Rapid Clinical Updates: From Gas Station Shelf to Hospital Bed: Managing Kratom and 7-OH Toxicity and Withdrawal-Presentation

Video Transcription

Video Summary

This Rapid Clinical Update reviewed kratom and 7-hydroxymitragynine (“7-hydroxy”) toxicity, dependence, and withdrawal. Dr. Ahrens explained that kratom is an unregulated plant product sold in capsules, teas, tinctures, and “shots,” often from gas stations or vape shops. Its main alkaloids, mitragynine and 7-hydroxymitragynine, act on opioid receptors and can cause opioid-like effects, though kratom also has other receptor activity. Products are highly variable in content, may contain more 7-hydroxy than labeled, and usually do not appear on routine urine drug screens.<br /><br />Dr. Barrett emphasized that many patients use kratom to self-treat pain, anxiety, depression, fatigue, or withdrawal from other substances. Clinical presentations can include opioid-like withdrawal symptoms such as anxiety, rhinorrhea, diarrhea, myalgias, tachycardia, hypertension, and restlessness. Treatment mirrors opioid use disorder care: buprenorphine is the preferred therapy when withdrawal is present, with clonidine and symptomatic medications as helpful adjuncts. Naltrexone should be avoided because it may worsen withdrawal.<br /><br />The speakers also discussed perioperative management, recommending continuation or initiation of buprenorphine, multimodal analgesia, and higher-dose short-acting opioids when needed. They stressed compassionate, nonjudgmental screening, naloxone co-prescribing, and referral for mental health or addiction care.

Meta Tag

Concept Kratom

Concept 7-Hydroxymitragynine

Concept Kratom intoxication

Concept Kratom Withdrawal

Concept Buprenorphine

Keywords

kratom

7-hydroxymitragynine

opioid-like withdrawal

buprenorphine

naloxone co-prescribing

unregulated plant product

perioperative management

clonidine

opioid receptor activity

Kratom

7-Hydroxymitragynine

Kratom intoxication

Kratom Withdrawal

Buprenorphine