Self‐treatment of opioid withdrawal using kratom (<i>Mitragynia speciosa korth</i>)

TLDR

Kratom is increasingly used by individuals to self‑treat opioid withdrawal and chronic pain, with its main alkaloid mitragynine binding mu‑ and kappa‑opioid receptors and other receptors that may enhance withdrawal mitigation, yet its clinical pharmacology, toxicology, and natural history remain poorly understood. The authors performed high‑throughput molecular screening to determine mitragynine’s binding affinity at mu, delta, and kappa opioid receptors. In a case of self‑treatment, the patient experienced a tonic‑clonic seizure when kratom was combined with modafinil, reported only modest abstinence after stopping kratom, and the ingested plant was confirmed as pure kratom with no contaminants.

Abstract

Kratom (Mitragynia speciosa korth) is recognized increasingly as a remedy for opioid withdrawal by individuals who self-treat chronic pain.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.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.