Kratom: Key Information for Dental Professionals

Bill Claytor, DDS, MAGD
Executive Director, NCCDP

Kratom, derived from the leaves of a Southeast Asian tree, contains active compounds such as mitragynine and 7-hydroxymitragynine (7-OH). Although sometimes referred to informally as “legal morphine,” Kratom currently has no FDA-approved medical use in the United States. Despite this, it is widely perceived by the public as a dietary supplement. Between 2022 and 2024, U.S. use of Kratom products increased significantly—by an estimated five- to eight-fold—with current user estimates ranging from 11 to 16 million people and retail sales exceeding $2.2 billion annually.

In 2016, efforts were made to classify Kratom as a Schedule I substance, indicating high abuse potential and no accepted medical use. The American Kratom Association (AKA) urged federal agencies to postpone scheduling to allow further research. As of today, Kratom is not scheduled federally, but it remains on the DEA’s “Drugs of Concern” list due to ongoing safety questions and reports of misuse.

Relevance to Dentistry

Many dental patients may be using Kratom, and its pharmacologic effects are clinically important. As with other substances—including tobacco, alcohol, opioids, cannabis, and vaping products—providers should include Kratom in routine substance-use histories. Three essential questions can guide this conversation:

1. What substance are you using, and how is it taken? (e.g., smoking, vaping, pills, extracts)
2. How frequently do you use it? (e.g., number of times per day or per month)
3. Have you experienced any consequences related to use? (e.g., employment issues, legal problems, missed responsibilities)

Question 3 is particularly important, as reported consequences may indicate escalating use, dependence, or potential addiction.

Pharmacology and Risks

Kratom acts as a partial μ-opioid receptor agonist, which explains both its stimulant effects at low doses and opioid-like effects at higher doses. The metabolite 7-OH is especially potent—estimated to be 30–40 times stronger at opioid receptors than mitragynine—and is associated with analgesia, euphoria, respiratory depression, dependence, and withdrawal. Although commercial Kratom products should contain less than 2% 7-OH, some extracts have been found with significantly higher concentrations, raising concerns about potency and labeling accuracy.

Kratom is sometimes used by individuals attempting to self-manage opioid withdrawal or cravings. However, this practice carries risks, and withdrawal symptoms from Kratom itself have been reported. Currently, no FDA-approved treatment exists specifically for Kratom dependence, though buprenorphine (Suboxone) has shown effectiveness in reducing withdrawal symptoms in some cases.

Summary

Kratom is a widely used but incompletely understood substance with pharmacologic actions similar to prescription opioids at higher doses. While not federally scheduled, it carries documented risks of dependence and withdrawal. Because its use is increasingly common among the public, dental professionals should routinely ask patients about Kratom use, recognize its potential impact on health and treatment planning, and be aware of its possible interaction with opioid-based pain management strategies.