Clinical Review in Journal for Nurse Practitioners Calls for Routine Kratom Screening, Warns of Cardiovascular and Respiratory Risks

Why it matters

With an estimated 1.9 to 5 million Americans using kratom, and most nurse practitioners receiving no formal education on the topic, this peer-reviewed clinical review fills a critical practice gap. NPs are often the first clinicians to detect kratom use disorder, and this guidance arms them with evidence-based tools to assess, treat, and educate patients.

The big picture

Kratom remains largely absent from nursing and medical school curricula despite its growing use in the U.S. The emergence of high-potency semi-synthetic 7-OH products has made clinical recognition more urgent, as patients may present with opioid-like adverse effects without having used traditional opioids. Drug-drug interactions via the CYP3A4 hepatic metabolism pathway add further complexity for clinicians managing polypharmacy patients.

Key findings

• Kratom prevalence in the U.S. is estimated at 0.7% to 6.1%, representing approximately 1.9 to 5 million people, with higher rates among those with prior substance use disorders
• Mitragynine is metabolized by the liver via CYP3A4 to 7-OH, a more potent mu-opioid receptor agonist — this conversion amplifies pharmacologic effects unpredictably
• Adverse effects include hepatotoxicity, seizures, cardiac dysrhythmias, and respiratory depression — all of which can occur even without chronic high-dose use
• NPs should incorporate kratom questions into routine substance use screening, including herbal medicine and supplement inquiries
• Regulatory status varies dramatically by state; NPs must stay current on DEA and FDA communications about kratom and 7-OH

What they say

"NPs must remain up-to-date on current scientific evidence, regulation, and interventions for patients using kratom," wrote the Florida Gulf Coast University School of Nursing authors. "Expert patient-focused care involves building proficiency in effective communication, accurate assessment, evidence-based treatment options, and multidisciplinary collaboration."

Bottom line

Kratom use is common but nearly absent from nursing education — a peer-reviewed clinical review argues that nurse practitioners must actively screen all patients for kratom and 7-OH use, understand the drug's complex pharmacology, and be prepared to manage severe adverse effects.