BACKGROUND: Kratom (Mitragyna speciosa) is an herbal preparation with opioid-like effects made from a tree native to Southeast Asia and the Pacific Islands. Increasingly, kratom is used for self-treatment of opioid use disorder and recently has been associated with a multistate outbreak of salmonellosis. Few data are available on the clinical outcomes of kratom use in pregnancy. CASES: We present two cases of pregnant women presenting with kratom dependence. Both women presented with symptoms consistent with opioid withdrawal. Both women were initiated on opioid replacement, with successful treatment of symptoms. CONCLUSIONS: Kratom is an emerging self-treatment for opioid use disorder in the obstetric population. Obstetric care providers should be aware of kratom and consider opioid replacement for pregnant women with kratom dependence.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

The objective of this study is to explore pregnant and postpartum individuals' knowledge, attitudes, and perceptions regarding extended-release buprenorphine (XR-BUP) treatment for opioid use disorder.Methods: We conducted a paper-based survey of pregnant or postpartum individuals with opioid use disorder attending a multidisciplinary perinatal addiction specialty care clinic where XR-BUP is available. Participants' nonidentifiable demographic and treatment characteristics were collected, including duration and satisfaction of current medication for opioid use disorder. Participants' knowledge, attitudes, and perceptions about XR-BUP were assessed using a 5-point Likert scale. Descriptive statistics were used to summarize the data. Results: From February 2021 to August 2021, 79 of 98 eligible participants completed the survey (81% response rate). More than 9 of 10 participants were currently taking medication for opioid use disorder, and 7 individuals (8.9%) were taking XR-BUP. Nearly half (49.4%) had never heard of XR-BUP, and 84.8% did not personally know anyone taking XR-BUP. However, 45.6% and 29.1% would consider an injectable medication for opioid use disorder to avoid trouble remembering to take their daily medications and avoid opioid withdrawal symptoms, respectfully. Conclusions: In a population of pregnant and postpartum individuals, nearly half were unaware of a monthly XR-BUP option for the treatment of opioid use disorder. Many were interested in considering this medication. Future studies are needed to rigorously assess outcomes as-sociated with XR-BUP among pregnant and postpartum individuals with opioid use disorder.