Bridge / NEAT National Kratom Survey Analysis

Treating Kratom / 7-OH / Pseudoindoxyl Use Disorder • February 2026

n = 45 U.S. Clinicians • Real-World Treatment Insights

Clinicians
ED • Outpatient • Inpatient

All Care Settings (select-all)

Emergency Department (ED): 56% (25)

Outpatient clinic: 53% (24)

Inpatient hospital: 18% (8)

Telehealth / telemedicine: 11% (5)

Other (EMS, street medicine, etc): 7% (3)

Patient Volume Treated

1–5 patients: 40% (18)

6–20 patients: 33% (15)

21–50 patients: 20% (9)

51–100 patients: 2% (1)

Geographies

California, Colorado, Connecticut, Idaho, Louisiana, Massachusetts, Michigan, Minnesota, Missouri, Montana, New Hampshire, New Jersey, New Mexico, New York, North Carolina, Ohio, Oregon, Pennsylvania, Washington

Total states: 19

🌿 vs 🔥 Withdrawal Severity Differs Dramatically by Product

Traditional Leaf Kratom

Milder

78% (35) Hydrocodone-like

7-OH / Pseudoindoxyl

Notably More Severe

62% (28) Fentanyl-like • faster onset • more anxiety

Consensus: 7-OH/pseudo withdrawal is faster, more intense, and requires treatment similar to fentanyl withdrawal

Typical Maintenance Buprenorphine Dose by Product Type

🌿

Traditional Leaf Kratom

Most common: 8–16 mg/day

<8 mg/day 28% (13)

8–16 mg/day 62% (28)

24–32+ mg/day 10% (4)

Clinicians frequently note: “actually lower” than traditional fentanyl/heroin OUD patients

🔥

7-OH / Pseudoindoxyl

Most common: 24–32+ mg/day

<8 mg/day 5% (2)

8–16 mg/day 32% (14)

24–32+ mg/day 63% (29)

Clinicians frequently note: “somewhat higher” to “notably higher” (treat like fentanyl-era OUD)

Based on clinician reports distinguishing by product type • Higher doses for 7-OH/Pseudo driven by experienced/high-volume providers

Bup Starts & Adjuncts

✔
COWS ≥8 most common threshold (many use clinical judgment)
✔
Flexible bup starts: micro-dosing or high-dose (16–32 mg Day 1) both used
⚠
At least one occurence of precipitated withdrawal reported by 22% (10/45) of clinicians — predominantly among higher-volume clinicians performing more buprenorphine starts
✔
Adjuncts nearly universal: clonidine, ondansetron, hydroxyzine, gabapentin, methocarbamol

Experience Matters

High-volume clinicians (21–100 patients, n=10) vs Lower-volume (n=35)

9/10

Recognize 7-OH as “notably more severe”

vs 19/35 in lower-volume group

6/10

Routinely use 24–32+ mg buprenorphine

vs 8/35 in lower-volume group

8/10

Need significantly more adjunct meds

vs 14/35 in lower-volume group

Key Learning Curve: Experienced clinicians now treat traditional leaf kratom with standard approaches and concentrated 7-OH/pseudo like fentanyl-era OUD — higher doses, more adjuncts, careful bup starts.

Quotes from High-Volume Clinicians

"7OH causes much more severe and prolonged withdrawal that does not respond as well to bup as full opioids… higher doses of bup for heavy 7OH use"

— Colorado clinician (21–50 patients)

"Moved to high-dose initiation protocol… approaching it similar to fentanyl has worked better for me personally"

— New Mexico clinician (21–50 patients)

"Even higher dose: >32 mg/day"

— California clinician (21–50 patients)

Clinical Takeaways

Screen aggressively — kratom/7-OH not on standard UDS. Ask everyone.

Differentiate by product — leaf products = moderate OUD; 7-OH = high-potency, treat like fentanyl OUD.

Buprenorphine is first-line and highly effective.

Buprenorphine overwhelmingly preferred — Methadone rarely used.

Prepared from clinician survey responses • Not medical advice