Vulnerable Veteran Innovative PACT (VIP) Initiative, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah, USA.
Veterans Affairs New York Harbor Health Care System, New York City, New York, USA.
Subst Abus. 2021;42(4):497-502. doi: 10.1080/08897077.2021.1878086. Epub 2021 Feb 22.
Kratom is a substance that when ingested produces an opioid-like effect. As kratom continues to gain popularity, increasing numbers of cases of addiction, dependence, and adverse events have been reported, as well as an increase in mortality associated with its use. George E. Wahlen Department of Veterans Affairs Medical Center has been using buprenorphine/naloxone for the treatment of kratom withdrawal and dependence in both primary care and specialty addiction treatment settings in the Veteran population. We present three cases that describe the use of buprenorphine/naloxone for kratom dependence. For each case, we describe the withdrawal symptoms from kratom, induction and long-term maintenance on buprenorphine/naloxone in kratom dependence, the impact of polysubstance use disorders in management of kratom dependence, and the use of urine drug screens for kratom alkaloids during treatment. This case series demonstrates that patients with kratom dependence can effectively be treated with buprenorphine/naloxone. It appears that it is safe to induce buprenorphine/naloxone as early as eight hours after last kratom use and maintenance dosing for kratom use was similar to maintenance doses used in opioid use disorder. Prolonged and continued withdrawal symptoms were reported despite treatment with buprenorphine/naloxone and multiple daily doses of up to 24mg per day may be beneficial for prolonged withdrawal symptoms and for cooccurring pain. Polysubstance use with kratom dependence may require higher levels of care and higher doses of buprenorphine/naloxone. Urine drug screens may be best practice for monitoring kratom alkaloids concentrations and facilities that utilize buprenorphine/naloxone to treat kratom dependence should have testing available. Further research is needed on the impact and the treatment of kratom dependence.
译文：
背景：
近年来，越来越多的人因使用卡痛叶而出现成瘾、依赖和不良事件，死亡率也有所上升。因此，美国乔治·E·沃尔纳退伍军人事务医疗中心开始在初级保健和成瘾治疗专科门诊中使用丁丙诺啡/纳洛酮治疗卡痛叶戒断和依赖。本文报道了 3 例使用丁丙诺啡/纳洛酮治疗卡痛叶依赖的病例。
方法：
详细描述了卡痛叶依赖患者的戒断症状、丁丙诺啡/纳洛酮诱导和长期维持治疗、共病物质使用障碍对卡痛叶依赖管理的影响，以及治疗过程中使用尿液药物筛查检测卡痛叶生物碱的情况。
结果：
3 例患者均使用丁丙诺啡/纳洛酮成功戒断卡痛叶依赖。丁丙诺啡/纳洛酮的诱导时间最早可在末次使用卡痛叶 8 小时后进行，维持剂量与阿片类药物使用障碍的维持剂量相似。尽管使用丁丙诺啡/纳洛酮治疗，但仍有患者报告存在长期持续的戒断症状，每日多次（多达 24mg）给药可能有助于缓解长期戒断症状和共病疼痛。卡痛叶依赖共病物质使用可能需要更高水平的护理和更高剂量的丁丙诺啡/纳洛酮。尿液药物筛查可能是监测卡痛叶生物碱浓度的最佳方法，使用丁丙诺啡/纳洛酮治疗卡痛叶依赖的机构应具备相关检测能力。卡痛叶依赖的影响和治疗方法仍需要进一步研究。
