Self-treatment of opioid withdrawal using kratom (Mitragynia speciosa korth).
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.
Boyer
Edward W
EW
Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA. edward.boyer@childrens.harvard.edu
Babu
Kavita M
KM
Adkins
Jessica E
JE
McCurdy
Christopher R
CR
Halpern
John H
JH
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
D000701:Analgesics, Opioid; D004091:Hydromorphone