November 18, 2025
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Key takeaways:
- Kratom is an herbal remedy derived from an evergreen tree in Southeast Asia.
- Data demonstrating the risks and benefits of kratom in rheumatology are lacking.
SAN ANTONIO — The herbal remedy known as kratom, which comes from a tree that grows primarily in Southeast Asia, has gained popularity among patients with chronic conditions despite little data supporting its use, according to a presenter.
“Its reported benefits include pain relief — it mitigates opiate withdrawal symptoms, it lifts mood and is energy boosting,” said J. Nicholas Manwaring, MSN, APRN, FNP-C, a nurse practitioner in the division of rheumatology at the Alaska Native Tribal Health Consortium, in Anchorage, and a commander in the U.S. Public Health Service Commissioned Corps at the Indian Health Service. “The caveat is that there is not a lot of research available.”
“Natural does not always mean safe,” said J. Nicholas Manwaring, MSN, APRN, FNP-C.
Speaking at the 2025 Rheumatology Nurses Society annual conference, Manwaring said kratom is an herbal extract that derives from the Mitragyna speciosa, an evergreen tree. Users will chew or eat the leaves dry, add the extract to a liquid or brew it like a tea.
Manwaring compared the substance to other medicinal treatments that originated from the natural world, including the willow bark used to make aspirin and the poppy seeds used to make opioids.
“When properly used, these things can be very helpful,” he said. “When not properly regulated, it can be a problem.”
Manwaring encouraged attendees to review research into mitragynine, the psychoactive component of the kratom plant that may or may not demonstrate the aforementioned therapeutic properties.
“It’s basically a benzo and an opiate all in one,” Manwaring said. “And we know what happens when people take benzos and opiates together.”
Highlighting this complicated profile, Manwaring noted that research into kratom’s safety and efficacy has been inconclusive.
“There are a lot of conflicting data,” Manwaring said. “There is underreporting and confounding variables about fatalities and overdoses. There are very small sample sizes with observational design. And there is a lack of randomized, controlled trials, so it is difficult to standardize the dose. The FDA has not done anything with it yet.”
Despite these concerns, many patients are using kratom for various ailments and symptoms. Manwaring said clinicians should use caution in managing patients with chronic diseases and chronic pain who may be using kratom.
“You have to ask patients if they are taking any herbal supplements,” Manwaring said. “Really, you need to be careful. Natural does not always mean safe.”
For more information:
J. Nicholas Manwaring, MSN, APRN, FNP-C, can be reached at nick.manwaring@rns-network.org.
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Sources/Disclosures
Source:
Manwaring N. Plant-Based and Problematic: Kratom’s Problematic Rise. Presented at: Rheumatology Nurses Society annual conference; Nov. 6-8, 2025, in San Antonio (hybrid meeting).
Disclosures:
Manwaring reports no relevant financial disclosures.
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