General: Used by people to manage chronic pain + treat opioid withdrawal symptoms + improve mood + recreational purposes.

-Deaths have occured, often when mixed with other substances; there are also isolated kratom overdose cases leading to fatalities as well.

-Not an illegal substance so can be ordered online or at various stores.

Pathology: Mu-agonist therefore weak opioid activity.

Clinical: opioid-like toxidrome at higher doses, much less respiratory depression with kratom alone but if mixed with with other opioids can lead to respiratory depression.

-stimulant-like effects at lower doses.

-case reports of hepatotoxicity.

Management:

-Similar to opioid overdose with naloxone.

-If you are starting Suboxone, kratom in the system may precipitate acute withdrawal.

References:

https://www.drugabuse.gov/publications/drugfacts/kratom