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

There is an increased interest in kratom and kratom-related products such as 7-hydroxymitragynine (7-OH). Here we present the case of a patient seeking inpatient substance use treatment for daily 7-OH use and the clinical course of care including clinical opiate withdrawal scale (COWS) and medication treatment response.

This is a single case report from an inpatient medically managed withdrawal level of substance use treatment care.

A 38-year-old man with a history of opioid use disorder reported escalation of use including kratom to 7-OH complicated by the development of use disorder, tolerance, and withdrawal. The patient experienced a withdrawal syndrome consistent with opioid withdrawal upon stopping use, with COWS peaking at 14. The patient was treated with a short course of buprenorphine sublingual (daily dosing 2-8 mg) based on signs and symptoms. He did not want to remain on buprenorphine after the medically managed withdrawal period and was successfully tapered off buprenorphine during his treatment stay and transitioned to residential level of care.

Given the widespread availability of kratom and kratom-related products it is important for health care providers to screen for use and development of use disorder and be prepared to provide counseling, support, and treatment for patients.