“Jason Kirby, MD, discussed the emerging public health threat posed by 7-hydroxymitragynine (often marketed as kratom) and its intersection with psychiatric comorbidities in patients with substance use disorder (SUD).
Kirby described kratom as a plant-derived substance indigenous to South America whose alkaloid mitragynine produces stimulant effects at lower doses and opioid-like effects at higher doses, via mu-opioid receptor binding. He identified a newer synthetic variant, 7-hydroxy kratom, as a particularly dangerous development, noting that it has proliferated rapidly over the past 2 years and is now widely available in vape shops across states where it remains legal. Kirby emphasized the compound’s extraordinary potency: “7-hydroxy binds to these mu-opioid receptors about 13 times the potency of morphine,” producing profound withdrawal syndromes upon abrupt cessation that closely resemble opioid withdrawal.
Kirby expressed concern that while many states have moved to ban 7-hydroxy kratom, most have failed to simultaneously expand treatment access for those already dependent. He urged clinicians to recognize its addictive potential and to connect patients with medical management, noting that pharmacological options exist to ease withdrawal. He illustrated addiction’s financial toll on patients with a clinical vignette: “I actually had a patient who took out a second mortgage on their house, and ended up spending that within 6 months, just on kratom,” he explained.
Kirby also broadened his discussion to psychiatric comorbidity. He noted that approximately 50% of patients with SUD have an undiagnosed or undertreated psychiatric illness, and roughly 70% carry a trauma history—both of which are significant predictors of relapse. At his organization, psychiatric screening is performed at admission to residential and outpatient programs, with treatment pathways encompassing both pharmacotherapy and cognitive-based interventions, he said. Screening and whole-patient care is essential in the era of growing synthetic drug availability, Kirby emphasized.
Dr Kirby is a psychiatrist and chief medical officer of Recovery Centers of America.”
See the full article and watch the full video here.
