Is Sublocade (buprenorphine) effective for treating kratom use disorder in younger to middle-aged adults with a history of substance use disorders or mental health conditions?

Buprenorphine (Sublocade) for Kratom Use Disorder

Buprenorphine, including extended-release formulations like Sublocade, is an effective treatment for kratom use disorder in younger to middle-aged adults, with multiple case series demonstrating successful outcomes in this population. 1, 2, 3

Evidence for Buprenorphine in Kratom Use Disorder

While no formal guidelines specifically address kratom use disorder, the available evidence strongly supports buprenorphine treatment based on kratom's opioid-like pharmacology:

• Kratom's active compounds (mitragynine and 7-hydroxymitragynine) act as partial mu-opioid receptor agonists, producing physiological dependence similar to traditional opioids, making buprenorphine a rational treatment choice. 2, 4

• The largest case series to date (28 patients) demonstrated that 82% achieved negative kratom tests by 12 weeks on buprenorphine/naloxone maintenance, with 71% remaining in treatment for an average of 11 months. 2

• Extended-release buprenorphine (Sublocade) has been successfully used for both maintenance and tapering in kratom use disorder, as demonstrated in a 36-year-old patient who failed naltrexone trials. 3

Induction Protocol

Buprenorphine induction for kratom use disorder can occur earlier than traditional opioid use disorder because kratom's partial agonist properties reduce precipitated withdrawal risk:

• Induction is safe as early as 8 hours after last kratom use, unlike full opioid agonists which typically require 12-24 hours. 4

• Home induction is feasible and effective for patients unable to access inpatient treatment due to work, school, or other obligations. 1

• Initial dosing ranges from 1-20 mg, with most patients stabilizing on 8-16 mg daily, though some require up to 24 mg for prolonged withdrawal symptoms or co-occurring pain. 2, 4

• No correlation exists between daily kratom dose and required buprenorphine stabilization dose, so titrate based on withdrawal symptoms rather than kratom consumption history. 2

Sublocade-Specific Considerations

Extended-release buprenorphine (Sublocade) offers advantages for kratom use disorder, particularly for patients with adherence concerns or those seeking tapering:

• Monthly 300 mg injections provide steady medication levels without daily dosing requirements, improving treatment retention. 3

• Tapering can be accomplished with sequential 100 mg monthly injections after stabilization on higher doses, as successfully demonstrated in isolated kratom use disorder. 3

• Patients should be stabilized on sublingual buprenorphine (8-16 mg) for at least 7 days before transitioning to Sublocade, following standard FDA guidance. 5

Treatment Duration and Monitoring

Long-term maintenance is more effective than short-term treatment:

• Treatment duration averaged 11 months in the largest case series, with 71% retention at follow-up. 2

• Urine drug screening for kratom alkaloids (mitragynine) should be performed at 4,8, and 12 weeks, then monthly, as standard opioid panels do not detect kratom. 2, 4

• Polysubstance use is common in kratom use disorder patients and may require higher buprenorphine doses and more intensive monitoring. 4

Special Population Considerations

Young adults with comorbid mental health conditions respond well to buprenorphine treatment:

• ADHD and other psychiatric comorbidities are common in younger kratom users and should be addressed concurrently, as stimulant medications can often be safely resumed after buprenorphine stabilization. 1

• Patients report improved mood and sleep patterns on buprenorphine maintenance beyond just withdrawal symptom relief. 1

• Contingency management combined with buprenorphine enhances outcomes, using nonmonetary reinforcers in office-based settings. 6

Critical Pitfalls to Avoid

Do not delay treatment waiting for specialized kratom protocols—treat as opioid use disorder:

• Prolonged withdrawal symptoms may persist despite adequate buprenorphine dosing, requiring divided daily doses (every 8-12 hours) rather than once-daily dosing. 4

• Do not assume lower buprenorphine doses suffice because kratom is "natural"—some patients require 20-24 mg daily for adequate symptom control. 2, 4

• Ensure kratom-specific urine testing is available before initiating treatment, as standard drug screens will not detect kratom alkaloids and you cannot monitor treatment response without it. 4

• Behavioral therapy must accompany medication—buprenorphine alone is insufficient for optimal outcomes in substance use disorders. 5, 7