Treatment of Hydroxymitragynine Addiction

Pharmacological Rationale

• Buprenorphine/naloxone successfully manages kratom/hydroxymitragynine dependence due to its pharmacological profile, as noted by Praxis Medical Insights 1, 2

Evidence for Efficacy

• The American Society of Addiction Medicine recommends buprenorphine/naloxone as a treatment for opioid use disorder, which includes hydroxymitragynine addiction, with a high level of evidence 1, 2

Maintenance Treatment Considerations

• The target maintenance dose of buprenorphine/naloxone is 16 mg daily for most patients, as recommended by Praxis Medical Insights 1, 2

Monitoring Requirements

• Regular assessment using DSM-5 opioid use disorder criteria is recommended, as noted by Praxis Medical Insights 1, 2
• Hepatitis C and HIV screening is recommended for patients with hydroxymitragynine addiction, according to the Centers for Disease Control and Prevention 3, 1

Critical Safety Considerations

• The American Heart Association recommends confirming the patient is in active withdrawal before initiating buprenorphine to prevent precipitated withdrawal, with a moderate level of evidence 3, 1
• Buprenorphine/naloxone is contraindicated with QT-prolonging agents due to cardiac risk, as noted by the Mayo Clinic 4, 1

Treatment Framework

• Medication-assisted treatment must be combined with counseling and behavioral therapies, not used as monotherapy, as recommended by Praxis Medical Insights 1, 2
• Prescribers must either hold an X-waiver to prescribe buprenorphine beyond 72 hours, or arrange appropriate referral to addiction treatment programs, according to the Substance Abuse and Mental Health Services Administration 5, 3