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

Drug Alcohol Depend. 2020 Mar 1;208:107849. doi: 10.1016/j.drugalcdep.2020.107849. Epub 2020 Feb 3.

Abstract

Background: Kratom, a Southeast Asian plant with opioid-receptor mediated effects, has emerged as a potential substance of abuse, with limited data on its use and effects. This study characterized kratom user demographics, use patterns, and perceived drug effects.

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: Harm reduction; Kratom; Mitragyna speciosa; Mitragynine; Opioid use disorder; Opioids.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Analgesics, Non-Narcotic / isolation & purification
  • Analgesics, Non-Narcotic / therapeutic use*
  • Analgesics, Opioid / adverse effects
  • Analgesics, Opioid / therapeutic use
  • Anxiety / drug therapy
  • Anxiety / epidemiology
  • Anxiety / psychology
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Mitragyna*
  • Opioid Epidemic / prevention & control*
  • Opioid-Related Disorders / drug therapy*
  • Opioid-Related Disorders / epidemiology
  • Opioid-Related Disorders / psychology
  • Pain / drug therapy
  • Pain / epidemiology
  • Pain / psychology
  • Plant Extracts / isolation & purification
  • Plant Extracts / therapeutic use*
  • Surveys and Questionnaires*
  • Young Adult

Substances

  • Analgesics, Non-Narcotic
  • Analgesics, Opioid
  • Plant Extracts