What is the recommended protocol for detoxing from kratom?

Kratom Detoxification Protocol

A gradual taper approach with adjunctive medications for withdrawal symptom management is the recommended protocol for detoxing from kratom, with consideration of buprenorphine treatment for severe cases of kratom use disorder. 1

Understanding Kratom Withdrawal

Kratom (Mitragyna speciosa) has both opioid-like and stimulant-like properties. The FDA warns against its use, and withdrawal syndrome can occur when taking more than 5-15g per day 2. Withdrawal symptoms are similar to opioid withdrawal and may include:

• Anxiety, restlessness, irritability
• Muscle aches, tremor, sweating
• Insomnia
• Rhinorrhea (runny nose)
• Nausea, vomiting, diarrhea
• Cravings

Detoxification Protocol

Step 1: Assessment

• Determine daily kratom intake (amount and frequency)
• Assess severity of dependence
• Screen for concurrent substance use
• Evaluate for underlying medical or psychiatric conditions

Step 2: Tapering Approach

For mild to moderate kratom dependence:

• Gradual taper: Reduce dose by 10% of original dose per week 1
• Maintain same dosing frequency during taper
• When reaching lowest available dose unit, increase time intervals between doses

Step 3: Management of Withdrawal Symptoms

• For sympathetic hyperactivity: α2-adrenergic agonists such as clonidine or tizanidine 1, 3, 4

  • Clonidine 0.1-0.2mg every 6 hours as needed for withdrawal symptoms
  • Lofexidine has also proven effective in treating kratom withdrawal 3

• For gastrointestinal symptoms: loperamide (monitor for abuse potential) 1

• For insomnia/anxiety: Short-term use of:

  • Trazodone
  • Hydroxyzine 4
  • Gabapentin
  • Mirtazapine 1

• For pain: NSAIDs or acetaminophen 1

Step 4: Medication-Assisted Treatment for Severe Cases

For severe kratom use disorder or failed outpatient detoxification:

• Buprenorphine/naloxone has been shown effective in multiple case studies 5, 6, 7
  • Induction doses typically range from 4-16mg daily
  • Can be maintained for several months before tapering
  • Home induction may be possible in appropriate cases 6
  • Extended-release buprenorphine has been used successfully for tapering 7

Monitoring and Follow-up

• Weekly follow-up during active tapering 1
• Assess for withdrawal symptoms at each visit
• Adjust tapering schedule based on individual tolerance
• Monitor for protracted withdrawal syndrome which may persist for months 1

Important Considerations and Pitfalls

Common Pitfalls to Avoid

• Tapering too rapidly: Increases withdrawal symptoms and reduces success rates 1
• Inadequate symptom management: Can lead to relapse or treatment discontinuation
• Overlooking psychological support: CBT and other psychological interventions improve outcomes during tapering 1

Special Considerations

• Inpatient detoxification may be necessary for patients with:
  • Severe dependence
  • Failed outpatient attempts
  • Significant medical or psychiatric comorbidities
  • Polysubstance use

Conclusion

Kratom withdrawal can be managed effectively with a gradual taper approach combined with targeted symptom management. For severe cases, buprenorphine-based treatment offers a promising alternative with good success rates for maintaining abstinence from kratom.