Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Sep;26(9):487-496.
doi: 10.1007/s11920-024-01524-1. Epub 2024 Aug 13.

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

Kirsten E Smith  1 , David H Epstein  2 , Stephanie T Weiss  3
Affiliations
Review

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

Kirsten E Smith et al. Curr Psychiatry Rep. 2024 Sep.

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.

Recent 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: Mitragyna speciosa addiction; DSM-5 diagnosis of substance use disorders; Kratom addiction; Kratom use disorder; Substance use disorder – other.

PubMed Disclaimer

Conflict of interest statement

Drs. Weiss and Epstein report no conflicts of interest to disclose. Drs. Weiss and Epstein are funded by the Intramural Research Program of the National Institute on Drug Abuse, National Institutes of Health. In the past 36 months, Dr. Smith has served as a paid scientific advisor to the International Plant and Herbal Alliance and The Kratom Coalition, and serves as an expert witness in legal cases involving kratom. Dr. Smith is funded by NIDA grant R00DA055571.

Figures

Fig. 1
Fig. 1
Algorithm of Considerations for the Assessment, Diagnosis, and Treatment of Patients with Suspected KUD
See this image and copyright information in PMC

References

    1. American Psychiatric Association, editor. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. 2013. 10.1176/appi.books.9780890425596.
    1. World Health Organization. International Classification of Diseases. Eleventh Revision (ICD-11). 2021. https://icd.who.int/browse11.
    1. Hasin DS, Shmulewitz D, Stohl M, Greenstein E, Aharonovich E, Petronis KR, Von Korff M, Datta S, Sonty N, Ross S, Inturrisi C, Weinberger ML, Scodes J, Wall MM. Diagnosing prescription opioid use disorder in patients using prescribed opioids for chronic pain. Am J Psychiatry. 2022;179(10):715–25. 10.1176/appi.ajp.21070721. 10.1176/appi.ajp.21070721 - DOI - PubMed
    1. Cosci F, Chouinard G. Acute and persistent withdrawal syndromes following discontinuation of psychotropic medications. Psychother Psychosom. 2020;89(5):283–306. 10.1159/000506868. 10.1159/000506868 - DOI - PubMed
    1. Kirisci L, Tarter RE, Reynolds M, Vanyukov MM. Item response theory analysis to assess dimensionality of substance use disorder abuse and dependence symptoms. Int J Pers Cent Med. 2016;6(4):260–73. - PMC - PubMed

MeSH terms