- Speaker #0
So kratom only made its way into the U.S. spotlight about 20 years ago, but it's exploded in popularity since then. What's so interesting is that we're just beginning to unravel how it actually affects people, especially when it comes to dependence and addiction.
- Speaker #1
What really stands out to me is how much confusion there still is around kratom. For example, a lot of people assume it's basically a natural opioid, but the reality is much messier. The products people buy as kratom can be totally different. Some are whole leaf, some are concentrated extracts, and then there's this whole new wave of 7-hydroxymitragynine, or 7-OH products, which act even more potently at opioid receptors.
- Speaker #0
Exactly. And the analogy to cannabis is spot on here. Think about how we lump CBD, Delta-8, high THC strains and synthetics under the same umbrella, even though their effects couldn't be more different. With kratom, it's the same. That makes it... tough for clinicians to even know what someone's actually using, let alone how to assess for problems.
- Speaker #1
Totally. And that's why just asking, do you use kratom? Isn't nearly enough. Clinicians really need to dig into which products people are taking, how much, how often, and even what brands they can all have vastly different effects. I've talked to people who swear whole leaf kratom just gives them a mild energy boost, while others had pretty severe withdrawal symptoms from extracts or blended products.
- Speaker #0
The scary part is some stuff sold as Kratom isn't really Kratom at all. 7OH products, for instance, aren't technically Kratom by scientific standards, but get lumped in together. It's easy to see how both patients and providers could get lost in the weeds. Now, when it comes to actually diagnosing Kratom use disorder, or KUD, what do you think are the key points clinicians need to wrap their heads around?
- Speaker #1
I think the first thing is not to assume that severe addiction always looks the same. With CUD, people rarely report things like using in dangerous situations or giving up major responsibilities. Instead, it's mostly symptoms like physical dependence and strong cravings that pop up.
- Speaker #0
That makes sense, and it also means the classic checklist for substance use disorders doesn't always fit neatly. I imagine that makes diagnosis tricky, especially with the range of products out there. there and the fact that Kratom's main alkaloids hit all sorts of brain receptors, not just the opioid ones.
- Speaker #1
Exactly. And that's a big reason why you can't just treat Kratom the same as traditional opioids in the clinic. The withdrawal might feel familiar, but the underlying chemistry is different. That's why lab testing, ideally chromatography mass spectrometry for alkaloids like mitragynine, is so crucial, instead of just relying on basic opioid screens.
- Speaker #0
It... It really comes down to paying attention to the details, asking, testing, and documenting what someone's actually using. And that actually leads into the whole question of how best to treat people dealing with CUD, especially when other substance use disorders are in the mix. Let's get into that. When someone has both CUD and opioid use disorder, what's the current thinking on treatment?
- Speaker #1
Most experts lean toward using medication for opioid use disorder, like buprenorphine or even methadone, especially if the person's struggling with both kratom and classic opioids. Even though we don't have huge studies yet, the risk of relapse with OUD alone is so high that it makes sense to start there.
- Speaker #0
But what about people who only have KUD with no opioid history? Do they still get those same medications or is it a different approach?
- Speaker #1
That's where it gets interesting. For isolated CUD, so no OUD, The best approach often isn't jumping straight to opioid medications, since most cases aren't severe and patients are often opioid-naive. Instead, managing withdrawal symptoms and supporting people as they taper off kratom is usually the first step, sometimes with outpatient care or behavioral therapies.
- Speaker #0
It sounds a lot like treating other polysubstance issues, where you really need to tailor the plan to what's actually going on with each individual. And as you mentioned earlier, it. The type of Kratom product makes a big difference, especially with those super potent 7-OH products making things even trickier.
- Speaker #1
Right, and it's important not to pathologize everyone who uses Kratom. Many people don't experience major problems, even if they develop some tolerance or mild withdrawal. The goal is to support people who really need intervention, while recognizing that Kratom use itself isn't always disordered or dangerous.
