Stanciu Cornel, Ahmed Saeed, Hybki Bryan, Penders Thomas, Galbis-Reig David
Dartmouth Geisel School of Medicine, Hanover, New Hampshire.
New Hampshire Hospital, Concord, New Hampshire.
WMJ. 2021 Apr;120(1):54-61.
An increasing number of Americans are turning to kratom for self-management of various pain, anxiety, and mood states and as an opioid substitute. Addiction to this unique botanical develops and carries a high relapse risk and, to date, there are no guidelines on how to maintain long-term abstinence. The aim of this article is to compile all available information on management of "kratom use disorder" (KUD)-as coined here-from the literature, with evidence from the clinical practice of expert addictionologists in an attempt to develop a standard of care consensus.
A systematic literature search was conducted to capture all relevant cases pertaining to maintenance treatment for KUD. Results were supplemented with case reports and scientific posters gleaned from reliable online sources and conference proceedings. Additionally, a survey of members of the American Society of Addiction Medicine (ASAM) was administered to assess the practice patterns of experts who treat patients with KUD in isolation of a comorbid opioid use disorder (OUD).
Based on a literature review, 14 reports exist of long-term management of KUD, half of which do not involve a comorbid OUD. Pharmacological modalities utilized include mostly buprenorphine but also a few cases of naltrexone and methadone, all with favorable outcomes. This is supported by the results of the expert survey, which demonstrated that those who have managed KUD in isolation of a comorbid OUD reported having utilized buprenorphine (89.5%), as well as the other medications for opioid use disorder (MOUD).
This is the first comprehensive review to examine the existing literature referring to management of KUD in combination with a survey of current experts' clinical consensus regarding pharmacological management. Based on this information, it seems reasonable that the indication for MOUD should be extended to cases of moderate to severe KUD.
越来越多的美国人转向使用 kratom 来自我管理各种疼痛、焦虑和情绪状态，并将其作为阿片类药物的替代品。对这种独特植物的成瘾会逐渐形成，且复发风险很高，迄今为止，尚无关于如何维持长期戒断的指南。本文的目的是汇总文献中所有关于“kratom 使用障碍”（此处所定义）管理的可用信息，并结合成瘾医学专家临床实践的证据，试图达成护理标准共识。
进行了系统的文献检索，以获取与 kratom 使用障碍维持治疗相关的所有病例。结果通过从可靠的在线资源和会议记录中收集的病例报告和科学海报进行补充。此外，对美国成瘾医学协会（ASAM）的成员进行了一项调查，以评估在不合并阿片类药物使用障碍（OUD）的情况下治疗 kratom 使用障碍患者的专家的实践模式。
基于文献综述，有 14 篇关于 kratom 使用障碍长期管理的报告，其中一半不涉及合并 OUD。使用的药物治疗方法主要是丁丙诺啡，但也有少数使用纳曲酮和美沙酮的病例，所有这些都取得了良好的效果。专家调查结果支持了这一点，该调查表明，在不合并 OUD 的情况下管理 kratom 使用障碍的人报告使用过丁丙诺啡（89.5%），以及其他用于阿片类药物使用障碍的药物（MOUD）。
这是首次综合审查，结合对当前专家关于药物管理的临床共识的调查，来研究关于 kratom 使用障碍管理的现有文献。基于这些信息，将 MOUD 的适应症扩展到中度至重度 kratom 使用障碍病例似乎是合理的。
