Kratom (Mitragyna speciosa): User demographics, use patterns, and implications for the opioid epidemic

Highlights

• Kratom is a Southeast Asian plant with opioid-receptor mediated effects.
• Kratom has recently emerged as a substance of abuse, with limited available data.
• Kratom is being used by White, middle-aged Americans for pain, anxiety, depression.
• Users also report using kratom to decrease opioid use, withdrawal, and craving.
• Additional research on kratom epidemiology and pharmacology is necessary.

Abstract

Methods

A cross-sectional, anonymous online survey was conducted between January and December 2017.

Results

2,798 kratom users – mean age 40 (SD = 12); predominantly White (90 %), female (61 %), and located in the US (97 %) – completed the survey. Kratom was primarily taken orally in doses of 1−3 g (49 %), with daily use (59 %) being most common. Kratom was used for pain (91 %), anxiety (67 %), and depression (65 %), with high ratings of effectiveness. 1,144 (41 %) used kratom to stop or reduce prescription or illicit opioid use, citing decreased opioid withdrawal and craving related to kratom use, with 411 reporting >1-year continuous abstinence from opioids attributed to kratom use. Roughly one-third of respondents reported adverse effects of kratom, largely rated as mild in severity and lasting ≤24 h. Seventeen participants (0.6 %) sought treatment for adverse effects. Fifty-six individuals (2 %) met DSM-5 criteria for a past-year moderate or severe kratom-related substance use disorder (SUD). When asked how troubled they felt regarding their kratom use, the mean (SD) rating was 3.2 (9.8) on a scale from 0 to 100.

Conclusion

Kratom is used among White, middle-aged Americans for symptoms of pain, anxiety, depression, and opioid withdrawal. Although regular use was typical, kratom-related SUD and serious adverse effects were uncommon. Additional research on kratom epidemiology and pharmacology is imperative in light of the present opioid epidemic.

Keywords

Kratom
Mitragyna speciosa
Mitragynine
Opioids
Opioid use disorder
Harm reduction

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