When Street Drugs Stop at Hospital Doors: A Closer Look at Kratom and Phenibut Withdrawal

The use of synthetic psychotropics is rapidly increasing across America, sometimes recreationally, sometimes as prescribed medicine. Medical literature systematically discusses Kratom, a synthetic opioid used for opioid dependence, withdrawal and mood enhancement. However, the research gap remains wide when faced with treating individuals using Phenibut, a GABA derivative used for its anxiolytic effect, and also known to have a synergistic effect with Kratom to produce euphoria. We present the case of a 37-year-old Caucasian female with history of opioid and alcohol use disorder, admitted to a psychiatric hospital for worsening depression and suicidal ideation with a plan to slit her wrists. Previously, she was prescribed buprenorphine (Subutex) for opioid dependence, though discontinued it due to cost. Consequently, she was self-treating her opioid dependence with Kratom for one year prior to presentation. As a result of the stimulating and anxiety provoking effects of Kratom during the day, patient started to use Phenibut as an anxiolytic and for better sleep at night. Last use of these substances was the day before admission. On presentation, patient endorsed nausea, rhinorrhea, diarrhea, anxiety, heart palpitations and poor sleep. Patient was closely monitored and managed appropriately based on the limited available evidence. Through this case and review of current literature, we explore the use of multiple unregulated psychotropic substances - Kratom and Phenibut. We discuss the mechanism of action, the effects when used both individually and together, and how to monitor and manage patients undergoing withdrawal from each substance.https://scholarlycommons.henryford.com/merf2019caserpt/1074/thumbnail.jp