If you have multiple sclerosis (MS), 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 MS symptoms like fatigue or mental health issues. 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.

Here is what you need to know about kratom, including what it is, how it may be helpful for MS, and its potential health risks.

What Is Kratom?

Native to Thailand, Malaysia, and other countries in Southeast Asia, kratom is an herbal extract derived from the leaves of a tropical evergreen (Mitragyna speciosa). 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 also billed a way to suppress one’s appetite.

How Does Kratom Work?

There is still some uncertainty surrounding how exactly kratom interacts with the body. What is known is that it contains two psychoactive (mind-affecting) substances called alkaloids: mitragynine and 7-hydroxymitragynine. These ingredients act on the body’s opioid receptors —part of the nervous system that cause feelings of pain relief or pleasure. Exactly how kratom triggers these receptors is currently unknown.

Studies have found that kratom can have stimulating effects when taken in low doses — increasing energy, alertness, and sociability. Higher doses of kratom, however, can have opioid-like effects, causing feelings of sedation, relaxation, pleasure, and pain-relief. Kratom generally begins to take effect five to 10 minutes after use, and its effects can last up to two to three hours.

How Could Kratom Help With MS Symptoms?

People with MS sometimes self-administer kratom to help manage three major symptoms of the condition: chronic pain, depression, and anxiety.

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. Some research also mentions the use of kratom for muscle spasms — a symptom commonly seen in MS that is referred to as spasticity. 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 pain medications. Research from 2021 indicates that about 20 percent of people with MS 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 opioid-like 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 neurologist 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 MS treatment plan.

Is Kratom Safe?

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 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 any medical use, and it’s not regulated in any way. The U.S. Drug Enforcement Administration (DEA) 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.

Potential Side Effects

Kratom’s effects can vary dramatically from person to person, depending on its strength, the amount of the drug that is taken, what form it is taken in, and a person’s unique medical history.

Research has indicated that despite the potential value kratom may offer, potential problems and side effects often outweigh any perceived health benefits.

Known physical, mental, and nervous system side effects of kratom include:

• Muscle pain
• Weight loss
• Constipation and urine changes
• Liver toxicity and damage
• Nausea and vomiting
• Chills
• Depression
• Hallucinations and delusions
• Dizziness
• Unexplained drowsiness
• Breathing suppression
• Seizure, coma, and death

Kratom also presents potential for abuse, as there is risk of kratom dependence, addiction, and withdrawal symptoms.

Purity and Concentration

The amount of active ingredients in kratom can vary greatly from plant to plant. Therefore, it can be difficult to anticipate what side effects you may experience when taking it, even if you stick to the recommended dosage on the label. One 2 gram dose, for example, may be significantly stronger than another 2 gram dose. In the United States,1,800 reports were made to poison control centers involving exposure to or use of kratom from 2011 to 2017. The outcomes included serious issues such as seizures, high blood pressure, opioid withdrawal, and even death.

Additionally, the lack of FDA regulation of kratom makes it difficult — or impossible — to determine the strength or concentration of the product’s active ingredients. Kratom products also often contain other contaminants, including bacteria and heavy metals. These ingredients may cause side effects that kratom or its active ingredients may not cause alone.

Potential Drug Interactions

If you take other medications like opioids for MS treatment or symptom management, kratom may interact with these drugs and cause further adverse effects. Some case reports have suggested that combining kratom with other substances can cause issues ranging from problems with liver function to death.

Long-Term Health Effects

More research must be done to understand the potential long-term health effects of kratom, particularly when taken in high doses. Despite its long history of use in alternative medicine, it remains an illicit drug in many countries, and researchers have not yet established the safety or efficacy of kratom in treating any medical condition, including MS.

MyMSTeam Members on Kratom

Some MyMSTeam members have reported using kratom to manage the symptoms of multiple sclerosis. As one member noted, “I did use [kratom] with success when I was out of my naltrexone,” but “like cannabis, kratom, another herbal, should be studied for its medicinal benefits.”

Another member wrote that both they and their spouse used kratom because “it works well for pain and sleep,” though they noted that the drug was not approved by the FDA for medicinal use.

Ultimately, you should first talk with your doctor before trying any new supplements or substances to manage the symptoms of MS. The short- and long-term effects of kratom are still not well understood, particularly in people with conditions like multiple sclerosis.

Find Your Team

Living with multiple sclerosis can be a challenge — but you do not have to go it alone. At MyMSTeam, you can share your story, ask questions, offer support and advice, and connect with members from around the world who understand life with MS.

Have something to add to the conversation? Share your story or thoughts in the comments below or by posting on MyMSTeam.