April 28, 2025 • 17 mins
Dr. Casey Grover shares his clinical experience treating Kratom Use Disorder through a detailed case presentation of a 38-year-old man who struggled to find medical professionals knowledgeable about kratom addiction.
• Many healthcare providers lack knowledge about kratom, causing delays in patients receiving proper treatment
• Kratom creates opioid dependence similar to traditional opioids, leading to withdrawal symptoms when stopping
• The convenience of buying kratom at smoke shops contrasts sharply with the barriers of traditional medical care
• Patients often use kratom to self-medicate underlying conditions like anxiety, ADHD, or pain
• Effective treatment involves addressing opioid dependence with buprenorphine (or methadone) plus treating underlying conditions
• Once dependent on opioids, patients must either use medications like Suboxone/methadone or endure withdrawal
• Understanding the "feel something, take something" pattern is key to breaking the addiction cycle
• Long-acting injectable buprenorphine (Sublocade) combined with as-needed oral doses proved effective
To contact Dr. Grover: ammadeeasy@fastmail.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:22):
For 14 years I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
Today we are going to betalking about kratom.
(00:43):
Now Kratom gets a lot ofairtime on my podcast and it's
actually because I am seeingmore and more of it in my
addiction medicine practice.
I've had several patientsreferred to me in just the past
few weeks who use Kratom, andthey are so relieved to hear
that I have a lot of experiencein treating patients with kratom
(01:04):
use disorder.
Earlier this month, I was askedto speak as a part of a virtual
conference on the topic ofopioids and I chose to speak
about kratom.
The lecture involved two partsFirst, an overview of kratom,
which we have covered in detailon this podcast, but the second
was a case presentation.
(01:25):
And just in case you don't knowwhat a case presentation is,
it's where doctors and otherhealthcare providers discuss a
patient's care in ade-identified fashion to learn
about the patient's conditionand treatment and I find, as a
doctor, that going through acase like this is very
educational.
(01:45):
In fact, my favorite lecturesin medical school were
presentations where the lecturerwould describe a patient's
condition and use the patient'sexperience, diagnosis and
treatment to teach us.
So I recorded the second partof the lecture and I wanted to
share it with all of you.
So here we go with a casepresentation of a patient I have
(02:08):
treated who uses Kratom.
Okay, so we are going to do acase presentation for a patient
I treated who was using Kratom.
I've changed some of thedetails, just so nothing about
this case is recognizable, butthis is someone that I treated
myself and I will go throughtheir experience getting off of
(02:30):
Kratom.
So this is a 38-year-old malethat presented to me in the
outpatient clinic setting.
The patient had completed ahigh school education and I
practice medicine in MontereyCounty.
We make lots of agriculture, sothere's a lot of fairly rural
areas around us and thisparticular individual lived in a
rural area on a family ranchand was very isolated.
(02:53):
He had his own online autoparts business.
He would basically go to awrecking yard and collect
functional parts and then sellthem in a secondhand fashion
online.
Had family that was supportiveof him, but not anything local,
so really didn't have a lot oflocal human connection or
support.
The patient came to me, we didour first intake visit and he
(03:15):
had a history of alcohol usedisorder but was in remission.
He had gotten successfullytreated for alcohol use and he
presented asking for help withKratom.
And you know he'd made anappointment with one of the
other doctors in the practiceand the doctor was like I really
don't know anything aboutKratom, go see Dr Grover.
And so I walked into clinic andthe office staff came up to me.
(03:37):
They're like Dr Grover, youhave a new Kratom patient today.
Do you know anything aboutKratom I like?
Well, hopefully a little bit.
So he was particularlyfrustrated that no one seemed to
know how to help him and he hadbeen using kratom for well over
a year and, as we see with mostsubstances, he had developed
(03:57):
both dependence, which leads towithdrawal when he stops, and
then tolerance, and just aDependence is when you use a
substance regularly and yourbrain chemistry changes and then
when you stop using thesubstance you feel withdrawal.
So for kratom that's opioidwithdrawal, nausea, vomiting,
diarrhea, restlessness, bodyaches, chills, goosebumps, very
(04:17):
uncomfortable.
The other thing is tolerance,which is that, again, when a
person uses a substanceregularly, their brain chemistry
changes and it means thatbasically the brain needs more
of the substance to feel thesame effects over time.
We see that with alcohol,people say they can quote hold
their liquor.
That means they have toleranceto alcohol.
So for him he was just I'm sodone with Kratom.
(04:40):
It doesn't work anymore.
I'm taking more and more.
I'm sick all the time.
So he made an appointment to beseen Again in terms of his
substance use history.
He was successfully treated foralcohol use disorder in 2012.
I don't have further details onthat, I don't know if it was
residential treatment and again,he had just decided to use
Kratom on his own, had seenescalating use and had tried to
(05:02):
stop on his own with really badwithdrawal symptoms, and so he
was referred to a psychiatristand was referred to my clinic.
He initially saw one of ourpain doctors, because my
practice is both pain medicineand addiction medicine, and the
pain doctor was just man, I'mnot sure you know, go see
addiction medicine.
And then he was able to connectwith me Medications.
The patient had a history, as Imentioned, of alcohol use
(05:25):
disorder and had been put ontopiramate, also known as
topamax.
There was a history ofmigraines so there probably was
double duty with the topiramatethere.
Just a level set.
Topiramate can be used formigraines but can be used to
reduce the desire to usesubstances.
The patient was also ondesvenlafaxine I apologize for
the typo there, that's genericfor Prostique to help with some
(05:47):
underlying depression, and thenthe psychiatrist had put him on
ritazapine, also known asRemeron for sleep.
Medical history was notable fordepression as well as anxiety
and attention deficit,hyperactivity disorder or ADHD.
We'll come back to that in justa little bit.
Otherwise, no medical history,just psychiatric.
In terms of what was triedbefore medication.
(06:12):
He tried just to wean off ofKratom.
He tried to use less and lessevery day and just had
debilitating withdrawal.
And that's a pretty commonexperience as to what I hear
from my patients.
Most of them, once they realizethey're dependent, think uh-oh,
I got to get off of this stuff.
And he was really not able tobecause of withdrawal symptoms
(06:32):
and he was using Kratom multipletimes a day.
Ultimately, his psychiatrist,to address underlying anxiety
and depression, referred him toa therapist which he was seeing.
My medical workup on the day Isaw him was pretty simple.
I did a urine drug test and itwas positive for Kratom and
negative for any othersubstances.
Just to level set, if you get aurine drug test from Amazon or
(06:55):
from Rite Aid or Walgreens, mostof these will not test for
kratom and kratom, because it'sstructurally dissimilar to
opiates, will not come uppositive.
So in my lab we actually had toadd kratom specifically as a
substance.
And this comes up at thehospital not infrequently.
Someone gets admitted to thehospital for, say, appendicitis.
They disclose that they've got,say, an alcohol history.
(07:17):
A urine drug test is ordered,they're test negative and then
day two of the hospitalizationthey're completely miserable and
then they say oh, by the way,I'm on kratom.
It really doesn't pop up on aurine drug test unless you're
specifically testing for kratom.
All right.
So on our first visit we wantedto level set what are the goals
(07:37):
that we want to achieve, and hewanted to get off of kratom and
remain abstinent from it, and Iwas 100% on board with that.
So in terms of frustrations orbarriers or struggles that he
had, the biggest one is that hedidn't really meet a medical
(07:58):
provider that was informed aboutKratom to be able to help him.
He had asked multiple times ofhis regular doctor, they sent
him to psychiatry.
The psychiatrist wasn't reallyfamiliar with it.
He was ultimately sent to mypractice and because he
mentioned having pain as areason why he was using Kratom,
they sent him.
He was ultimately sent to mypractice and because he
mentioned having pain as areason why he was using Kratom,
they sent him to the pain sideof the practice.
They weren't sure, so they senthim to me.
(08:19):
So it was actually weeks, ifnot months, after he asked for
help before he was able to getto me.
And, as I mentioned, in mypractice we have two addiction
doctors and then one doctorwho's addiction-focused, and
between the three of us, I'mreally the Kratom geek.
So this actually happened.
On Monday, a Kratom usedisorder patient was referred to
one of the other doctors, whohas actually re-referred them
(08:41):
back to me.
So yeah, I mean considering youcan walk into a smoke shop and
buy it.
We probably, as a medicalcommunity, need to do better
education around Kratom.
The next part to me is reallyfascinating, which is let's talk
about the difference betweengoing and buying Kratom and
(09:01):
going to see a medicalprofessional, and I have to give
kudos to my colleagues who dothe Addiction Medicine Journal
Club podcast, drs John Keenanand Dr Sonia Deltredici.
I've done a couple of jointepisodes between our two
podcasts about Kratom, and DrSonia was on it, so she, like me
(09:22):
, was just hey, grover, I heardyou went into a smoke shop Like
I got to do that too, and herpoint when she walked into a
smoke shop was this is so easyand convenient to get.
Let's imagine that you haveanxiety and ADHD and your back
hurts.
Okay, you can go into a smokeshop and buy Kratom as much as
(09:45):
you want and walk out in just afew minutes.
If you need more, they don'tdeny you early refills.
You just go get more.
It's very consumer-friendly.
And same thing with goingonline and going to Kraken
Kratom you just put in yourcredit card and the stuff shows
up.
Now let's imagine you haveanxiety and ADHD and your back
(10:07):
hurts and you're going to gothrough the medical community.
Okay, let's say you have a goodprimary care position.
You might call them and ittakes three weeks to get an
appointment and then you mighthave a copay and then you got to
sit in the waiting room andthen you have to talk to the
doctor and the doctor mightorder tests and you've got to
get those tests done.
And then you got to see thedoctor again.
And then they're going to orderyour medicines and, oops, the
(10:30):
pharmacy's out of stock and oh,you've got to co-pay.
And then, oops, you needed ahigher dose and you can't get a
hold of the doctor to get arefill.
Like it's fairly inconvenientto go through the traditional
medical channels as compared tojust walking to a smoke shop and
buying Kratom.
So kudos to Dr Sonia Deltrenicifor her wisdom around that,
(10:50):
because that was a really goodpoint.
And many people who use Kratomdo not have a lot of confidence
in the traditional medicalcommunity, which is why they go
to Kratom.
And then the last point forthis patient is he has untreated
ADHD, which I had to work on.
So what has he tried beforethat didn't work?
We talked about the fact thathe tried to wean himself off the
Kratom and just wasn't able todo it, which is fairly common
(11:12):
with all of my opioid usedisorder patients.
My patients using fentanyl justcan't wean themselves off.
So what did I do?
So the first thing is we had toaddress his opioid dependence,
and I'm going to go on a littlerant here for just a second,
okay.
Opioid dependence happens whenany human being on planet Earth
(11:36):
is exposed to an opioid orsomething that activates the
opiate receptor, like Kratom,for about 10 to 14 days.
There is no quick fix to manageopioid dependence.
The options are we treat youwith an opioid so that you don't
withdraw, and the two we useare methadone and buprenorphine,
(11:57):
also known as Subutex orSuboxone, or you have to
withdraw.
There is nothing else.
So people will talk to youabout kratom and they'll say,
well, I don't want to be onsuboxone, because then I'm
hooked on suboxone.
Suboxone is not the problem,it's the opiate dependence that
is the problem.
Or sometimes you'll hear peoplesay, well, don't go on
(12:18):
methadone.
That's just trading oneaddiction for the other.
That's not the issue.
The issue is the opioiddependence.
Once a person is dependent onopioids, we only have two
treatments.
Like I said, we can eithermanage their dependence with
methadone or buprenorphine, orthey have to go through
withdrawal.
That's it.
We can wean people off ofmethadone or buprenorphine, but
(12:43):
they still have to go throughwithdrawal.
In other words, weaninginvolves stretching out the
withdrawal over as long as theweaning period is, and so I just
want to be very clear.
The issue is the opioiddependence.
So for this patient, I had toget him to where he wasn't sick
all the time.
So I put him on buprenorphine.
He had a fantastic response.
He took eight milligrams ofbuprenorphine in the form of
(13:06):
Suboxone twice a day.
No more withdrawal Great.
I also put him on someadamoxetine, also known as
Drotera.
That's a non-addictivemedication for ADHD.
He had a very good responsethere as well.
Now he did not really want tobe on Suboxone or buprenorphine
every day, so I transitioned himto long-acting injectable
(13:28):
buprenorphine.
What is this stuff?
It's an injection that youreceive once a month under your
skin that releases the medicine,buprenorphine, over about four
to six weeks.
So, in other words, instead oftaking a medicine every day to
stay out of withdrawal, you geta shot once a month to stay out
of withdrawal.
It works amazing.
(13:48):
And there are two products.
I have no financial ties tothem.
One is Berksadi, that's onebrand.
The other is Sublocade, that'sthe other brand.
In his case, I used Sublocadeand he did great.
Used sublocate and he did greatuntil he relapsed.
(14:10):
So I tell my patients when theyrelapse, you are not in trouble,
it means you need anotherappointment with me right.
I'm treating their addiction.
Relapse can be part ofaddiction, so when they relapse,
I need to talk to them.
We've got to figure out whatwent wrong.
It's almost like we do adebrief like what went wrong, to
talk to them.
We've got to figure out whatwent wrong.
It's almost like we do adebrief like what went wrong and
what we found.
And I have to give credit forone of the other addiction
doctors in my practice, the verylovely Dr Reb Close, who I
(14:34):
happen to be married to.
We talk about these sort ofcases all the time and she
created this little catchphrasethat really helps me, and she
describes her addiction patientsas the way their brain works.
It's feel something, takesomething right.
What is addiction?
Fundamentally, people usesubstances to regulate how they
(14:54):
feel, and what I need to getthem to do is to learn to
self-regulate without substances.
Okay, so this patient was usedto taking alcohol when he didn't
feel good.
He's in recovery.
He's used to using kratom whenhe doesn't feel good, and when
he was on the shot and wasn'ttaking suboxone every day, he
(15:14):
didn't have something to takewhen he didn't feel good, so he
went back to kratom.
So what we actually did for himis.
We gave him a little baby, tinydose of buprenorphine again.
That's the medicine in Suboxoneor Subutex to take when he was
having negative feelings orneeded something.
So the shot provided him with astable dose of buprenorphine.
(15:35):
So he didn't withdraw.
He took his adamoxetine orStratera for his ADHD and if he
was having a bad day or had abreakthrough craving he would
take an extra dose of a smallamount of buprenorphine in the
form of, actually, subutex.
That was his preferred productand with that I was actually
able to keep him in recovery asof December.
(15:57):
That was the last time he used.
I'm seeing him this week.
He's doing great.
He's about four months sober.
Before we wrap up, a huge thankyou to the Montage Health
Foundation for backing mymission to create fun, engaging
education on addiction and ashout out to the nonprofit
(16:17):
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdosesTo those healthcare providers
out there treating patients withaddiction.
You're doing life-saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto learn about addiction.
(16:39):
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together, we can make it happen.
Thanks for listening andremember treating addiction
saves lives.
I'll see you next time.
Welcome to the Addiction Medicine Made Easy
Podcast.
Hey there, I'm Dr Casey Grover,an addiction medicine doctor
based on California's CentralCoast.
(00:22):
For 14 years I worked in theemergency department, seeing
countless patients strugglingwith addiction.
Now I'm on the other side ofthe fight, helping people
rebuild their lives when drugsand alcohol take control.
Thanks for tuning in.
Let's get started.
Today we are going to betalking about kratom.
(00:43):
Now Kratom gets a lot ofairtime on my podcast and it's
actually because I am seeingmore and more of it in my
addiction medicine practice.
I've had several patientsreferred to me in just the past
few weeks who use Kratom, andthey are so relieved to hear
that I have a lot of experiencein treating patients with kratom
(01:04):
use disorder.
Earlier this month, I was askedto speak as a part of a virtual
conference on the topic ofopioids and I chose to speak
about kratom.
The lecture involved two partsFirst, an overview of kratom,
which we have covered in detailon this podcast, but the second
was a case presentation.
(01:25):
And just in case you don't knowwhat a case presentation is,
it's where doctors and otherhealthcare providers discuss a
patient's care in ade-identified fashion to learn
about the patient's conditionand treatment and I find, as a
doctor, that going through acase like this is very
educational.
(01:45):
In fact, my favorite lecturesin medical school were
presentations where the lecturerwould describe a patient's
condition and use the patient'sexperience, diagnosis and
treatment to teach us.
So I recorded the second partof the lecture and I wanted to
share it with all of you.
So here we go with a casepresentation of a patient I have
(02:08):
treated who uses Kratom.
Okay, so we are going to do acase presentation for a patient
I treated who was using Kratom.
I've changed some of thedetails, just so nothing about
this case is recognizable, butthis is someone that I treated
myself and I will go throughtheir experience getting off of
(02:30):
Kratom.
So this is a 38-year-old malethat presented to me in the
outpatient clinic setting.
The patient had completed ahigh school education and I
practice medicine in MontereyCounty.
We make lots of agriculture, sothere's a lot of fairly rural
areas around us and thisparticular individual lived in a
rural area on a family ranchand was very isolated.
(02:53):
He had his own online autoparts business.
He would basically go to awrecking yard and collect
functional parts and then sellthem in a secondhand fashion
online.
Had family that was supportiveof him, but not anything local,
so really didn't have a lot oflocal human connection or
support.
The patient came to me, we didour first intake visit and he
(03:15):
had a history of alcohol usedisorder but was in remission.
He had gotten successfullytreated for alcohol use and he
presented asking for help withKratom.
And you know he'd made anappointment with one of the
other doctors in the practiceand the doctor was like I really
don't know anything aboutKratom, go see Dr Grover.
And so I walked into clinic andthe office staff came up to me.
(03:37):
They're like Dr Grover, youhave a new Kratom patient today.
Do you know anything aboutKratom I like?
Well, hopefully a little bit.
So he was particularlyfrustrated that no one seemed to
know how to help him and he hadbeen using kratom for well over
a year and, as we see with mostsubstances, he had developed
(03:57):
both dependence, which leads towithdrawal when he stops, and
then tolerance, and just aDependence is when you use a
substance regularly and yourbrain chemistry changes and then
when you stop using thesubstance you feel withdrawal.
So for kratom that's opioidwithdrawal, nausea, vomiting,
diarrhea, restlessness, bodyaches, chills, goosebumps, very
(04:17):
uncomfortable.
The other thing is tolerance,which is that, again, when a
person uses a substanceregularly, their brain chemistry
changes and it means thatbasically the brain needs more
of the substance to feel thesame effects over time.
We see that with alcohol,people say they can quote hold
their liquor.
That means they have toleranceto alcohol.
So for him he was just I'm sodone with Kratom.
(04:40):
It doesn't work anymore.
I'm taking more and more.
I'm sick all the time.
So he made an appointment to beseen Again in terms of his
substance use history.
He was successfully treated foralcohol use disorder in 2012.
I don't have further details onthat, I don't know if it was
residential treatment and again,he had just decided to use
Kratom on his own, had seenescalating use and had tried to
(05:02):
stop on his own with really badwithdrawal symptoms, and so he
was referred to a psychiatristand was referred to my clinic.
He initially saw one of ourpain doctors, because my
practice is both pain medicineand addiction medicine, and the
pain doctor was just man, I'mnot sure you know, go see
addiction medicine.
And then he was able to connectwith me Medications.
The patient had a history, as Imentioned, of alcohol use
(05:25):
disorder and had been put ontopiramate, also known as
topamax.
There was a history ofmigraines so there probably was
double duty with the topiramatethere.
Just a level set.
Topiramate can be used formigraines but can be used to
reduce the desire to usesubstances.
The patient was also ondesvenlafaxine I apologize for
the typo there, that's genericfor Prostique to help with some
(05:47):
underlying depression, and thenthe psychiatrist had put him on
ritazapine, also known asRemeron for sleep.
Medical history was notable fordepression as well as anxiety
and attention deficit,hyperactivity disorder or ADHD.
We'll come back to that in justa little bit.
Otherwise, no medical history,just psychiatric.
In terms of what was triedbefore medication.
(06:12):
He tried just to wean off ofKratom.
He tried to use less and lessevery day and just had
debilitating withdrawal.
And that's a pretty commonexperience as to what I hear
from my patients.
Most of them, once they realizethey're dependent, think uh-oh,
I got to get off of this stuff.
And he was really not able tobecause of withdrawal symptoms
(06:32):
and he was using Kratom multipletimes a day.
Ultimately, his psychiatrist,to address underlying anxiety
and depression, referred him toa therapist which he was seeing.
My medical workup on the day Isaw him was pretty simple.
I did a urine drug test and itwas positive for Kratom and
negative for any othersubstances.
Just to level set, if you get aurine drug test from Amazon or
(06:55):
from Rite Aid or Walgreens, mostof these will not test for
kratom and kratom, because it'sstructurally dissimilar to
opiates, will not come uppositive.
So in my lab we actually had toadd kratom specifically as a
substance.
And this comes up at thehospital not infrequently.
Someone gets admitted to thehospital for, say, appendicitis.
They disclose that they've got,say, an alcohol history.
(07:17):
A urine drug test is ordered,they're test negative and then
day two of the hospitalizationthey're completely miserable and
then they say oh, by the way,I'm on kratom.
It really doesn't pop up on aurine drug test unless you're
specifically testing for kratom.
All right.
So on our first visit we wantedto level set what are the goals
(07:37):
that we want to achieve, and hewanted to get off of kratom and
remain abstinent from it, and Iwas 100% on board with that.
So in terms of frustrations orbarriers or struggles that he
had, the biggest one is that hedidn't really meet a medical
(07:58):
provider that was informed aboutKratom to be able to help him.
He had asked multiple times ofhis regular doctor, they sent
him to psychiatry.
The psychiatrist wasn't reallyfamiliar with it.
He was ultimately sent to mypractice and because he
mentioned having pain as areason why he was using Kratom,
they sent him.
He was ultimately sent to mypractice and because he
mentioned having pain as areason why he was using Kratom,
they sent him to the pain sideof the practice.
They weren't sure, so they senthim to me.
(08:19):
So it was actually weeks, ifnot months, after he asked for
help before he was able to getto me.
And, as I mentioned, in mypractice we have two addiction
doctors and then one doctorwho's addiction-focused, and
between the three of us, I'mreally the Kratom geek.
So this actually happened.
On Monday, a Kratom usedisorder patient was referred to
one of the other doctors, whohas actually re-referred them
(08:41):
back to me.
So yeah, I mean considering youcan walk into a smoke shop and
buy it.
We probably, as a medicalcommunity, need to do better
education around Kratom.
The next part to me is reallyfascinating, which is let's talk
about the difference betweengoing and buying Kratom and
(09:01):
going to see a medicalprofessional, and I have to give
kudos to my colleagues who dothe Addiction Medicine Journal
Club podcast, drs John Keenanand Dr Sonia Deltredici.
I've done a couple of jointepisodes between our two
podcasts about Kratom, and DrSonia was on it, so she, like me
(09:22):
, was just hey, grover, I heardyou went into a smoke shop Like
I got to do that too, and herpoint when she walked into a
smoke shop was this is so easyand convenient to get.
Let's imagine that you haveanxiety and ADHD and your back
hurts.
Okay, you can go into a smokeshop and buy Kratom as much as
(09:45):
you want and walk out in just afew minutes.
If you need more, they don'tdeny you early refills.
You just go get more.
It's very consumer-friendly.
And same thing with goingonline and going to Kraken
Kratom you just put in yourcredit card and the stuff shows
up.
Now let's imagine you haveanxiety and ADHD and your back
(10:07):
hurts and you're going to gothrough the medical community.
Okay, let's say you have a goodprimary care position.
You might call them and ittakes three weeks to get an
appointment and then you mighthave a copay and then you got to
sit in the waiting room andthen you have to talk to the
doctor and the doctor mightorder tests and you've got to
get those tests done.
And then you got to see thedoctor again.
And then they're going to orderyour medicines and, oops, the
(10:30):
pharmacy's out of stock and oh,you've got to co-pay.
And then, oops, you needed ahigher dose and you can't get a
hold of the doctor to get arefill.
Like it's fairly inconvenientto go through the traditional
medical channels as compared tojust walking to a smoke shop and
buying Kratom.
So kudos to Dr Sonia Deltrenicifor her wisdom around that,
(10:50):
because that was a really goodpoint.
And many people who use Kratomdo not have a lot of confidence
in the traditional medicalcommunity, which is why they go
to Kratom.
And then the last point forthis patient is he has untreated
ADHD, which I had to work on.
So what has he tried beforethat didn't work?
We talked about the fact thathe tried to wean himself off the
Kratom and just wasn't able todo it, which is fairly common
(11:12):
with all of my opioid usedisorder patients.
My patients using fentanyl justcan't wean themselves off.
So what did I do?
So the first thing is we had toaddress his opioid dependence,
and I'm going to go on a littlerant here for just a second,
okay.
Opioid dependence happens whenany human being on planet Earth
(11:36):
is exposed to an opioid orsomething that activates the
opiate receptor, like Kratom,for about 10 to 14 days.
There is no quick fix to manageopioid dependence.
The options are we treat youwith an opioid so that you don't
withdraw, and the two we useare methadone and buprenorphine,
(11:57):
also known as Subutex orSuboxone, or you have to
withdraw.
There is nothing else.
So people will talk to youabout kratom and they'll say,
well, I don't want to be onsuboxone, because then I'm
hooked on suboxone.
Suboxone is not the problem,it's the opiate dependence that
is the problem.
Or sometimes you'll hear peoplesay, well, don't go on
(12:18):
methadone.
That's just trading oneaddiction for the other.
That's not the issue.
The issue is the opioiddependence.
Once a person is dependent onopioids, we only have two
treatments.
Like I said, we can eithermanage their dependence with
methadone or buprenorphine, orthey have to go through
withdrawal.
That's it.
We can wean people off ofmethadone or buprenorphine, but
(12:43):
they still have to go throughwithdrawal.
In other words, weaninginvolves stretching out the
withdrawal over as long as theweaning period is, and so I just
want to be very clear.
The issue is the opioiddependence.
So for this patient, I had toget him to where he wasn't sick
all the time.
So I put him on buprenorphine.
He had a fantastic response.
He took eight milligrams ofbuprenorphine in the form of
(13:06):
Suboxone twice a day.
No more withdrawal Great.
I also put him on someadamoxetine, also known as
Drotera.
That's a non-addictivemedication for ADHD.
He had a very good responsethere as well.
Now he did not really want tobe on Suboxone or buprenorphine
every day, so I transitioned himto long-acting injectable
(13:28):
buprenorphine.
What is this stuff?
It's an injection that youreceive once a month under your
skin that releases the medicine,buprenorphine, over about four
to six weeks.
So, in other words, instead oftaking a medicine every day to
stay out of withdrawal, you geta shot once a month to stay out
of withdrawal.
It works amazing.
(13:48):
And there are two products.
I have no financial ties tothem.
One is Berksadi, that's onebrand.
The other is Sublocade, that'sthe other brand.
In his case, I used Sublocadeand he did great.
Used sublocate and he did greatuntil he relapsed.
(14:10):
So I tell my patients when theyrelapse, you are not in trouble,
it means you need anotherappointment with me right.
I'm treating their addiction.
Relapse can be part ofaddiction, so when they relapse,
I need to talk to them.
We've got to figure out whatwent wrong.
It's almost like we do adebrief like what went wrong, to
talk to them.
We've got to figure out whatwent wrong.
It's almost like we do adebrief like what went wrong and
what we found.
And I have to give credit forone of the other addiction
doctors in my practice, the verylovely Dr Reb Close, who I
(14:34):
happen to be married to.
We talk about these sort ofcases all the time and she
created this little catchphrasethat really helps me, and she
describes her addiction patientsas the way their brain works.
It's feel something, takesomething right.
What is addiction?
Fundamentally, people usesubstances to regulate how they
(14:54):
feel, and what I need to getthem to do is to learn to
self-regulate without substances.
Okay, so this patient was usedto taking alcohol when he didn't
feel good.
He's in recovery.
He's used to using kratom whenhe doesn't feel good, and when
he was on the shot and wasn'ttaking suboxone every day, he
(15:14):
didn't have something to takewhen he didn't feel good, so he
went back to kratom.
So what we actually did for himis.
We gave him a little baby, tinydose of buprenorphine again.
That's the medicine in Suboxoneor Subutex to take when he was
having negative feelings orneeded something.
So the shot provided him with astable dose of buprenorphine.
(15:35):
So he didn't withdraw.
He took his adamoxetine orStratera for his ADHD and if he
was having a bad day or had abreakthrough craving he would
take an extra dose of a smallamount of buprenorphine in the
form of, actually, subutex.
That was his preferred productand with that I was actually
able to keep him in recovery asof December.
(15:57):
That was the last time he used.
I'm seeing him this week.
He's doing great.
He's about four months sober.
Before we wrap up, a huge thankyou to the Montage Health
Foundation for backing mymission to create fun, engaging
education on addiction and ashout out to the nonprofit
(16:17):
Central Coast OverdosePrevention for teaming up with
me on this podcast.
Our partnership helps me getthe word out about how to treat
addiction and prevent overdosesTo those healthcare providers
out there treating patients withaddiction.
You're doing life-saving workand thank you for what you do
For everyone else tuning in.
Thank you for taking the timeto learn about addiction.
(16:39):
It's a fight we cannot winwithout awareness and action.
There's still so much we can doto improve how addiction is
treated.
Together, we can make it happen.
Thanks for listening andremember treating addiction
saves lives.
I'll see you next time.
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