Approaches to Treating Kratom Use Disorder in the Perinatal Population

Kratom is an emerging substance in the United States that is commonly used to manage chronic pain and withdrawal symptoms from opioids. Kratom products are federally unregulated and legal in many states, and prolonged use can lead to the development of a substance use disorder. For pregnant persons, there are additional risks of maternal and infant withdrawal symptoms. Treatment of kratom use disorder (KUD) is complicated by misperception of the substance's harmful effects as well as limited screening options to identify and track use. There are few reports on the management of perinatal KUD and outcomes following childbirth. Buprenorphine has limited evidence for the treatment of KUD in the general population. This medication is supported for the treatment of opioid use disorder in pregnancy, but only 3 cases describe its application for pregnant persons with KUD. Key considerations for this treatment approach include identifying an effective buprenorphine dose and using collaborative care to address patient concerns. This case study illustrates strategies for the diagnosis and management of KUD in pregnancy.