title: Self-treatment of opioid withdrawal using kratom (Mitragynia speciosa korth).
abstract: BACKGROUND
  Kratom (Mitragynia speciosa korth) is recognized increasingly as a remedy for opioid withdrawal by individuals who self-treat chronic pain.
  
  
  METHODS
  A patient who had abruptly ceased injection hydromorphone abuse self-managed opioid withdrawal and chronic pain using kratom. After co-administering the herb with modafinil he experienced a tonic-clonic seizure, but he reported only modest abstinence once kratom administration stopped. We confirmed the identity of the plant matter he ingested as kratom and identified no contaminants or adulterants. We also conducted high-throughput molecular screening and the binding affinity at mu, delta and kappa receptors of mitragynine.
  
  
  CONCLUSIONS
  We report the self-treatment of chronic pain and opioid withdrawal with kratom. The predominant alkaloid of kratom, mitragynine, binds mu- and kappa-opioid receptors, but has additional receptor affinities that might augment its effectiveness at mitigating opioid withdrawal. The natural history of kratom use, including its clinical pharmacology and toxicology, are poorly understood.
authors.affiliation: Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA. edward.boyer@childrens.harvard.edu
authors.forename: Edward W
authors.initials: EW
authors.lastname: Boyer
authors.forename: Kavita M
authors.initials: KM
authors.lastname: Babu
authors.forename: Jessica E
authors.initials: JE
authors.lastname: Adkins
authors.forename: Christopher R
authors.initials: CR
authors.lastname: McCurdy
authors.forename: John H
authors.initials: JH
authors.lastname: Halpern
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D006801:Humans; D004091:Hydromorphone / Q000009:adverse effects*; D008297:Male; D032065:Mitragyna / Q000187:drug effects*; D008517:Phytotherapy; D012651:Self Medication / Q000523:psychology; D013375:Substance Withdrawal Syndrome / Q000534:rehabilitation*; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D004091:Hydromorphone