Kratom, a novel herbal opioid in a patient with benzodiazepine use disorder

Abstract A case of a patient with a history of depression, who was concomitantly using Kratom has been described. Kratom (Mitragyna speciosa) is a psychoactive plant indigenous to certain regions of southeast Asia where it has been traditionally used for its stimulatory and analgesic effects. The active compounds in Kratom are mitragynine and 7-hydroxymitragynine. Kratom’s use for self-management of chronic pain and as supportive therapy for managing opioid withdrawal is increasing. This case highlights the observation that Kratom use is also prevalent amongst patients with other mental health and/or substance abuse conditions. The discussion explores the current understanding on pharmacology and toxicology of mitragynine and 7-hydroxymitragynine, and analytical methods used for kratom analysis in a toxicology laboratory.