Medications commonly used to treat opioid use disorder (OUD) may also be effective for the growing public health problem of kratom. addiction, a sample of new research.
The results of a thorough review of the literature and an expert survey suggest buprenorphine, naltrexone, i methadone are effective for kratom use disorder (KUD) and that the indication for these drugs “should be extended to [treat] cases of moderate to severe kratom addiction, ”said study researcher Saeed Ahmed, MD, medical director of the West Ridge Center at Rutland Regional Medical Center, Rutland, Vermont. Medscape Medical News.
Ahmed, who practices general psychiatry and addiction psychiatry, presented the results at the 2021 annual meeting of the American Psychiatric Association (APA) virtual.
Emerging public health problem
Kratom can be ingested in the form of pills or capsules or as an extract. Its leaves can be chewed or dried and powdered to make a tea. It can also be incorporated into topical creams, balms or tinctures.
The products containing the substance are “available and legal for sale in many U.S. states and cities,” said Ahmed, who added that it can be purchased online or at local smoking stores and that he increasingly uses them. more to treat a variety of conditions that include conditions of pain, anxiety and mood and as a substitute for opioids.
How reported per Medscape Medical News, a 2018 analysis by the U.S. Food and Drug Administration showed that kratom is, in fact, an opioid, a finding that gained significant to step back of the American Kratom Association.
Kratom addiction, Ahmed said, is an “emerging public health problem,” noting that in recent years the number of calls to poison control centers across the country has multiplied by 52, from the same per month to that of two. per day. He believes that misinformation through social media has helped fuel its use.
In addition, Ahmed points out that kratom is addictive and carries a high relapse rate; so far, however, there are no guidelines on how to maintain long-term abstinence.
To investigate, the researchers conducted a systematic search of the literature on cases related to the maintenance treatment of kratom addiction. They also took advantage of case reports and scientific posters from trusted online sources and conference proceedings. In addition, they conducted a survey of members of the American Society of Addiction Medicine (ASAM).
The researchers found 14 reports on the long-term management of kratom addiction, half of which did not involve a TUD. Ahmed said it is important to exclude ear discs to avoid possible confusion.
In most cases buprenorphine was used, but in some cases naltrexone or methadone was prescribed. All cases had a favorable result. Ahmed noted that maintenance doses of buprenorphine appear to be lower than those needed to effectively treat the IUD.
With a response rate of 11.5% (82 respondents), the results of the ASAM survey showed that 82.6% of respondents (n = 57) had experience in KUD management, including 27 , 5% (n = 19) who had only kratom addiction. Of these, 89.5% (n = 17–19) used buprenorphine to control KUD and of these 6 combined it with conversation therapy.
Ahmed warned that the included cases varied significantly in terms of relevant data, including kratom dose and route of administration, toxicology screening used to control abstinence, and duration of maintenance follow-up.
Despite these limitations, the review and survey underscore the importance of including moderate to severe kratom as an indication of current drugs against DUD, Ahmed said.
Including kratom addiction as an indication of these drugs is especially important for patients who use high doses of kratom and meet the DSM-5 diagnostic criteria for moderate or severe LDS, Ahmed said.
In addition, physicians should consider referring patients with moderate to severe KUD for counseling or enrollment in 12-step addiction treatment programs, he said.
A separate diagnosis?
Ahmed said he would like KUD to be included in the DSM-5 as an independent entity.
“This will not only help better inform physicians about a diagnostic criterion that encompasses problematic use and facilitate screening, but will also pave the way for treatments to be explored for this diagnosable condition.”
Commenting on the study for Medscape Medical News, Petros Levounis, MD, professor and chair of the Department of Psychiatry, and associate dean for professional development at Rutgers New Jersey Medical School, Newark, said the authors “have done a great job reviewing the literature and asking experts.” on the treatment of kratom addiction.
“The focus of his study is that kratom behaves a lot like an opioid and is treated like an opioid.”
Levounis noted that kratom dependence is so new that experts don’t know much about it. However, he added, emerging evidence suggests that kratom “should be considered an opioid more than anything else,” but added that it does not guarantee its own diagnosis of KUD.
He noted that individual opioids do not have their own diagnostic category and that opioid use disorder is a general term that covers all of these drugs.
Ahmed and Levounis have not revealed any relevant financial relationship.
Annual Meeting of the American Psychiatric Association (APA) 2021: Poster no. 5284. Filed May 2, 2021.