Kratom Use and Associations With Mental Health in the United States

OBJECTIVES: To assess the US lifetime and past-year prevalence of kratom Mitragyna speciosa use and its associations with mental health and DSM-5 substance use disorder (SUD). METHODS: This study examined cross-sectional survey data collected from 169,408 non-institutionalized individuals aged 12 and older in US households between 2021 and 2024. Measures included kratom use, nonmedical use of cannabis, prescription drugs (opioids, sedatives/tranquilizers, stimulants), other drugs, mental health indicators (serious psychological distress, DSM-5 major depression, suicidal ideation), and DSM-5 SUD. RESULTS: Between 2021 and 2024, lifetime and past-year kratom use were highest among adults aged 21 to 34, 3.40% (95% CI: 3.17-3.65) and 1.01% (95% CI: 0.91-1.13), respectively. Among people who reported prior-to-past-year kratom use, most reported past-year cannabis (65.7%; 95% CI: 60.4-70.3) and had a past-year SUD (52.8%; 95% CI: 50.1-55.4), whereas an estimated 37.8% (95% CI: 37.2-47.3) experienced serious psychological distress. Similar results were observed for those who reported past-year kratom use. Multivariate logistic regression analysis revealed prior-to-past-year and past-year kratom use was associated with increased adjusted odds of past-year SUD (AOR: 4.36; 95% CI: 3.89-4.88 and AOR: 4.81; 95% CI: 3.99-5.80, respectively). Similar results were found for other substance use, DSM-5 major depression, and suicidal ideation. CONCLUSIONS: Over 5 million people in the United States used kratom in their lifetime, with the highest use at ages 21-34 years. Kratom use is increasing and strongly associated among individuals who use cannabis, have a DSM-5 SUD, and experience serious psychological distress. These findings reinforce a profile of individuals who use kratom, many with behavioral health symptoms, and need evidence-based treatment warranting consideration in clinical and policy efforts.