Kratom-dependent users show opioid withdrawal symptoms; Small studies show buprenorphine, methadone, and naltrexone may help kratom dependence; Kratom overdoses should be treated as opioid overdoses with naloxone; Regular kratom use leads to dependence; Long-term health hazards and optimal treatment remain under-studied

What they say

"Kratom and its opioid derivatives are widely available, with the potential for dependence and addiction. It is critical for both primary and specialty clinicians to be aware of this substance and to include it in routine substance use disorder screening." — Dr. Lief Fenno, Chair, APA Council on Addiction Psychiatry

Bottom line

**Psychiatrists should screen for kratom use during substance abuse assessments and recognize that kratom dependence requires opioid-like treatment including buprenorphine or methadone.**