Kratom Use in the US: Both a Regional Phenomenon and a White Middle-Class Phenomenon? Evidence From NSDUH 2019 and an Online Convenience Sample

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.

Kratom (Mitragyna speciosa): eine psychoaktive Pflanze mit Chancen und Risiken

“…Eine aktuelle Analyse von Kommentaren aus sozialen Median von Kratomkonsumenten aus den USA zwischen 06/2019 und 06/2020 zeigte, dass die Mehrheit Kratom zur Behandlung von Opioidentzugssymptomatik, geringer auch zur Substitution von Opioiden nutzten 22 . Im Rahmen einer Auswertung von zwei Befragungen waren weiße Hautfarbe, Zugehörigkeit zur Mittelklasse, und vorstädtischer Wohnort mit Kratomkonsum assoziiert 23 . Eine Online-Befragung von US-amerikanischen Erwachsenen, die angaben, in den letzten sechs Monaten Alkohol, Opioide und/oder Stimulantien konsumiert zu haben, ergab als stärkste Prädiktoren für den Konsum von Kratom den Konsum anderer psychotroper Substanzen wie Cannabidiol, Psychedelika und verschreibungspflichtiger Opiode sowie früheren Gebrauch von Opioidagonisten 24 .…”

“…Eine weitere Auswertung von zwei Befragungen zeigte eine Lebenszeitprävalenz bzgl. Kra tomkonsum von 1,1 % und eine Prävalenz von 6,7 %, Kratom im letz ten Jahr konsumiert zu haben [23]. Zufällig durchgeführte Kontrol len motorisierter Verkehrsteilnehmer in Thailand zwischen 12/2005 und 03/2006 zeigten eine Prävalenz von Kratom von 0,9 % (vs. 5,5 % Alkohol, 2,0 % Antihistaminika, 1,8 % Amphetamine und 1,1 % Can nabis) in Urinuntersuchungen [31].…”

Kratom’s Emergence and Persistence Within the US Polydrug Epidemic

“…Data from the 2020 National Survey on Drug Use and Health (NSDUH) indicate that among people who used stimulant drugs (i.e., cocaine, methamphetamine, MDMA, and prescription stimulants) in the past year, past-year kratom use was overrepresented relative to the US population (20.8% vs. 6.6%, F(1, 50) = 10.62, p = 0.002) [58]. Indeed, data from both surveys and case reports document lifetime, past-year, or past 30-day use of kratom and contemporaneous use of alcohol, opioids, and/ or stimulants, but no causal or otherwise explanatory associations can be made with respect to polydrug use broadly or drug substitution or nonmedical management of SUD symptoms specifically [59][60][61][62][63]. These findings have not been detected among US adolescents (there, nicotine and cannabis displayed the strongest relationship) [64].…”

“…Kratom users in this sample were also more likely to have ever participated in MOUD treatment. Complete survey data from this crowdsourced study (see [62] included 2615 responses with 11.1% reporting lifetime kratom use. From this sample, 129 kratom-using respondents were re-recruited for follow-up [5 •].…”

Health Effects Associated With Kratom (Mitragyna speciosa) and Polysubstance Use: A Narrative Review

“… 13 Reported estimated prevalence of past-year kratom use in the U.S. ranges from 0.7% to 4.1%. 10 , 14 - 16 People using this herb tend to be males, 13 , 15 , 17 - 19 middle-aged, 13 , 15 , 17 , 19 employed, 13 , 17 - 19 have an household income of $35 000 or more, 13 , 17 , 19 and possess at least some college education. 17 Prior research has revealed geographic variations in kratom exposure rates reported to U.S. poison control centers and in kratom use patterns.…”