Abstract
There is limited understanding regarding kratom use among US adults. Although motivations for use are increasingly understood, typical kratom doses, threshold of (low and high) doses for perceived effectiveness, and effects produced during cessation are not well documented. We aimed to extend prior survey work by recruiting adults with current and past kratom exposure. Our goal was to better understand kratom dosing, changes in routines, and perception of effects, including time to onset, duration, and variability of beneficial and adverse outcomes from use and cessation. Among respondents who reported experiencing acute kratom effects, we also sought to determine if effects were perceived as helpful or unhelpful in meeting daily obligations. Finally, we attempted to detect any signal of a relationship between the amount of kratom consumed weekly and weeks of regular use with ratings of beneficial effects from use and ratings of adverse effects from cessation. We conducted an online survey between April-May 2021 by re-recruiting participants from a separate study who reported lifetime kratom use. A total of 129 evaluable surveys were collected. Most (59.7%) had used kratom >100 times and reported currently or having previously used kratom >4 times per week (62 weeks on average). Under half (41.9%) reported that they considered themselves to be a current “regular kratom user.” A majority (79.8%) reported experiencing acute effects from their typical kratom dose and that onset of effects began in minutes but dissipated within hours. Over a quarter reported that they had increased their kratom dose since use initiation, whereas 18.6% had decreased. Greater severity of unwanted effects from ≥1 day of kratom cessation was predicted by more weeks of regular kratom use (β = 6.74, p = 0.02). Acute kratom effects were largely reported as compatible with, and sometimes helpful in, meeting daily obligations. In the absence of human laboratory studies, survey methods must be refined to more precisely assess dose-effect relationships. These can help inform the development of controlled observational and experimental studies needed to advance the public health understanding of kratom product use.
Highlights
The plant indigenous to Southeast Asia, Mitragyna speciosa, commonly referred to among Westerners as “kratom,” has been used in the United States and other regions outside of Asia since at least 2004 (Burkill, 1935; Boyer et al, 2007; Boyer et al, 2008)
“Workers” are persons who register in Mechanical Turk (mTurk) who are enabled to volunteer to participate in research by choosing to accept “human intelligence tasks” (HITs) that are presented to workers who meet broad study inclusion criteria or who may be eligible and are subsequently screened for eligibility
Of the 289 eligible mTurk workers who reported lifetime kratom use in our larger survey study, 6 no longer had active mTurk worker IDs and were unable to participate in our kratom recontact survey, making 283 people eligible
Summary
The plant indigenous to Southeast Asia, Mitragyna speciosa, commonly referred to among Westerners as “kratom,” has been used in the United States and other regions outside of Asia since at least 2004 (Burkill, 1935; Boyer et al, 2007; Boyer et al, 2008). Motivations for using kratom have become the topic of numerous case reports and surveys (Griffiths et al, 2018; Agapoff and Kilaru, 2019; Aldyab et al, 2019; Coe et al, 2019; Stanciu et al, 2019; Bowe and Kerr, 2020; Covvey et al, 2020; GarciaRomeu et al, 2020; Schmuhl et al, 2020; Smith et al, 2021a; Weiss and Douglas, 2021; Grundmann et al, 2022a) Case reports, including those of kratom-associated fatalities, are insightful but provide limited detail and generalizability beyond the clinical presentation(s) described in the report (Olsen et al, 2019; Post et al, 2019). Larger epidemiological level surveys have been conducted with samples in the US; these studies provide more definitive understandings of kratom use motivations These are somewhat limited in their use of convenience samples of current, regular kratom-using adults who self-select into kratom-specific survey participation. Some people may be regular current users due to an inability to stop
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