Abstract
Kratom products available in the United States are becoming increasingly diverse both in terms of content and in terms of how they are marketed. Prior survey research indicates that kratom has been primarily used in the US to self-treat anxiety, depression, pain, fatigue, and substance use disorder (SUD) symptoms. Kratom is also well-known for its use as a short- or long-term full opioid agonist substitute. Therefore, use may be greater in regions particularly impacted by addiction to prescription opioids. Use may also be greater in demographic groups targeted by media outlets (such as specific podcasts) in which kratom is touted. Here, we aimed to determine whether lifetime and past-year kratom use were associated with region of residence and with being young, White, post-secondary educated, and employed. To strengthen confidence in our findings, we analyzed data from two sources: our own crowdsourced online convenience sample and the 2019 National Survey on Drug Use and Health (NSDUH). In our sample (N = 2,615), 11.1% reported lifetime and 6.7% reported past-year kratom use, and the odds of kratom use were higher among people who were White, younger, at least high school educated, employed, and above the poverty line, as well as those reporting nonmedical opioid use, past-year SUD, or lifetime SUD treatment; residence was not a significant predictor. In NSDUH data, suburban residence and other demographic factors, concordant with those from the crowdsourced sample, were associated with kratom use. Taken together, the findings support a general “White middle-class suburban” profile of the modal kratom user, but more research is needed to understand it. In the interim, focus should be on our finding that lifetime nonmedical opioid use was associated with an up to five times greater likelihood of past-year kratom use, suggesting that drug-use history may presently be the strongest predictor of kratom use.
Highlights
Kratom, the lay term referring to the Mitragyna speciosa Korth [Rubiaceae] tree native to Southeast Asia, has leaves that contain at least over 40 alkaloids with pharmacologic activity
The subset of participants who reported lifetime and past-year kratom use contained a higher proportion of male, high school-educated people, people making below United States (US) poverty line annual incomes, people living in non-metro counties, people having ever received substance use disorder (SUD) treatment, and people meeting criteria for a severe SUD
We aimed to determine whether rurality was associated with lifetime or past-year kratom use while controlling for potentially confounding factors, and, at the same time, whether there was an emerging subpopulation of kratom users who we believe are increasingly being exposed to kratom-related media content, namely younger, White, educated, employed people
Summary
The lay term referring to the Mitragyna speciosa Korth [Rubiaceae] tree native to Southeast Asia, has leaves that contain at least over 40 alkaloids with pharmacologic activity. Most notable among these with dose-dependent psychoactive effects are mitragynine (MG) and 7-hydroxymitragynine (7-HMG). Both alkaloids bind to and partially agonize the mu-opioid receptor, producing analgesic, stimulatory, and anxiolytic effects (Kruegel and Grundmann, 2018; Kruegel et al, 2019; Obeng et al, 2021; Todd, et al, 2020). Exploratory surveys in the US seeking to better understand kratom use, motivations, and effects have found that many people report using kratom to “self-manage” chronic pain, fatigue, psychiatric, and symptoms of substance use disorders (SUDs), including opioid-withdrawal symptom relief and/or as a replacement for full opioid agonists (Bath et al, 2020; Boyer et al, 2008; Coe, et al, 2019; Garcia-Romeu, et al, 2020; Grundmann, 2017; Smith and Lawson, 2017; Swogger and Walsh, 2018)
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