Evidence mapPaperPMID 41487756Full record

ArticleCureus2025

7-Hydroxymitragynine and Nicotine Pouch Withdrawal Syndrome: A Case Report.

Akshay Sharma, Beena S Nair, Sudhakar Pemminati

Abstract readCase Reports
In one paragraph

Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors.

Akshay SharmaDepartment of Biomedical Education, California Health Sciences University College of Osteopathic Medicine, Clovis, USA.
Beena S NairDepartment of Psychiatry, University of California San Francisco, Fresno, USA.
Sudhakar PemminatiDepartment of Biomedical Education, California Health Sciences University College of Osteopathic Medicine, Clovis, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Novel psychoactive substances (NPSs) such as kratom and oral nicotine pouches present new challenges in clinical management, particularly regarding dependence and withdrawal. We report a case of severe withdrawal from concentrated 7-hydroxymitragynine (7-OH), a potent kratom alkaloid, and high-dose oral nicotine pouches, following long-term use in a patient with a history of polysubstance use. The patient developed acute, overlapping opioid-like (insomnia, myalgia, anxiety, diaphoresis, and gastrointestinal upset) and nicotinic (intense craving, irritability, restlessness, and difficulty concentrating) withdrawal symptoms. These symptoms rapidly escalated to severe agitation, psychosis, and respiratory compromise requiring intubation and intensive care. The clinical course was further complicated by failed outpatient management, precipitated withdrawal after initiation of buprenorphine, and eventual discharge against medical advice (AMA). This case report highlights the diagnostic and therapeutic complexities of managing withdrawal from novel psychoactive substances, the need for multidisciplinary and flexible approaches, and the importance of systematic assessment and harm reduction as these products become increasingly prevalent.

Indexed as

7-hydroxymitragyninekratom addictionnicotine withdrawalpsycho-behavioralpsychodiagnostics and therapy

Identifiers

PMID41487756
PMCPMC12758578

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.