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Use of Kratom, an Opioid-like Traditional Herb, in Pregnancy

Smid, Marcela C., MD, MS; Charles, Jasmin E., PA-C; Gordon, Adam J., MD, MPH; Wright, Tricia E., MD, MS

doi: 10.1097/AOG.0000000000002871
Contents: Opioids: Case Report

BACKGROUND: Kratom (Mitragyna speciosa) is an herbal preparation with opioid-like effects made from a tree native to Southeast Asia and the Pacific Islands. Increasingly, kratom is used for self-treatment of opioid use disorder and recently has been associated with a multistate outbreak of salmonellosis. Few data are available on the clinical outcomes of kratom use in pregnancy.

CASES: We present two cases of pregnant women presenting with kratom dependence. Both women presented with symptoms consistent with opioid withdrawal. Both women were initiated on opioid replacement, with successful treatment of symptoms.

CONCLUSIONS: Kratom is an emerging self-treatment for opioid use disorder in the obstetric population. Obstetric care providers should be aware of kratom and consider opioid replacement for pregnant women with kratom dependence.

Kratom dependence is an emerging phenomenon among pregnant women, and opioid replacement pharmacotherapy may be an option.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, and the Program of Addiction Research, Clinical Care, Knowledge, and Advocacy (PARCKA), Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, and Informatics, Decision-Enhancement, and Analytic Sciences Center (IDEAS 2.0), Salt Lake City VA Health Care System, Salt Lake City, Utah; and the Department of Obstetrics and Gynecology, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii.

Corresponding author: Marcela C. Smid, MD, MS, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Utah, 30 N 1900 E #2B200, Salt Lake City, UT 84312; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

Each author has indicated that he or she has met the journal's requirements for authorship.

© 2018 by the American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.