Kratom Use Among U.S. Adults: Clinical Characteristics and Sex Differences in Co-Occurring Drug Use

BACKGROUND: The expansion of kratom's availability, popularity, and product diversity in the United States has drawn scientific and national attention. Characterizing the sociodemographic and behavioral correlates of kratom use may help public health efforts. METHOD: We examined data from the National Survey of Drug Use and Health (2022-2023), to investigate lifetime prevalence and sociodemographic, mental health, and behavioral correlates of self-reported use of kratom as well as the interaction of cannabis and heroin with sex, given co-used patterns with kratom and report sex differences. RESULTS: A pooled prevalence estimate of lifetime kratom use among U.S. adults (18+) was 1.95%, of whom 34.84% reported past-year use and 18.39% reported past-month use. Among those with past-year use, 52.79% reported past-month use. Lifetime use was most common among White, unmarried, younger, working males and those with lower incomes, living in poverty, and participating in government assistance programs. In multivariable analysis, lifetime kratom use was associated with lifetime major depressive episodes, use of pain-relieving medications, and past-year serious psychological distress. Lifetime cannabis and heroin use were associated with elevated odds of kratom use in both sexes. However, kratom's relationship with cannabis use was over three times stronger in males, while its relationship with heroin use was approximately half as strong in males compared to females. CONCLUSION: Kratom use was correlated with specific demographic, behavioral, and sex- and substance-specific characteristics, suggesting the need for more study to examine whether certain populations may benefit from targeted screening and intervention.