Home Induction and Outpatient Treatment of Kratom use Disorder with Buprenorphine-Naloxone: A Case Report in a Young Adult

Abstract

Background: The use of the natural product, kratom, has increased significantly in recent years. The active compounds in kratom have been shown to produce both opioid and stimulant-like effects. While kratom is marketed as a safe, non-addictive method to treat pain and opioid withdrawal, there have been reports demonstrating that kratom is physiologically addictive and linked to overdose deaths. A limited number of case-reports are available describing treatment of kratom use disorder in middle-aged adults, generally in the context of chronic pain and in inpatient settings. Our case is unique in that we describe outpatient treatment of kratom use disorder in a young adult with comorbid attention deficit hyperactivity disorder (ADHD) and in the absence of chronic pain. Case: A 20-year-old college student with ADHD presented to an office-based opioid agonist treatment clinic (OBOT) for treatment of kratom use disorder. He was unable to attend inpatient or residential substance use treatment due to work and school obligations. Additionally, he had stopped taking his prescribed stimulant due to cardiac side effects. The OBOT team successfully initiated buprenorphine-naloxone (BUP/NAL) sublingual films via home induction to treat his kratom use disorder. The patient is being monitored monthly with plans to slowly taper his BUP/NAL dose as tolerated. Discussion: We present a case of a young adult male with kratom use disorder, complicated by a diagnosis of ADHD, successfully treated with BUP/NAL via home induction. The patient is currently kratom-free, reports improved mood and sleep patterns since initiating BUP/NAL, and is able to once again tolerate his ADHD stimulant medication. Healthcare providers should be aware of the use of kratom and consider utilizing BUP/NAL to treat dependence to this botanical drug.

Searching for a Signal: Self-Reported Kratom Dose-Effect Relationships Among a Sample of US Adults With Regular Kratom Use Histories

“…Motivations for using kratom have become the topic of numerous case reports and surveys ( Griffiths et al, 2018 ; Agapoff and Kilaru, 2019 ; Aldyab et al, 2019 ; Coe et al, 2019 ; Stanciu et al, 2019 ; Bowe and Kerr, 2020 ; Covvey et al, 2020 ; Garcia-Romeu et al, 2020 ; Schmuhl et al, 2020 ; Smith et al, 2021a ; Weiss and Douglas, 2021 ; Grundmann et al, 2022a ). Case reports, including those of kratom-associated fatalities, are insightful but provide limited detail and generalizability beyond the clinical presentation(s) described in the report ( Olsen et al, 2019 ; Post et al, 2019 ).…”

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

“…As reported in the literature, this patient self-administered kratom as a tea from supplies purchased online (Buresh, 2018) and sought support after struggling with self-detoxification as has been similarly described by Agapoff and Kilaru (2019) and Schmuhl et al. (2020).…”

“…(2020). Individuals typically dose kratom every 6–12 hours (Boyer et al., 2007): this patient often took their tea in four divided doses as reported by McWhirter and Morris (2010), though at times, this patient dosed up to once an hour and usually up to 70 g/day which is higher than noted in other case reports (Agapoff and Kilaru, 2019; Diep et al., 2018; Khazaeli et al., 2018; Schmuhl et al., 2020; Stanciu et al., 2019). She spent an estimated £400/month on kratom, which is notably less than Buresh (2018) who reported $2500/month on online purchases.…”

Pharmacology of Herbal Sexual Enhancers: A Review of Psychiatric and Neurological Adverse Effects

“…Restlessness, generalized body aches, overwhelming anxiety, thoughts of suicide, hallucinations, and withdrawal symptoms [67] Dextroamphetamine Case report of a 22-year-old male with ADHD and kratom use disorder; took kratom tea every 2 h daily (30 g at maximum dosage) for 2 years Tolerance, irritability, and withdrawal symptoms [68] Diphenhydramine Case report of a 27-year-old male with a history of ANX, ADHD, benzodiazepine, and opioid use disorders; took up to 4 × 8 mL/day bottles of kratom for 1.5 years Tonic-clonic seizures [69] Alcohol, antidepressants, benzodiazepines, cannabis, cocaine, hallucinogens, opioids (prescribed or illicit), tobacco…”