1310 - Managing complications of Kratom Dependence in inpatient rehabilitation: A Case Report

A 44-year-old male with hypothyroidism, chronic pain after a motor vehicle accident, six years of kratom dependence, morbid obesity, and depression presented with respiratory distress. He was diagnosed with acute-on-chronic diastolic heart failure and acute respiratory failure requiring intubation. Prior to this admission he was so severely deconditioned that he was essentially dependent for bed mobility and transfers and rarely left his apartment. The acute hospital course was complicated by severe hypothyroidism and kratom withdrawal, managed with opioids. Due to profound functional deficits, he was transferred to inpatient rehabilitation. Pain management challenges initially limited therapy participation. Buprenorphine was initiated with notable improvement in pain control and engagement. Other complications included opioid-induced constipation, depression, substance use history, and psychosocial barriers. By discharge, he progressed to supervision for bed mobility, partial transfer assistance, and ambulating 10 feet, improving mood and independence.

Discussions: Kratom (Mitragyna speciosa) contains mitragynine and 7-hydroxymitragynine, alkaloids acting on mu-opioid, adrenergic, and serotonergic receptors. Often used for self-managing pain or withdrawal, kratom has dose-dependent stimulant and sedative effects. Its abuse potential and systemic effects remain under-researched. Emerging evidence suggests links to cardiotoxicity and thyroid suppression. In this case, long-term kratom use likely contributed to early heart failure and refractory hypothyroidism. Pain was amplified by kratom withdrawal. Buprenorphine, a partial mu-opioid receptor agonist, provided effective pain relief without escalating opioid-related risks, enabling rehabilitation progress. Aggressive neuropsychological support was initiated to address psychosocial stressors.

Conclusions:

This case underscores the complexity of managing pain and medical problems potentially exacerbated in kratom-dependent patients. Buprenorphine was effective in addressing withdrawal-amplified pain, supporting participation in rehabilitation. Clinicians should recognize and manage kratom’s potential systemic effects within a multidisciplinary approach for patients with overlapping pain, substance use, and medical comorbidities.