How to safely withdraw someone from kratom dependence?

Safe Withdrawal from Kratom Dependence

For patients dependent on kratom, a gradual taper approach combined with supportive care and possible buprenorphine treatment is recommended for safe withdrawal. 1, 2

Understanding Kratom and Its Effects

• Kratom (Mitragyna speciosa) contains over 40 alkaloids, with mitragynine and 7-hydroxymitragynine being the primary psychoactive compounds that act on opioid receptors 3
• An estimated 2.1 million US residents used kratom in 2020, often as a "legal high" or self-medication for pain, opioid withdrawal, and other conditions 2
• Up to 20% of US kratom users develop symptoms consistent with kratom use disorder 2
• Regular kratom use can negatively impact quality of life, particularly in physical health, psychological well-being, and environmental domains 4

Assessment Before Withdrawal

• Evaluate the severity of kratom dependence, including daily amount used and duration of use 5
• Screen for co-occurring substance use disorders, as kratom use is often associated with polysubstance use 2, 5
• Assess for underlying conditions that may have led to kratom use (pain, anxiety, depression, PTSD) 3, 6
• Consider using diagnostic criteria similar to opioid use disorder to determine the severity of kratom dependence 5

Withdrawal Management Protocol

Gradual Tapering Approach

• Implement a slow, collaborative taper with the patient rather than abrupt discontinuation 1
• Start with very small dose decreases (approximately 10% of the previous dose) to build patient confidence in the process 1
• Adjust taper rate based on the patient's ability to tolerate withdrawal symptoms 1
• The taper may take weeks to months depending on the severity of dependence and initial dose 1

Pharmacological Support

• Buprenorphine (with or without naloxone) is the recommended medication for managing kratom withdrawal symptoms 1, 2
• For patients with significant withdrawal symptoms or those unable to tolerate tapering, consider transitioning to buprenorphine treatment 1, 2
• Other medications to manage specific withdrawal symptoms may include:
  • Clonidine for autonomic symptoms (anxiety, restlessness) 1
  • Non-opioid analgesics for pain 1
  • Supportive medications for gastrointestinal symptoms, insomnia, and irritability 5

Monitoring and Support

• Provide close observation and support during the taper process 1
• Address depression, anxiety, and insomnia that may emerge or worsen during withdrawal 1
• Be available to treat emerging symptoms and manage patient fears about the withdrawal process 1
• Monitor for signs of withdrawal including gastrointestinal upset, restlessness, anxiety, irritability, fatigue, and craving 5

Special Considerations

• Avoid abrupt discontinuation of kratom, as this can lead to significant withdrawal symptoms similar to opioid withdrawal 1
• For patients with co-occurring opioid use disorder, treatment with medication-assisted therapy is essential 1
• Consider consultation with addiction specialists, particularly for complex cases or when buprenorphine treatment is indicated 1
• Be aware that kratom may interact with other medications through modulation of cytochrome P450, P-glycoprotein, and UGT enzymes 3

Follow-up Care

• Provide ongoing support to address underlying conditions that led to kratom use 6
• Consider non-pharmacological approaches for managing chronic pain, anxiety, or depression 1
• Educate patients about the risks of kratom use, including potential for liver toxicity, seizures, and dependence 3
• Implement regular follow-up to monitor progress and adjust treatment as needed 1