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Controversies in Assessment, Diagnosis, and Treatment of Kratom Use Disorder.

Kirsten Smith, David Epstein & Stephanie Weiss

Kirsten Smith, David Epstein & Stephanie Weiss

Reviews To Read – August 2024.

Published in Current Psychiatry Reports by Kirsten Smith, David  Epstein & Stephanie Weiss of the NIDA IRP Translational Addiction Medicine Branch.

This publication arose because Dr. Weiss was asked to write about “kratom misuse” for a kratom-focused issue of Current Psychiatry Reports.  She agreed to contribute, but with a change of title and aims.  With Drs. Smith and Epstein, the piece that emerged was: (1) a critical evaluation of the criteria for substance-use disorders (SUDs), (2) a consolidation of our own findings (and others’ findings) on the prevalence and nature of kratom-use disorder (KUD) among people who use kratom, with careful consideration of the respects in which KUD is and isn’t comparable to daily reliance on caffeinated beverages, (3) our best attempt at a decision tree for physicians to evaluate and treat cases of KUD that require biomedical intervention, accounting especially for the presence or absence of a co-occurring opioid-use disorder (OUD).


Kirsten E Smith; David H Epstein; Stephanie T Weiss

Controversies in Assessment, Diagnosis, and Treatment of Kratom Use Disorder Journal Article

In: Curr Psychiatry Rep, vol. 26, no. 9, pp. 487–496, 2024, ISSN: 1535-1645.

Abstract | Links

@article{pmid39134892,
title = {Controversies in Assessment, Diagnosis, and Treatment of Kratom Use Disorder},
author = {Kirsten E Smith and David H Epstein and Stephanie T Weiss},
url = {https://pubmed.ncbi.nlm.nih.gov/39134892/},
doi = {10.1007/s11920-024-01524-1},
issn = {1535-1645},
year = {2024},
date = {2024-09-01},
urldate = {2024-09-01},
journal = {Curr Psychiatry Rep},
volume = {26},
number = {9},
pages = {487--496},
abstract = {PURPOSE OF REVIEW: 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.nnRECENT FINDINGS: 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.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}

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PURPOSE OF REVIEW: 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.nnRECENT FINDINGS: 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.

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  • https://pubmed.ncbi.nlm.nih.gov/39134892/
  • doi:10.1007/s11920-024-01524-1

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