Buprenorphine-Naloxone in the Setting of Kratom Withdrawal, Opioid Use Disorder, and Stage IV Lung Adenocarcinoma

Management of cancer-associated pain warrants consideration of many factors, including characterization and etiology of the pain, socioeconomic factors, medication tolerance, and substance use history. Kratom (Mitragyna speciosa) is an herbal substance with stimulant and analgesic properties that is becoming a popular drug in the United States. In this report, we present a patient with a history of opioid use disorder (OUD) who had been using high doses of kratom to alleviate progressive chest pain and dyspnea secondary to newly diagnosed stage IV lung adenocarcinoma. He underwent kratom withdrawal shortly after his index admission and was reluctant to continue full opioid agonists given his history of OUD and complex living situation. His kratom withdrawal and cancer-associated symptoms were successfully managed with buprenorphine-naloxone. Providers should obtain a careful history of novel substance use such as kratom. Furthermore, buprenorphine-naloxone is a safe and effective option to simultaneously manage kratom withdrawal and cancer-associated pain.