Background
Kratom is a Southeast Asian plant, which is widely used in this region, and making an increasing appearance in Europe and the US.
Case report
We present the case of a 26-year-old man in Substitol-assisted treatment of excessive Kratom and Tilidin use expressing the wish for a drug-free management of a chronic pain condition. After an accidental calcaneus impression fracture, the patient was suffering from severe chronic pain and anxiety of further accidents. This was managed initially with Tilidin. Resulting from the wish to self-manage the pain condition in a way that permitted continuation of a job, the patient searched for a ‘natural’ treatment alternative obtained from an Internet vendor. He successfully instrumentalized Kratom for 3 years with daily consumption intermixed with occasional Tilidin for pain management. However, the dose of Kratom was increased considerably up to a level of effect reversal, when no analgesic and behaviorally activating effects occurred any more, but only intense drowsiness. The patient was treatment seeking and subsequently detoxified from Kratom and Tilidin. Pain management was shifted to retarded morphine.
Conclusion
Kratom instrumentalization for pain management might appear to be more problematic for addiction development than when its use is established for other consumption motives.
important need. We recommend that health systems teaching is included in the undergraduate medical curriculum in order to prepare newly qualified physicians to find their place in shaping, leading and improving health services in the future.
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