Buprenorphine for the management of kratom dependency during covid-19: A case report

Abstract

We describe a case report where buprenorphine was successfully used for the management of kratom ( Mitragyna speciosa) dependency during the Covid-19 pandemic in a specialist community substance misuse treatment service. The individual had a notable iatrogenic dependency on oral over the counter and prescribed opioid medication. She resorted to using kratom as a ‘tea’ to self-detoxify before getting into difficulty. Upon presentation, she disclosed using kratom up to 70 g/day with hourly dosing, in addition to co-codamol (8 mg codeine/500 mg paracetamol tablets) three times a week. Initiation of oral buprenorphine sublingual tablets was complicated due to Covid-19: dispensing arrangements were liberalised from the outset and the dose was incrementally increased, eventually to 24 mg/day. Comorbidities included mental health conditions and chronic pain which improved with buprenorphine treatment and psychotherapy. Further research is required to determine optimal regimens for the management of kratom dependency. This case study adds to the current paucity of published data regarding how to manage such cases in the community setting, which is important since kratom is thought to be increasingly used in the western world.

‘It's a horrible situation for everyone’: The impact of over the counter and prescription medication misuse on friends and family

“…Thematic analysis was used for the associated qualitative data. All researchers were suitably experienced in qualitative analyses and have a particular interest in this area of research and have previously published on the topic of OTC/POM misuse (Gittins and Cole, 2021; Gittins et al, 2022a; Gittins et al, 2022b; Gittins et al ., 2022c). The lead researcher (RG) who is a female pharmacist and was previously unknown to the participants conducted the interviews and checked the transcripts to ensure completeness and anonymity; any contradictions to the key conclusions; any observations such as changes in intonation; and coded the data.…”

The use of opioid in treating a patient with kratom use disorder: A case report

“…Recent case studies on the use of buprenorphine/naloxone (suboxone) to treat kratom withdrawal or overdose have been reported [4,5]. Mitragynine and 7-hydroxy-mitragynine, the two main active alkaloids in kratom have been demonstrated to be μ-opioid receptors agonists.…”

Misuse of Over the Counter and Prescription Only Medication by Adults Accessing Specialist Treatment Services in the UK: A Narrative Synthesis

“… 19 Misuse occurs for a variety of reasons, including for desired psychoactive effects or manage side-effects of recreational drug use, to self-medicate for withdrawal symptoms, psychiatric conditions and unmanaged pain disorders. 20 - 24 …”

“…19 Misuse occurs for a variety of reasons, including for desired psychoactive effects or manage sideeffects of recreational drug use, to self-medicate for withdrawal symptoms, psychiatric conditions and unmanaged pain disorders. [20][21][22][23][24] Although the issue is thought to be increasing, due to an absence of a coordinated approach to national data monitoring regarding OTC/POM misuse, actual UK prevalence is unknown. 25 Relevant data may be obtained using a multitude of different approaches, though each has their own strengths and limitations.…”