Treatment of Kratom Use Disorder With Methadone in an Opioid Treatment Program

Kratom (Mitragyna speciosa) and its active alkaloids, mitragynine and 7-hydroxymitragynine, can produce opioid-like dependence and withdrawal meeting DSM-5 criteria for opioid use disorder (OUD). While buprenorphine has been described for kratom use disorder (KUD), published experience with methadone is limited.

We identified 14 patients across multiple Opioid Treatment Programs (OTPs) with KUD who were treated with methadone between January 2024 and October 2025. Demographic, dosing, and urine toxicology data were reviewed.

The mean age was 36.8 years; 71% were male. Sixty-four percent reported using both kratom and 7-OH. The mean first-day methadone dose was 27.5 mg (range 15-30), and the mean maximum dose was 98.6 mg (range 35-190). Thirteen patients (93%) remained in treatment at the last follow-up. No adverse events were reported.

Methadone was well tolerated and effective in stabilizing patients with KUD, supporting its use as a viable alternative when buprenorphine is not suitable.