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

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.