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.