Case Report: Transdermal Buprenorphine Successfully Manages Kratom Withdrawal and Cancer Pain Simultaneously

Why it matters

Clinicians increasingly encounter patients using kratom for pain management who then need to transition to evidence-based treatments — especially in palliative care settings. This case provides a practical treatment protocol for managing both kratom withdrawal and complex cancer-related pain simultaneously.

The big picture

Kratom use disorders are appearing in unexpected clinical settings, including palliative care and oncology, where patients self-manage pain without clinician oversight. As healthcare providers adapt, there is growing need for evidence-based protocols for transitioning patients off kratom to approved medications. Buprenorphine, a partial opioid agonist used for opioid use disorder and pain, is emerging as a promising option given its ability to address both withdrawal symptoms and pain control simultaneously.

Key findings

• A palliative care team successfully managed kratom withdrawal and severe neuropathic and cancer-related pain using transdermal buprenorphine in a patient with endometrial cancer
• The patient had used kratom for several years as a natural alternative to opioids for lumbar and cancer-related pain, declining traditional opioid agonists due to personal preference for traditional medicine
• Kratom discontinuation was required for enrollment in an immunotherapy clinical trial, requiring simultaneous management of withdrawal and escalating pain
• Transdermal buprenorphine achieved adequate pain control and improved patient satisfaction; the patient was successfully discharged on the regimen
• One-month follow-up confirmed well-controlled symptoms, suggesting transdermal buprenorphine as a viable kratom-to-medication transition in palliative settings

What they say

The authors concluded: "With the ongoing opioid epidemic leading to hundreds of thousands of deaths in the United States, kratom formulations are gaining popularity as natural alternatives to opioids. These over-the-counter opioid-like supplements present a challenge for providers, requiring novel approaches to strengthen therapeutic alliances, provide patient education, and adapt evidence-based treatment strategies to account for individual perspectives and fears."

Bottom line

**Transdermal buprenorphine may provide a practical clinical solution for managing kratom withdrawal alongside complex pain in palliative care settings, though current evidence remains limited to case reports.**