S3 Ep25: #533: What’s the Tea on Kratom?S3 Ep25: #533: What’s the Tea on Kratom?
The Curbsiders Addiction Medicine Podcast
The conversation focuses on understanding kratom and potent mitragynine-derived products, and on practical ways clinicians can identify and treat related withdrawal and dependence. It highlights detailed history-taking, use of buprenorphine and comfort medications, and a person-centred, collaborative approach to care.
1:05:36•20 Jul 2026
Kratom, 7-OH and Beyond: Making Sense of Mitragynine Use in Clinical Practice
Episode Overview
- Kratom is a mix of alkaloids, with mitragynine and 7-OH producing opioid-like effects that vary by dose and product type.
- Synthetic 7-OH and related compounds are far more potent than kratom powder and often lead to severe, frequent withdrawal and high financial cost.
- A careful history – exact product, dose, form, source and reasons for use – is crucial for assessing risk and planning treatment.
- Standard opioid withdrawal strategies, including clonidine, ondansetron and buprenorphine, can be used for mitragynine-derived withdrawal with attention to timing and dose.
- Patient-centred care, flexible taper planning and motivational interviewing help address stigma, ambivalence and long-term treatment decisions.
“"I tell patients, like, you know, just give yourself some grace. You’re giving your brain a rest by getting on this medication."”
How do different strategies aid in addiction recovery? This episode of The Curbsiders Addiction Medicine Podcast takes a clinical yet chatty look at kratom and mitragynine-derived products, with a clear focus on helping frontline clinicians make sense of a very messy drug landscape.
You’ll hear Drs Carolyn Chan and Zina Huxley-Reicher sit down with Chicago-based addiction medicine physician Dr Jonathan Tanawan to break down what kratom actually is: a plant with multiple alkaloids rather than a single drug, producing a "hodgepodge of different effects" from mild stimulation to full opioid-like sedation.
They contrast traditional kratom leaf with potent synthetic products such as 7-hydroxymitragynine (7-OH), MGM-15 and mitragynine pseudoindoxyl, and talk through why these stronger compounds are showing up in kava bars, smoke shops, gas stations and online as "energy boosters". The conversation is aimed squarely at clinicians who are starting to see patients with escalating kratom or 7-OH use, opioid-style withdrawal, and big financial and functional consequences.
Dr Tanawan walks through practical history-taking tips – clarifying exactly which product, dose, form and source a person is using – and highlights common reasons people start, from chronic pain and anxiety to concentration issues and relapse from other opioids. Management is covered in detail, using familiar opioid withdrawal tools such as clonidine, ondansetron and buprenorphine.
The team compare kratom to "pre-fentanyl" inductions and 7-OH to much higher-potency opioids, with careful timing to avoid precipitated withdrawal and realistic dosing targets that often reach 16–32 mg of buprenorphine per day. Throughout, there’s a strong emphasis on person-centred care: letting patients choose their own language for their use, using motivational interviewing, and being willing to "learn alongside your patients" in this fast-shifting area of practice.
If you’re seeing kratom in your clinic and feeling a bit lost, this conversation might be the clinical catch-up you’ve been waiting for. How are you preparing yourself to recognise and support patients using these emerging opioid-like products?
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