Background and aims Mitragyna speciosa (‘kratom’) contains mu opioid partial agonists. It is widely available, and occasionally used as a home remedy for opioid use disorder. The Drug Enforcement Agency considers kratom a drug of concern; however, prevalence of use and role in drug misuse are unknown. This study aimed to characterize kratom use in the United States. Design Cross‐sectional Survey of Non‐Medical Use of Prescription Drugs (NMURx) Program, 2018 third quarter and 2019 first quarter. Setting A validated non‐probability online survey in the United States. Participants A total of 59 714 respondents aged 18 years or older, weighted to represent the adult US population (n = 252 063 800). Measurements In addition to prevalence of past‐year kratom and other drug use, behavior proportions were estimated. The Drug Abuse Screening Test (DAST‐10) estimated consequences of drug abuse. Findings The estimated prevalence of past‐year kratom use in the adult US population was 0.8% [95% confidence interval (CI) = 0.7–0.9], representing 2 031 803 adults. Life‐time prevalence was 1.3% (95% CI = 1.2–1.4), representing 3 353 624 adults. Kratom users were younger (mean 35 years, P < 0.001), with higher proportions of males (61.0 versus 48.6%, P < 0.001), students (14.1 versus 7.5%, P < 0.001) and health‐care professionals (9.7 versus 4.5%, P < 0.001) and fewer bachelor's/advanced degree graduates (33.4 versus 42.6%, P < 0.001) compared with non‐users. Results were inconclusive on whether there was a difference in kratom use by race, household income or employment status. Among those with past‐year kratom use, 36.7% (95% CI = 32.1–41.3) non‐medically used prescription opioids, 21.7% (95% CI = 18.0–25.5) used illicit opioids, 54.4% (95% CI = 49.5–59.3) used another illicit drug and 67.1% (95% CI = 62.5–71.8) used cannabis. The DAST‐10 profile was more often substantial/severe in kratom users (21 versus 1%, P < 0.001) compared with non‐users. Conclusions Estimated United States past‐year prevalence of kratom use is 0.8%, and kratom users tend to have more serious substance abuse profiles than non‐users or users of cannabis, alcohol or cigarettes. To our knowledge, this is the first description of kratom use at the national level.

Objectives Opioid pain reliever (OPR) prescribing at Emergency Department (ED) discharge has increased in the past decade but specific prescription details are lacking. Prior ED OPR prescribing estimates relied on national survey extrapolation or prescription databases. The main goal of this study was to utilize a research consortium to analyze the characteristics of patients and opioid prescriptions using a national sample of ED patients. We also aimed to examine the indications for OPR prescribing, characteristics of opioids prescribed both in the ED and at the time of discharge, and characteristics of patients who received OPRs compared with those who did not. Methods This observational, multi-centered, retrospective cohort study assessed OPR prescribing to consecutive patients presenting to the consortium EDs during 1 week in October 2012. The consortium study sites consisted of 19 EDs representing 1.4 million annual visits, varied geographically, and were predominantly academic centers. Medical records of all patients aged 18-90 years discharged with an OPR (excluding tramadol) were individually abstracted via standardized chart review by investigators for detailed analysis. Descriptive statistics were generated. Results During the study week, 27,516 patient visits were evaluated in the consortium EDs. 19,321 (70.2%) were discharged and 3,284 patients (11.9% of all patients and 17.0% of discharged patients) received an OPR prescription. For those prescribed an OPR, mean age was 41.1 (SD 14.7) years and 1,694 (51.6%) were female. Mean initial pain score was 7.7 (SD 2.4). The most common diagnoses associated with OPR prescribing were back pain (10.2%), abdominal pain (10.1%), and extremity fracture (7.1%) or sprain (6.5%). The most common OPRs prescribed were oxycodone (52.3%), hydrocodone (40.9%) and codeine (4.8%). >99% were immediate release, 90.0% were combination preparations, and the mean and median number of pills was 16.6 (SD 7.6) and 15 (IQR=12-20) respectively. Conclusion In a study of ED patients treated over a single week across the country, 17% of discharged patients were prescribed OPRs. The majority of the prescriptions had small pill counts and almost exclusively immediate release formulations.

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BackgroundTherapeutic use and abuse of prescription opioids in the United States increased substantially between 1990 and 2010. The Centers for Disease Control estimated deaths related to pharmaceutical opioids reached nearly 19,000 in 2014. Of prescription opioids sold, 10% are extended release (ER) and 90% immediate release (IR). However, most regulations and interventions have focused on decreasing ER abuse. Our objective was to compare rates of abuse and diversion of ER and IR opioid analgesics over time using multiple surveillance programs.MethodsRates of abuse and diversion of ER and IR opioid formulations were compared using data from four surveillance programs in the Researched Abuse, Diversion and Addiction Related Surveillance (RADARS®) System. Data were evaluated from 2009 through 2015, and Poisson regression used to compare IR and ER opioid cases over time.ResultsFrom 2009 to 2015, IR opioids were prescribed at a rate 12 to 16 times higher than ER. In the Poison Center Program, population-adjusted rates of Intentional Abuse for IR were 4.6 fold higher than ER opioids (p<0.001). In the Drug Diversion Program, population-adjusted rates of diversion were 6.1 fold higher for IR than ER opioids (p<0.001). In the Opioid Treatment Program, population-adjusted rates of endorsements for abuse were 1.6 fold higher for IR opioids than ER (p = 0.002). In the Survey of Key Informants' Patients Program, population-adjusted rates of endorsements for abuse were 1.5 fold higher for IR opioids than ER (p<0.001).ConclusionsBetween 2009 and 2015, IR opioids were prescribed at a much higher rate than ER opioids. Results from four surveillance programs show population-adjusted rates of prescription opioid abuse were markedly higher for IR than ER medications. For the greatest public health benefit, future interventions to decrease prescription opioid abuse should focus on both IR and ER formulations.