As clinicians and their patients scramble for opioid analgesic alternatives and ways to blunt opioid withdrawal, kratom (also known as mitragynine) use among desperate patients has surged. Thousands are self-treating, and clinicians are left to carry the bag of benefits vs risks of this natural substance as a single agent and combined as part of a polypharmaceutical regimen. Added to this dilemma is whether or not to include kratom with routine toxicology monitoring. Concerns around health and safety have spurred US regulatory agencies to scrutinize attributes and detrimental effects, variations among products, quality control, and adverse health outcomes. This session will focus on the history of kratom, its epidemiology, advocacy among support groups, product inconsistency among manufacturers and related dangers, pharmacology, therapeutic risks vs benefits, and dangerous drug-drug, drug-disease interactions.