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Abstract

Preclinical data have consistently suggested the pharmaceutical potential of kratom (Mitragyna speciosa), including as a substitute therapy in opioid dependence. In this case report, we present a case of a man with a long history of kratom use to help him cope with his opiate withdrawals while abstaining from illicit drug use. This is the first published detailed case report highlighting the potential use of kratom to aid opioid dependence encountered in the clinical setting. Our article is also supported by literature review with regards to kratom’s safety profile and pharmacological potential.

References

Brown, P. N., Lund, J. A., & Murch, S. J. (2017, April 18). A botanical, phytochemical and ethnomedicinal review of the genus Mitragyna korth: Implications for products sold as kratom. Journal of Ethnopharmacology. Elsevier. https://doi.org/10.1016/j.jep.2017.03.020

Castine, B. R., Albein-Urios, N., Lozano-Rojas, O., Martinez-Gonzalez, J. M., Hohwy, J., & Verdejo-Garcia, A. (2019). Self-awareness deficits associated with lower treatment motivation in cocaine addiction. American Journal of Drug and Alcohol Abuse, 45(1), 108–114. https://doi.org/10.1080/00952990.2018.1511725

Coe, M. A., Pillitteri, J. L., Sembower, M. A., Gerlach, K. K., & Henningfield, J. E. (2019). Kratom as a substitute for opioids: Results from an online survey. Drug and Alcohol Dependence, 202, 24–32. https://doi.org/10.1016/J.DRUGALCDEP.2019.05.005

Corkery, J. M., Streete, P., Claridge, H., Goodair, C., Papanti, D., Orsolini, L., … Hendricks, A. (2019). Characteristics of deaths associated with kratom use. Journal of Psychopharmacology, 33(9), 1102–1123. https://doi.org/10.1177/0269881119862530

de Moraes, N. V., Moretti, R. A. C., Furr, E. B., McCurdy, C. R., & Lanchote, V. L. (2009). Determination of mitragynine in rat plasma by LC-MS/MS: Application to pharmacokinetics. Journal of Chromatography B: Analytical Technologies in the Biomedical and Life Sciences, 877(24), 2593–2597. https://doi.org/10.1016/j.jchromb.2009.06.023

Diep, J., Chin, D. T., Gupta, S., Syed, F., Xiong, M., & Cheng, J. (2018). Kratom, an Emerging Drug of Abuse: A Case Report of Overdose and Management of Withdrawal. A&A Practice, 10(8), 192–194. https://doi.org/10.1213/xaa.0000000000000658

Frank, D. (2020). Methadone maintenance treatment is swapping one drug for another, and that’s why it works: Towards a treatment-based critique of the war on drugs. International Journal of Drug Policy, 83, 102844. https://doi.org/10.1016/j.drugpo.2020.102844

Haber, P. S., Elsayed, M., Espinoza, D., Lintzeris, N., Veillard, A. S., & Hallinan, R. (2017). Constipation and other common symptoms reported by women and men in methadone and buprenorphine maintenance treatment. Drug and Alcohol Dependence, 181, 132–139. https://doi.org/10.1016/j.drugalcdep.2017.09.024

Hassan, Z., Suhaimi, F. W., Ramanathan, S., Ling, K. H., Effendy, M. A., Müller, C. P., & Dringenberg, H. C. (2019). Mitragynine (Kratom) impairs spatial learning and hippocampal synaptic transmission in rats. Journal of Psychopharmacology, 33(7), 908–918. https://doi.org/10.1177/0269881119844186

Hemby, S. E., McIntosh, S., Leon, F., Cutler, S. J., & McCurdy, C. R. (2019). Abuse liability and therapeutic potential of the Mitragyna speciosa (kratom) alkaloids mitragynine and 7-hydroxymitragynine. Addiction Biology, 24(5), 874–885. https://doi.org/10.1111/adb.12639

Janchawee, B., Keawpradub, N., Chittrakarn, S., Prasettho, S., Wararatananurak, P., & Sawangjareon, K. (2007). A high-performance liquid chromatographic method for determination of mitragynine in serum and its application to a pharmacokinetic study in rats. Biomedical Chromatography, 21(2), 176–183. https://doi.org/10.1002/bmc.731

Kapoor, A., Provasi, D., & Filizola, M. (2020). Atomic-level characterization of the methadone-stabilized active conformation of μ-opioid receptor. Molecular Pharmacology, 98(4), 475–486. https://doi.org/10.1124/mol.119.119339

Kennedy, K., & Gregoire, T. K. (2009). Theories of motivation in addiction treatment: Testing the relationship of the transtheoretical model of change and self-determination theory. Journal of Social Work Practice in the Addictions, 9(2), 163–183. https://doi.org/10.1080/15332560902852052

Khalid, K., Ku Md Saad, S., Soelar, S. A., Mohamed Yusof, Z., & Warijo, O. (2021). Exploring adolescents’ practice and perspective on the use and misuse of kratom in northwest Malaysia. Journal of Ethnicity in Substance Abuse. https://doi.org/10.1080/15332640.2021.1906816

Khazaeli, A., Jerry, J. M., & Vazirian, M. (2018). Treatment of kratom withdrawal and addiction with buprenorphine. Journal of Addiction Medicine, 12(6), 493–495. https://doi.org/10.1097/ADM.0000000000000435

Kruegel, A. C., Gassaway, M. M., Kapoor, A., Váradi, A., Majumdar, S., Filizola, M., … Sames, D. (2016). Synthetic and receptor signaling explorations of the mitragyna alkaloids: Mitragynine as an atypical molecular framework for opioid receptor modulators. Journal of the American Chemical Society, 138(21), 6754–6764. https://doi.org/10.1021/jacs.6b00360

Matson, M., & Schenk, N. (2019). Fatality of 33-Year-Old Man Involving Kratom Toxicity. Journal of Forensic Sciences, 64(6), 1933–1935. https://doi.org/10.1111/1556-4029.14082

Matsumoto, K., Takayama, H., Narita, M., Nakamura, A., Suzuki, M., Suzuki, T., … Horie, S. (2008). MGM-9 [(E)-methyl 2-(3-ethyl-7a,12a-(epoxyethanoxy)-9-fluoro-1,2,3,4,6,7,12,12b-octahydro-8-methoxyindolo[2,3-a]quinolizin-2-yl)-3-methoxyacrylate], a derivative of the indole alkaloid mitragynine: A novel dual-acting μ- and κ-opioid agonist with potent a. Neuropharmacology, 55(2), 154–165. https://doi.org/10.1016/j.neuropharm.2008.05.003

Meireles, V., Rosado, T., Barroso, M., Soares, S., Gonçalves, J., Luís, Â., … Gallardo, E. (2019). Mitragyna speciosa: Clinical, Toxicological Aspects and Analysis in Biological and Non-Biological Samples. Medicines, 6(1), 35. https://doi.org/10.3390/medicines6010035

Metastasio, A., Prevete, E., Singh, D., Grundmann, O., Prozialeck, W. C., Veltri, C., … Corazza, O. (2020). Can Kratom (Mitragyna speciosa) Alleviate COVID-19 Pain? A Case Study. Frontiers in Psychiatry, 11, 1298. https://doi.org/10.3389/fpsyt.2020.594816

Palasamudram Shekar, S., Rojas, E. E., D’Angelo, C. C., Gillenwater, S. R., & Martinez Galvis, N. P. (2019). Legally lethal kratom: A herbal supplement with overdose potential. Journal of Psychoactive Drugs, 51(1), 28–30. https://doi.org/10.1080/02791072.2018.1562591

Parthasarathy, S., Ramanathan, S., Ismail, S., Adenan, M. I., Mansor, S. M., & Murugaiyah, V. (2010). Determination of mitragynine in plasma with solid-phase extraction and rapid HPLC-UV analysis, and its application to a pharmacokinetic study in rat. Analytical and Bioanalytical Chemistry, 397(5), 2023–2030. https://doi.org/10.1007/s00216-010-3707-7

Sablaban, I. M., & Gautam, M. (2020). The diagnosis of severe obsessions in the setting of kratom withdrawal and treatment with lorazepam: Case report. Journal of Addictive Diseases, 39(1), 138–139. https://doi.org/10.1080/10550887.2020.1813357

Salas-Wright, C. P., Vaughn, M. G., & Reingle González, J. M. (2017). Drug abuse and antisocial behavior : a biosocial life course approach. Springer.

Stanciu, C. N., Gnanasegaram, S. A., Ahmed, S., & Penders, T. (2019). Kratom withdrawal: A systematic review with case series. Journal of Psychoactive Drugs. Taylor & Francis. https://doi.org/10.1080/02791072.2018.1562133

Váradi, A., Marrone, G. F., Palmer, T. C., Narayan, A., Szabó, M. R., Le Rouzic, V., … Majumdar, S. (2016). Mitragynine/Corynantheidine Pseudoindoxyls As Opioid Analgesics with Mu Agonism and Delta Antagonism, Which Do Not Recruit β-Arrestin-2. Journal of Medicinal Chemistry, 59(18), 8381–8397. https://doi.org/10.1021/acs.jmedchem.6b00748

Vicknasingam, B., Chooi, W. T., Rahim, A. A., Ramachandram, D., Singh, D., Ramanathan, S., … Chawarski, M. C. (2020). Kratom and pain tolerance: a randomized, placebo-controlled, double-blind study. Yale Journal of Biology and Medicine, 93(2), 229–238. Retrieved from /pmc/articles/PMC7309661/

Wallace, M. S., & Papp, A. (2017). Opioid withdrawal. In Challenging Cases and Complication Management in Pain Medicine (pp. 15–20). StatPearls Publishing. https://doi.org/10.1007/978-3-319-60072-7_3

Weiss, S. T., & Douglas, H. E. (2021). Treatment of kratom withdrawal and dependence with buprenorphine/naloxone: A case series and systematic literature review. Journal of Addiction Medicine, 15(2), 167–172. https://doi.org/10.1097/ADM.0000000000000721

White, C. M. (2018, March 1). Pharmacologic and clinical assessment of kratom. American Journal of Health-System Pharmacy. Oxford Academic. https://doi.org/10.2146/ajhp161035

Wilson, L. L., Chakraborty, S., Eans, S. O., Cirino, T. J., Stacy, H. M., Simons, C. A., … McLaughlin, J. P. (2021). Kratom alkaloids, natural and semi-synthetic, show less physical dependence and ameliorate opioid withdrawal. Cellular and Molecular Neurobiology, 41:5, 41(5), 1131–1143. https://doi.org/10.1007/S10571-020-01034-7

Wilson, L. L., Harris, H. M., Eans, S. O., Brice-Tutt, A. C., Cirino, T. J., Stacy, H. M., … McCurdy, C. R. (2020). Lyophilized Kratom Tea as a Therapeutic Option for Opioid Dependence. Drug and Alcohol Dependence, 216, 108310. https://doi.org/10.1016/j.drugalcdep.2020.108310

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