A Case of 7-Hydroxymitragynine Use Requiring Inpatient Medically Managed Withdrawal

Area of Science:

• Pharmacology and Toxicology
• Addiction Medicine
• Clinical Case Reports

Background:

• Kratom and its derivative, 7-hydroxymitragynine (7-OH), are gaining attention for their psychoactive properties.
• Increasing use of kratom-related products necessitates understanding their impact on substance use disorders.

Purpose of the Study:

• To present a case of inpatient substance use treatment for daily 7-hydroxymitragynine (7-OH) use.
• To describe the clinical course, withdrawal symptoms, and medication response in a patient with 7-OH use disorder.

Main Methods:

• Single case report from an inpatient medically managed withdrawal setting.
• Utilized the Clinical Opiate Withdrawal Scale (COWS) to assess withdrawal severity.
• Administered sublingual buprenorphine for symptom management.

Main Results:

• A 38-year-old male with opioid use disorder escalated to daily 7-OH use, developing tolerance and withdrawal.
• Patient experienced opioid-like withdrawal, with COWS scores peaking at 14.
• Treated with buprenorphine (2-8 mg daily), successfully tapered, and transitioned to residential care.

Conclusions:

• Healthcare providers must screen for kratom and 7-OH use and associated use disorders.
• Clinicians should be prepared to offer counseling, support, and treatment for patients with kratom-related substance use.
• Early identification and intervention are crucial for managing emerging substance use disorders related to kratom products.