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Publication Date



oregon; portland; ppmc


Pharmacy and Pharmaceutical Sciences



Kratom (Mitragynaspeciosa) is an herb native to Southeast Asia with opioid and stimulant-like properties that is commonly used to achieve a legal recreational high. •Kratom purchase and consumption is legal in most U.S. states. •Cases of acute toxicity and withdrawal have been increasing over the past decade.

Case Presentation

Pre-hospital course •Well adjusted 38 y.o. male presented with respiratory arrest requiring intubation by EMS in the field. •Found to have pinpoint pupils and bradypnea that was minimally responsive to naloxone. ICU course •Transferred to ICU and quickly extubated. •12 hours after arrival the patient became tachycardiac, tachypneic, and developed a new tremor along with new visual hallucinations. •Patient was reintubateddue to progression of symptoms. •Was restarted on his home dose of tramadol due to fear of withdrawal, symptoms persisted. •A Fentanyl drip provided minor improvement in his tremors and hallucinations.

Case resolution •On day 5, multiple empty bags of “MaengDa” tea were found in the patient’s home. •Clonidine and hydroxyzine provided further improvement in his anxiety, tremor, and tachycardia. •Extubated on day 9. •Once stable, induction therapy with buprenorphine was started and eventually discharged on day 18.

What is Kratom

History •Leaves were historically chewed by laborers in SE Asia to combat fatigue and to help treat aches and pains. Current uses •Commonly used as an opium substitute to treat pain or to treat mood disorders. •Also used to obtain a recreational high. Effects •A low doses (1-5g) has stimulant effects causing increased alertness, stamina and euphoria. •At high doses (5-15 grams) kratomacts on μ and κopioid receptors causing increase euphoria, sedation, and analgesia. •Effects begin 5-10 minsafter use and last for 2-5 hours.

Kratom Withdrawal

Withdrawal symptoms are common after discontinuing use following weeks to months of daily use. •Kratomwithdrawal begins approximately 12 hours after last use. •Duration of kratomwithdrawal is similar tothat opioid withdrawal. Symptoms of Kratomwithdrawal Treatment •There are no concrete guidelines on management of Kratomwithdrawal, however, multiple case reports have described successful treatment with symptom-triggered clonidine & scheduled hydroxyzine during acute phase. •Case reports have also described success with transitioning patients onto long term buprenorphine-naloxone maintenance.

Increase use/abuse in US

Legality of Kratom •Kratom has a long history of abuse in SE Asia and is a controlled substance in this region. •The DEA is aware of the dangers of Kratom,however it is not currently a scheduled substance. •As of 2020, there are no federal laws prohibiting Kratomuse. Purchase and consumption is legal in most states. Increasing use/abuse in U.S. •Kratomuse in the U.S. has been steadily increasing since 2010 which has caused in increase in the amountof cases of acute toxicity and withdrawal.

Learning Points

Kratom is herb with opioid and stimulant-like properties which is legal to buy and consume in most U.S. states. • Cases of acute toxicity and withdrawal from kratomare becoming increasingly common due to widespread availability in our community • Many physicians are unaware of the effects of kratom and fail to ask patients about their use of herbal medications. • Kratomwithdrawal is treatable with clonidine, hydroxyzine and buprenorphine.


Internal Medicine


Graduate Medical Education

Conference / Event Name

Academic Achievement Day, 2021


Providence Portland Medical Center

Traditional herb or drug of abuse? A case of severe Kratomwithdrawal