Case Report: Pharmacist-Led Induction of Sublingual Buprenorphine/Naloxone for Kratom Use Disorder.

Kratom is a psychoactive herbal substance derived from a tree indigenous to Southeast Asia that provides both stimulant and analgesic (opioid agonist) effects. It is currently available in most areas of the United States and has potential for misuse/abuse. The proper treatment of kratom use disorder is not widely defined, but prior case reports and case series purport that sublingual buprenorphine/naloxone is an effective treatment. Pain management clinical pharmacist practitioners (CPPs) are uniquely equipped to work as independent providers and implement the treatment of many disease states including kratom use disorder. We present a case report of a patient who was referred to the CPP-run pain pharmacotherapy clinic for management of chronic lower back pain and shoulder pain in the setting of long-term kratom use. While collaborating with the patient's primary care provider, it was determined that buprenorphine/naloxone would be started to treat his chronic pain and kratom use disorder/dependence. The pain CPP led, planned, and performed the induction of buprenorphine/naloxone and frequently followed up with the patient to reassess his symptoms. The buprenorphine/naloxone, along with other pharmacologic and nonpharmacologic treatments, successfully managed his pain and other symptoms without significant withdrawal or return of cravings.