From the Guidelines
Suboxone (buprenorphine) can be used to manage kratom withdrawal symptoms, though this is considered an off-label use, and its effectiveness is based on buprenorphine's partial opioid agonist properties, which provide enough receptor activation to prevent withdrawal while limiting euphoric effects, as seen in the treatment of opioid withdrawal 1. When considering the use of Suboxone for kratom withdrawal, it's essential to understand that kratom affects the same opioid receptors as other opioids, and thus, the principles of managing opioid withdrawal can be applied, including the use of buprenorphine or methadone to alleviate withdrawal symptoms, as noted in the clinical policy for opioids in adult patients presenting to the emergency department 1. Key points to consider in the management of kratom withdrawal with Suboxone include:
- Starting with a low dose of Suboxone, typically 2-4mg, when withdrawal symptoms begin, and adjusting the dose as needed, usually within the range of 4-16mg daily.
- The treatment should be undertaken under medical supervision due to the potential for Suboxone itself to cause dependence.
- A gradual taper over 1-4 weeks may be necessary, depending on the severity of kratom dependence.
- Complementary approaches such as therapy, support groups, and lifestyle modifications should accompany medication management for the best outcomes. It's crucial for patients to be honest with healthcare providers about their kratom use to ensure appropriate treatment, given that the management of kratom withdrawal with Suboxone is an off-label use and may require individualized care plans, as there is no nationwide standard protocol for treating opioid withdrawal in the ED with buprenorphine, but rather institution-specific treatment plans 1.
From the Research
Suboxone for Kratom Withdrawal
- Suboxone, which contains buprenorphine, has been studied as a potential treatment for kratom withdrawal symptoms 2, 3, 4, 5, 6.
- Research suggests that buprenorphine can effectively manage kratom dependence and withdrawal in both human and animal studies 2, 3.
- A case series presented in the study 2 demonstrates that patients with kratom dependence can be treated with buprenorphine/naloxone, with maintenance dosing similar to that used in opioid use disorder.
- Another study 3 found that methadone, buprenorphine, and clonidine can attenuate mitragynine withdrawal effects in rats, suggesting potential treatment options for problematic mitragynine/kratom use in humans.
- Additional case reports 4, 5, 6 describe successful treatment of kratom use disorder with buprenorphine-naloxone in various patient populations, including young adults and individuals with chronic pain.
Key Findings
- Buprenorphine/naloxone can be safely induced as early as eight hours after last kratom use 2.
- Maintenance dosing for kratom use may require higher doses of buprenorphine/naloxone, up to 24mg per day, to manage prolonged withdrawal symptoms and co-occurring pain 2.
- Polysubstance use with kratom dependence may require higher levels of care and higher doses of buprenorphine/naloxone 2.
- Urine drug screens can be used to monitor kratom alkaloids concentrations during treatment 2.