Cornel N. Stanciu, MD, MRO, FASAM, FAPA Assistant Professor Dartmouth’s Geisel School of Medicine Hanover, New Hampshire Director of Addiction Services New Hampshire Hospital Concord, New Hampshire
Bryan G. Hybki, MD PGY-4 Psychiatry Resident Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire
Thomas M. Penders, MS, MD Affiliate Professor East Carolina University Brody School of Medicine Attending Psychiatrist Walter B. Jones Alcohol and Drug Abuse Treatment Center Greenville, North Carolina
Acknowledgment The authors would like to acknowledge the contribution of Karen Goodman, MSLIS, MA, Medical Librarian at the Dorothy M. Breene Memorial Library, New Hampshire Hospital, who assisted with the literature search and procuration of the studies needed for this article.
Disclosures The authors report no financial relationships with any companies whose products are mentioned in this article, or with manufacturers of competing products.
Similarly, while the standard of care for treating a patient with opioid use disorder is medication-assisted treatment in combination with counseling and behavioral therapies, there is little evidence on the efficacy of such treatments for patients who use kratom. There are no specific guidelines, and the risk of relapsing to kratom use is high.48,49 Nonetheless, some clinicians have used the same protocol for patients with opioid use disorder to treat patients using kratom, and several published case reports describe this approach.50,51 Because administering buprenorphine/naltrexone to a patient who is dependent on kratom can precipitate withdrawal, clinicians should follow a similar initiation protocol as for opioid dependence when starting a patient on these agents (ie, a washout period with a challenge test would be prudent prior to starting naltrexone).
In cases of kratom overdose, naloxone has been shown to reverse the analgesic effects of mitragynine in rats. However, in a case report of an individual who accidently overdosed on a kratom product, naloxone had a modest effect.52
Bottom Line
Kratom is a botanical substance that acts like a stimulant at low doses and an opioid at higher doses. Patients might use it to treat mood-related symptoms, relieve pain, or manage opioid withdrawal. Kratom use has been associated with the development of addiction as well as a multitude of serious adverse effects, including hepatotoxicity and overdose. Long-term management may be required for a patient who uses kratom.
Related Resources
White CM. Pharmacologic and clinical assessment of kratom: an update. Am J Health Syst Pharm. 2019;76(23):1915-1925.
Smith KE, Lawson T. Prevalence and motivations for kratom use in a sample of substance users enrolled in a residential treatment program. Drug Alcohol Depend. 2017;180:340-348.
