Managing 7-Hydroxymitragynine Use Disorder with Buprenorphine-Naloxone.
Miki Kiyokawa, Alex Chun, Charlene Hsia
✦ AI-curated · Sources linked
Case in brief
A patient who had used kratom to stop illicit opioids developed tolerance and transitioned to 7-hydroxymitragynine, believing the plant-derived product was safe. She later developed tolerance to it, spending approximately $150 per day; the financial burden affected her mental health and contributed to suicidal ideation. In hospital, her withdrawal symptoms resembled opioid withdrawal. Buprenorphine-naloxone was used to manage withdrawal and the use disorder, with 40mg-10mg per day required to control cravings.
What made this case unusual
The patient developed tolerance and a substantial financial burden from a minor kratom alkaloid available for purchase online and in Hawai'i vape shops; withdrawal resembled opioid withdrawal.
Diagnostic / clinical pearl
Ask about botanical products as well as illicit substances: patients may develop tolerance and opioid-like withdrawal from 7-hydroxymitragynine.
Why it matters
The report describes successful management of 7-hydroxymitragynine withdrawal and use disorder with buprenorphine-naloxone, requiring 40mg-10mg per day to control cravings.