Kratom instrumentalization for severe pain self-treatment resulting in addiction – A case report of acute and chronic subjective effects

Abstract

Background Kratom is a Southeast Asian plant, which is widely used in this region, and making an increasing appearance in Europe and the US. Case report We present the case of a 26-year-old man in Substitol-assisted treatment of excessive Kratom and Tilidin use expressing the wish for a drug-free management of a chronic pain condition. After an accidental calcaneus impression fracture, the patient was suffering from severe chronic pain and anxiety of further accidents. This was managed initially with Tilidin. Resulting from the wish to self-manage the pain condition in a way that permitted continuation of a job, the patient searched for a ‘natural’ treatment alternative obtained from an Internet vendor. He successfully instrumentalized Kratom for 3 years with daily consumption intermixed with occasional Tilidin for pain management. However, the dose of Kratom was increased considerably up to a level of effect reversal, when no analgesic and behaviorally activating effects occurred any more, but only intense drowsiness. The patient was treatment seeking and subsequently detoxified from Kratom and Tilidin. Pain management was shifted to retarded morphine. Conclusion Kratom instrumentalization for pain management might appear to be more problematic for addiction development than when its use is established for other consumption motives.

Case Report: Treatment of Kratom Use Disorder With a Classical Tricyclic Antidepressant

“…The latter case and four other cases of kratom withdrawal were treated successfully with buprenorphine-naloxone maintenance ( 98 – 100 ). A further withdrawal from combined kratom-tilidine addiction has been successfully treated with retarded morphine ( 101 ). Finally, a recent paper reported an unusual presentation of obsessive-compulsive disorder-like syndrome during kratom withdrawal that responded to lorazepam ( 102 ).…”

Kratom use for depression/anxiety self-management: challenges during the COVID-19 pandemic – A case report

“…An important question that arises from the current case is the potential sudden loss of efficacy of Kratom in self-management of major depression and generalized anxiety disorder. The loss of functionality may have its origin in non-pharmacological factors ( Ahmed et al., 2020 ) as well as in non-Kratom related pharmacological factors ( Müller et al., 2020 ). The patient reported a massive increase in stress level short before long-term effective Kratom started to fail.…”

“…A particular risk of any Kratom instrumentalization is the establishment of a Kratom addiction and emerging cognitive deficits, as it was shown for Kratom and its main psychoactive alkaloids ( Yusoff et al., 2016 ; Ismail et al., 2017 ; Hassan et al., 2019 ; Swogger and Walsh, 2018 ). Other case studies have also brought up cases of problematic Kratom use in Europe and the U.S., in particular in the self-management of severe pain ( Müller et al., 2020 ; Metastasio et al., 2020 ) or in the context of opiate ( Boyer et al., 2007 ; Singh et al., 2020 ) or alcohol self-withdrawal ( Havemann-Reinecke, 2011 ).…”

“…This kind of drug consumption was classified as drug instrumentalization and is distinct from drug consumption for primarily hedonistic motives ( Müller and Schumann, 2011a , 2011b ; Ahmed et al., 2020 ; Müller, 2020 ). Nevertheless, also successful and long-term controlled drug instrumentalization may lead to drug addiction that requires treatment ( Müller et al., 2020 ).…”

Can Kratom (Mitragyna speciosa) Alleviate COVID-19 Pain? A Case Study

“…Several cases have been reported in both Western (53-55), including cases of neonatal abstinence syndrome (56,57), and Eastern countries (27,58,59), where those who used kratom for a long time experienced both physical (e.g., constipation) and psychological (e.g., anxiety) withdrawal symptoms. More recently an article have been published by Muller et al (60) in which an individual self-prescribing kratom for pain treatment reported an escalation of the dosage needed and eventually developed a dependence.…”