Research · 2025-02-01
Johns Hopkins Proposes Treatment Algorithm for Kratom Use Disorder; First Clinical Study Examines Withdrawal Symptoms
Source: Johns Hopkins Medicine
Why it matters
Johns Hopkins is conducting the first empirical study of kratom withdrawal symptoms and has developed a treatment algorithm for clinicians. This fills a critical gap: kratom use disorder is not yet in DSM-5, leaving clinicians without standard assessment and treatment protocols.
The big picture
Kratom use disorder requires individualized assessment because kratom products vary dramatically in potency and alkaloid composition. Clinicians must consider whether patients use whole-leaf products, extracts, blended products with kava or caffeine, or synthetic 7-OH—each requiring different diagnostic and treatment approaches. Most kratom users experience mild-to-moderate symptoms, contrasting with severe substance use disorders.
Key findings
- Most kratom alkaloids act on multiple receptor systems (opioid, adrenergic, serotonergic, dopaminergic, adenosinergic), not just opioid receptors
- Some kratom products advertised as kratom are actually synthetic 7-OH, which has opioid-like properties 14-22 times more potent than morphine
- Physical dependence symptoms (tolerance, withdrawal) and craving are the most common kratom use disorder symptoms
- Buprenorphine has been used successfully to treat kratom use disorder, though research remains limited
- Clinicians should not assume kratom use disorder equals opioid use disorder—treatment must be tailored to the specific product and symptom profile
What they say
"Clinicians must assess KUD not only for kratom generally, but also ideally with a specifier for the type of kratom product used... Before DSM-5 KUD is assessed, patients should be screened for their use of any kratom-derived products across four subtypes: kratom whole-leaf products, kratom extract products, blended kratom products, and kratom-derived synthetic products." — Kirsten E. Smith, Johns Hopkins
Bottom line
Clinicians must distinguish between whole-leaf kratom and synthetic 7-OH products, use individualized assessment, and taper kratom or treat with buprenorphine based on symptom severity and product type.