Treatment of obsessive compulsive disorder and Kratom dependence with buprenorphine and supportive care

Kratom is an herbal product derived from Mitragyna speciosa which, depending on the dose, has stimulant and opioid-like effects and is increasingly being used recreationally to self-medicate symptoms of anxiety and depression. This case describes a man in his 30 s who presented to a community drug and alcohol service seeking support for problematic Kratom use, which he started using to try and manage obsessive-compulsive disorder symptoms and low mood. Despite attempts to reduce his use, he was unable to discontinue Kratom use independently. Initiation of low-dose sublingual buprenorphine led to complete abstinence within 3 weeks. This case highlights not only the potential use of low-dose buprenorphine to manage Kratom withdrawal but also the complexity in managing co-existent mental health disorders in addiction services, emphasising the importance of psychiatry within a multidisciplinary approach.