Broyan Viktoriya R, Brar Jessica K, Allgaier Student Tristen, Allgaier Jeffrey T
Ideal Option, PLLC, Pasco, Washington, USA.
Elson S. Floyd College of Medicine, Washington State University, Spokane, Washington, USA.
Subst Abus. 2022;43(1):763-766. doi: 10.1080/08897077.2021.2010250.
Opioid agonist therapy with buprenorphine is an effective, evidence-based treatment for opioid use disorder. However, there has been increasing use of alternative substances which can still produce opioid-like effects. One of these substances is the herbal supplement kratom. The chemical composition of kratom, specifically mitragynine and 7-hydroxymitragynine, has partial mu-opioid receptor agonist and antagonist effects at the kappa- and delta-opioid receptors. Due to its addictive potential, accessibility, and legal status, there have been increasing cases of kratom use disorder (KUD). Thus, it is important to consider effective treatment options for this nontraditional substance. Twenty-eight patients self-identified kratom as their primary substance of use. Length of kratom use ranged between 1 month and 25 years, with an average daily kratom dose of 92 g/d. Nine patients were inducted on a buprenorphine/naloxone dose between 1 and 6 mg, 18 patients between 8 and 16 mg, and 1 patient at 20 mg. Three patients were stabilized on a dose at 4 mg, 23 patients between 8 and 16 mg, 1 patient at 18 mg, and 1 patient at 20 mg. There was no correlation between stabilizing dose of buprenorphine/naloxone and past daily dose of kratom. As of March 2020, 20 of the 28 patients were still receiving outpatient buprenorphine/naloxone treatment. Six patients were lost to follow-up due to missed appointments, 1 tapered down to 0.25 mg of buprenorphine/naloxone and self-discharged, and 1 moved out of town. The rest have remained in treatment from 5 to 22 months, with an average duration of 11 months. Of the 28 patients, 68%, 82%, and 82% had negative test results for mitragynine at 4, 8, and 12 weeks of treatment, respectively. To our knowledge, this is the largest case series exploring long-term buprenorphine/naloxone treatment for KUD. Our findings suggest buprenorphine/naloxone can be used as an effective treatment option for KUD.
丁丙诺啡的阿片类激动剂疗法是一种针对阿片类物质使用障碍的有效、循证治疗方法。然而，仍能产生阿片样效应的替代物质的使用越来越多。这些物质之一是草药补充剂 kratom。kratom的化学成分，特别是帽柱木碱和7-羟基帽柱木碱，在κ-和δ-阿片受体上具有部分μ-阿片受体激动剂和拮抗剂作用。由于其成瘾潜力、可及性和法律地位，kratom使用障碍（KUD）病例不断增加。因此，考虑针对这种非传统物质的有效治疗方案很重要。28名患者自述kratom是他们主要使用的物质。kratom的使用时长在1个月至25年之间，平均每日kratom剂量为92克/天。9名患者开始使用1至6毫克的丁丙诺啡/纳洛酮剂量，18名患者使用8至16毫克的剂量，1名患者使用20毫克的剂量。3名患者在4毫克的剂量下病情稳定，23名患者在8至16毫克的剂量下病情稳定，1名患者在18毫克的剂量下病情稳定，1名患者在20毫克的剂量下病情稳定。丁丙诺啡/纳洛酮的稳定剂量与过去每日kratom剂量之间没有相关性。截至2020年3月，28名患者中有20名仍在接受门诊丁丙诺啡/纳洛酮治疗。6名患者因错过预约而失访，1名患者将丁丙诺啡/纳洛酮剂量减至0.25毫克并自行出院，1名患者搬离了城镇。其余患者的治疗时间为5至22个月，平均时长为11个月。在28名患者中，分别有68%、82%和82%在治疗4周、8周和12周时帽柱木碱检测结果为阴性。据我们所知，这是探索丁丙诺啡/纳洛酮长期治疗KUD的最大病例系列。我们的研究结果表明，丁丙诺啡/纳洛酮可作为KUD的有效治疗选择。
