Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Translational Addiction Medicine Branch, Intramural Research Program, National Institute on Drug Abuse, National Institutes of Health, 251 Bayview Blvd., Baltimore, MD, 21224, USA.
Curr Psychiatry Rep. 2024 Sep;26(9):487-496. doi: 10.1007/s11920-024-01524-1. Epub 2024 Aug 13.
We apply the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) criteria for substance use disorders (SUDs) to the herbal product kratom. Similarities and differences between kratom use disorder (KUD) and other SUDs are explored, along with assessment, diagnostic, and therapeutic recommendations for KUD.
Literature reports of "kratom addiction" or KUD rarely specify the criteria by which patients were diagnosed. Individuals meeting DSM-5 KUD criteria typically do so via tolerance and withdrawal, using more than intended, and craving, not functional or psychosocial disruption, which occur rarely. Most clinicians who use medication to treat patients with isolated KUD select buprenorphine formulations, although there are no controlled studies showing that buprenorphine is safe or efficacious in this patient population. Diagnosis and treatment decisions for KUD should be systematic. We propose an algorithm that takes into consideration whether KUD occurs with comorbid opioid use disorder.
我们将精神障碍诊断与统计手册第五版（DSM-5）的物质使用障碍（SUD）标准应用于草药产品卡痛。探讨了使用卡痛（KUD）与其他 SUD 的异同，并对 KUD 的评估、诊断和治疗提出了建议。
关于“卡痛成瘾”或 KUD 的文献报道很少具体说明诊断患者的标准。符合 DSM-5 KUD 标准的个体通常通过耐受和戒断、使用超过预期以及渴望来确定，而不是功能或心理社会障碍，这些情况很少发生。大多数使用药物治疗孤立性 KUD 患者的临床医生选择丁丙诺啡制剂，尽管没有对照研究表明丁丙诺啡在这一患者群体中安全有效。KUD 的诊断和治疗决策应该是系统的。我们提出了一个算法，考虑了 KUD 是否与合并的阿片类药物使用障碍同时发生。
