Kratom Use in the United States

"Mitragyna speciosa (i.e., kratom) is a psychoactive plant indigenous to Southeast Asia that has increased in popularity across the US in recent years (Grundmann, 2017, Prozialeck et al., 2012). Evidence from the National Survey on Drug Use and Health suggests that nearly 2 million Americans reported kratom use in 2022 (Substance abuse and mental health services administration., 2023), yet industry reports place estimates between 5 and 15 million US adults (American Kratom Association, 2019). Marketed as a dietary supplement, rising rates of kratom use may be attributable to the botanical’s various purported effects, with motivations for use that include increased focus, nonmedical self-management of physical pain and psychiatric symptoms (e.g., anxiety), and use of kratom to self-manage substance use disorders (SUDs) (Grundmann et al., 2022, Smith et al., 2024a, Smith et al., 2022b, Smith et al., 2021b, Smith and Lawson, 2017). Notably, however, there have also been some reports of toxicity and overdose fatalities involving kratom exposure, typically involving complicated health history and polydrug use (Corkery et al., 2019, Eggleston et al., 2019, Olsen et al., 2019). Development of kratom physical dependence (e.g., tolerance, withdrawal) and DSM-5-derived SUD for kratom (i.e., kratom use disorder; [KUD]) have also been documented among some people who use kratom regularly (Hill et al., 2024, Smith et al., 2022a, Weiss et al., 2024).

"Currently, kratom is unscheduled at the federal level and legal in most US states, with some states adopting legislation to regulate kratom (Ellis et al., 2023). Despite kratom’s lack of federal regulation, proliferating product formulations, and increasing popularity, human data on kratom remains limited in comparison to other commonly used substances. Current scientific gaps, while narrowing, hinder individuals' ability to make informed decisions about their use, while leaving policy makers and clinicians without the data necessary to develop appropriate regulations and health recommendations."