Clinical evidence of opioid-like dependence, withdrawal syndromes, ICU-level care, and medication-assisted treatment associated with kratom use.
A 37‑year‑old woman developed severe opioid‑like withdrawal after 2 years of kratom extract use – high‑dose clonidine (2 mg over 36 hours) and hydroxyzine required. Weight loss, hiding use, meeting DSM‑5 criteria for substance use disorder.
Read Case →38‑year‑old escalated to 35‑42 g/day, developed tolerance, withdrawal (anxiety, abdominal pain, akathisia), and overdosed on psychiatric medications. Illustrates severe dependence and psychiatric crisis.
Read Case →Naltrexone triggered severe opioid‑like withdrawal in a daily kratom user, requiring ICU and high‑dose benzodiazepines – demonstrating physical dependence akin to classic opioids.
Read Case →Chronic user developed withdrawal (COWS 9) and required buprenorphine for symptom control. Opioid‑type dependence meeting DSM‑5 criteria.
Read Case →55‑year‑old woman developed severe withdrawal (hallucinations, fever, tachycardia, hypotension) after surgery – ICU for aspiration pneumonia. Undisclosed chronic use (5‑10g daily).
Read Case →18‑year‑old consuming 35g/day – anesthetic resistance, opioid tolerance, emergence delirium. Highlights withdrawal risk and need for multimodal pain management.
Read Case →Patient on ~90g kratom/day developed serotonin syndrome and QTc prolongation; required buprenorphine to stop kratom. Demonstrates abuse liability and MAT utility.
Read Case →A man in his 40s with 12 years of kratom use escalated to 40 g/day – tapered off successfully over 6 months using buprenorphine/naloxone. Proves opioid‑like addiction potential.
Read Case →A 44‑year‑old man developed severe anxiety, dysphoria, and insomnia during kratom withdrawal lasting months – resolved after 1 month of clomipramine. Highlights prolonged psychiatric morbidity.
Read Case →FDA Adverse Event Reporting System (FAERS) shows drug dependence (13.72%), withdrawal syndrome (8.92%), and drug abuse (12.79%) among top reactions to kratom/mitragynine. Over 1,600 total reports, 744 deaths.
View FAERS Data →2023 NPDS "Emerging Trends": 4.76% of kratom exposures coded for withdrawal; 33.5% of those seen in healthcare were admitted. 57.6% of single‑substance cases had moderate/major/fatal effect.
View Poison Center Data →38‑year‑old with AST 173, ALT 586 after chronic kratom use. Naltrexone precipitated withdrawal – need for kratom screening before MAT initiation.
Read Case →Published case reports and poison center surveillance demonstrate that kratom produces opioid‑type physical dependence and withdrawal. Symptoms include anxiety, agitation, insomnia, abdominal pain, diarrhea, myalgias, rhinorrhea, and autonomic instability (tachycardia, hypertension). Severe withdrawal has required ICU admission, high‑dose benzodiazepines, and vasopressors. Precipitated withdrawal can occur when naltrexone is administered to a kratom‑dependent individual.
Medication‑assisted treatment options successfully used include:
The need for MAT to discontinue kratom use in many cases underscores its addiction potential and supports consideration of scheduling under the Controlled Substances Act.
