Given the choice to be in chronic pain or not, the most likely choice is no pain. And that choice has fueled the opioid addiction crisis with more than 64,000 Americans died from opioid overdoses in 2016 alone.

Opioid drugs have been used around the world to manage pain from a wide variety of conditions such as surgery recovery chronic disease and war injuries. Over the years, these drugs have been used for a variety of medical conditions and have been abused for recreational purposes.

Like opium, morphine and heroin, opioid drugs are well known to be addictive whether they are used medically or recreationally. Consequently, people are searching for alternatives.

A relatively new dietary supplement has shown up that has its own benefits and risks. This became vividly clear with a recent Food and Drug Administration (FDA) mandatory recall of the supplement called kratom.

QUESTION: What is kratom and are there downsides?

ANSWER: Kratom is a plant (Mitragyna speciosa) originating from parts of south-east Asia and contains opioids known to provide mild pain relief.

Compared to other opioid painkillers, kratom is touted as being relatively safe. However, the increase in kratom rehab centers throughout the U.S. and the 44 kratom-related deaths clearly contradict claims of safety. Some of the health issues related to overuse of kratom include liver damage, psychological problems, seizures, rapid heart rate, insomnia, vomiting and death.

For those addicted to kratom, withdrawal side effects include many of the overdose symptoms along with muscle pain, anxiousness and depression.

Presently the FDA is reviewing scientific and medical evidence to see if kratom should be listed as a Schedule 1 Controlled Substance. Others are encouraging more research on kratom to better identify its potential benefits and risks as a useful drug.

Q: What is an FDA mandatory recall and how does it differ from other FDA recalls?

A: Generally, when FDA notifies a company that a product has a safety problem, the company immediately issues a voluntary recall notice.

An FDA mandatory recall occurs when a company ignores the FDA notice, and the product is adulterated in a way that could cause serious health problems or even death.

Q: Why did FDA issue a mandatory recall of kratom-containing products?

A: Although there have been kratom-related deaths, the FDA issued this first mandatory recall because 26 Triangle Pharmanaturals kratom products were contaminated with salmonella and the company did not issue a voluntary recall nor stop production.

This bacteria causes diarrhea, fever and abdominal cramps, and can cause hospitalization and death.

If you have any of these supplements in your home, discard them immediately and make sure to wash your hands and anything else that may have come in contact with these products.

Alan Titchenal, Ph.D., C.N.S., and Joannie Dobbs, Ph.D., C.N.S., are nutritionists in the Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa. Dobbs also works with University Health Services.