Journal
ADDICTION
Volume 103, Issue 6, Pages 1048-1050Publisher
WILEY
DOI: 10.1111/j.1360-0443.2008.02209.x
Keywords
dependence; kratom; molecular screening; opioid; opioid replacement; withdrawal
Categories
Funding
- NCRR NIH HHS [P20 RR021929, P20RR021929] Funding Source: Medline
- NIDA NIH HHS [R21 DA022677, R21 DA014929, DA014929, DA022677] Funding Source: Medline
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Background Kratom (Mitragynia speciosa korth) is recognized increasingly as a remedy for opioid withdrawal by individuals who self-treat chronic pain. Case description 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. Conclusion 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.
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