 Kratom, an herbal supplement popular for recreational use within the US, exerts opioid-like effects and is commonly used for self-treatment of pain, withdrawal management from opioids, and euphoria. However, it has been associated with drug-related hepatic injury, raising concerns about patient safety and monitoring. The potential for additive liver toxicity must be considered when Kratom is used concurrently with hepatotoxic medications. This case report describes a case of Kratom-induced liver inflammation complicated by opioid withdrawal precipitated by initiation of IM naltrexone in a patient using Kratom without other opioids, highlighting potential complications that may arise with Kratom use and considerations that should be taken prior to initiating naltrexone in Kratom users. This article was authored by Amy N. Jensen, PharmD, BCPS, BCPP, Gwynne Neutruong, PharmD, BCPS, Melanie Jameson, PharmD, and others.