Buprenorphine Successfully Treats 7-Hydroxymitragynine Withdrawal

Why it matters

As semi-synthetic 7-hydroxymitragynine products proliferate, clinicians need proven withdrawal management protocols — this case demonstrates buprenorphine is an effective option.

The big picture

The rising market in concentrated 7-hydroxymitragynine products is creating a new clinical challenge of kratom-specific opioid use disorder; this case shows standard opioid-use-disorder treatments can bridge the gap.

Key findings

• • A 54-year-old woman presented with weakness, dizziness, vomiting, and acute kidney injury after using 7-hydroxymitragynine extract (~30mg/day) for opioid withdrawal
• • COWS (Clinical Opiate Withdrawal Scale) was "high" on admission; standard opioid withdrawal protocol was initiated
• • Buprenorphine 2mg sublingual + 4mg x3 hours later led to significant symptom improvement; up-titrated to 8mg twice daily by day 3
• • Discharged on day 4 with a 30-day buprenorphine supply for maintenance

What they say

Letter to the editor / case report published in Clinical Toxicology (2025) from a hospital emergency department team.

Bottom line

Buprenorphine effectively managed 7-hydroxymitragynine withdrawal, suggesting clinicians can apply standard opioid use disorder protocols to treat dependence on these increasingly common kratom products.