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When "Kava" Isn't Kava: Opioid-like Withdrawal Responsive to Buprenorphine: A Case Study
Journal of Addiction Medicine
|June 29, 2026
Summary
A "kava" beverage caused severe opioid-like withdrawal symptoms due to undeclared kratom. Treatment with buprenorphine/naloxone suggests opioid receptor involvement, highlighting risks of adulterated supplements.
Area of Science:
- Pharmacology
- Toxicology
- Clinical Medicine
Background:
- Opioid use disorder (OUD) requires careful management during remission.
- Kava products are sometimes marketed as non-opioid alternatives.
- Adulteration of herbal supplements poses significant health risks.
Purpose of the Study:
- To report a case of severe withdrawal symptoms attributed to a kava product.
- To investigate the potential opioid-mediated mechanism of the observed withdrawal.
- To highlight the risks associated with mislabeled or adulterated herbal supplements.
Main Methods:
- Case report of a patient with OUD experiencing withdrawal symptoms.
- Clinical assessment of withdrawal severity and response to treatments (benzodiazepines, buprenorphine/naloxone).
- Product analysis to identify active compounds in the consumed kava beverage.
Main Results:
- The patient exhibited severe opioid-like withdrawal symptoms, inconsistent with typical kava withdrawal.
- Symptoms improved rapidly with buprenorphine/naloxone, indicating potential µ-opioid receptor agonism.
- Product testing confirmed the presence of kratom derivatives and kavalactones, alongside akuamma.
Conclusions:
- Commercially available kava products may be adulterated with substances like kratom, leading to opioid-like dependence.
- Clinicians should consider opioid-mediated withdrawal in patients using unregulated supplements.
- Symptom-guided treatment, including opioid receptor-targeting medications, may be necessary for withdrawal from such products.
Keywords:
buprenorphinedietary supplementsopioid-related disorderspiper methysticumssubstance withdrawal syndromeMore Related Videos
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