Citation
Mulloy K, Nawab A, Patel D — University of Miami
Successful Buprenorphine Microinduction in Patient With Severe Kratom (7-OH) Use Disorder. Poster presentation, American Society of Addiction Medicine 57th Annual Conference, 2026.
Read the original abstract at ASAM →
Authors: Kavan Mulloy, MD (PGY2 Psychiatry Resident, University of Miami); Aria Nawab (Medical Student, University of Miami); Dhruti Patel, MD (Assistant Professor of Psychiatry, University of Miami).
The patient
A 2-year history of high-dose 7-OH use.
The patient reported using 30 to 50 mg of 7-OH product daily for the past two years. This represents the kind of concentrated, isolated 7-OH exposure seen with tablets, shots, and drink products that have proliferated since 2024.
Importantly: this is not occasional natural kratom leaf use. At these daily doses of isolated 7-hydroxymitragynine — a compound the FDA describes as an opioid product more potent than morphine in some assays — substantial opioid receptor occupancy and physiological dependence are expected.
What was done
Low-dose buprenorphine microinduction, starting Day 1.
Rather than the traditional approach of waiting for objective withdrawal before starting buprenorphine, clinicians used a microinduction strategy: very small doses of buprenorphine introduced on Day 1, then gradually titrated upward.
By the time the patient was discharged, the total buprenorphine dose was 12 mg per day, delivered as Suboxone (buprenorphine 4 mg / naloxone 1 mg) three times daily.
Total inpatient stay: 5 days.
Outcome
Cravings controlled. Residual anxiety. Followed up.
At follow-up, the patient reported continued control of cravings. He also reported residual anxiety symptoms, and agreed to pursue psychotherapy for anxiety management.
Note: this is the honest version. The case did not erase every symptom. Cravings were controlled and the patient stayed engaged in care — which is the goal of medication treatment. Residual anxiety is common during early recovery and is best addressed with a parallel mental health plan, not by escalating opioid medication.
Why it matters
Why this case is significant.
Before this report, the published literature on buprenorphine for kratom and 7-OH dependence consisted of case reports and small series — mostly on kratom leaf, not on concentrated 7-OH products.
- First-of-its-kind: the first published case to specifically describe buprenorphine microinduction for severe, isolated 7-OH use disorder.
- Microinduction as alternative: microinduction avoided the need to wait for spontaneous withdrawal before starting buprenorphine — a real barrier for patients who relapse during the wait.
- Clinically transferrable: the protocol used — small doses, gradual titration, target around 12 mg daily — is consistent with how buprenorphine is used for high-potency opioid dependence more broadly.
- Honest reporting: the case describes both what worked (cravings) and what did not fully resolve (anxiety). This is how good clinical evidence reads.
MyStreetHealth offers this approach
We treat kratom and 7-OH dependence with buprenorphine, including microinduction in selected cases.
If you have been using concentrated 7-OH products or kratom and want to stop, a licensed physician can discuss whether buprenorphine — classical induction or microinduction — is appropriate for your situation.
Same-day telehealth visits often available. Direct-pay — no insurance required. Licensed in 10 states.
How MyStreetHealth thinks about this
This is one case, not a prescription.
One case report is hypothesis-generating, not definitive. It does not prove microinduction is the right strategy for every 7-OH patient. It does, however, add to a growing body of evidence that:
- Concentrated 7-OH products produce opioid-type dependence severe enough to warrant medical treatment.
- Buprenorphine, including with microinduction strategies, is a reasonable clinical option in selected patients.
- Withdrawal from 7-OH can be managed clinically; patients do not have to white-knuckle it alone.
What the right approach is for a specific patient depends on dose, duration, other substances, medical history, mental health, pregnancy, and prior attempts to stop. That is a clinical conversation, not a one-size-fits-all answer.
Related
Further reading on this site.
Medical note
This page summarizes a single published case report for educational purposes. It is not a treatment plan, and it does not replace medical care. The decision to use buprenorphine — with or without microinduction — for kratom or 7-OH dependence requires individual clinical evaluation. Buprenorphine for kratom/7-OH is off-label use.