National study finds kratom use is rising

A national study of kratom use in the U.S. finds rising popularity among young adults, and shows that those who use kratom are more likely to have addiction and mental health issues, according to new research from the University of Michigan and Texas State University.

This is the first known national study to examine the use patterns of kratom and its association with mental health and addiction, researchers say. Kratom is a plant from southeast Asia that’s sold online and in some stores in powders, liquid shots, pills and teas. Opponents of kratom argue that it is addictive and widely available to children, while proponents say it is a safe, natural alternative for managing a host of ailments.

Given the changing policy landscape involving kratom in the U.S., it was an important time to conduct a national study with recent data to examine how many people—including children—use kratom, and its associations with mental health and substance use disorder, said Sean Esteban McCabe, Carol J. Boyd Collegiate Professor in the U-M School of Nursing, and principal investigator. The study appears in the Journal of Addiction Medicine.

Takeaways:

• More than 5 million people in the U.S. say they have used kratom in their lifetime, including more than 100,000 children ages 12-17.
• Kratom use is at an all-time high and is increasing in the U.S., which is particularly notable given that about half of U.S. states ban or regulate kratom.
• Most people who have used or currently use kratom have a substance use disorder, report cannabis use, and many have serious psychological distress and major depression.
• The findings reinforce that policy action is warranted to limit access to kratom by children and that better addiction and mental health treatment is needed.

The U.S. Food and Drug Administration has not approved kratom for any medical use, and federal agencies have warned about potential risks, including addiction and serious side effects. The U.S. Drug Enforcement Administration has also flagged kratom as a drug or chemical of concern, said McCabe, who is also the director of the Center for the Study of Drugs, Alcohol, Smoking and Health, or DASH.

Products like 7-OH, or 7-hydroxymitragynine—a synthetic derivative of the kratom plant—are often sold in gas stations, smoke shops and online in tablets, gummies and drinks—can be five to 50 times more potent than regular kratom. It is sometimes marketed as legal morphine.

The researchers emphasized that the study does not prove kratom––whose
main psychoactive chemical, mitragynine, comes from the plant’s leaves and stems––causes addiction or mental health problems. Because the survey captures a only a snapshot in time, it cannot determine which came first: kratom use or the mental health symptoms.

While the study examined mental health issues, a striking secondary finding was the increase in use, McCabe said. The share of Americans ages 12 and older who said they had ever used kratom rose from 1.6% in 2021 to 1.9% in 2024.

Adults ages 21-34 reported the highest use: About 3.4% said they had used kratom at least once, and about 1% said they used it in the past year.

“Policy changes regarding kratom and 7-OH products are needed in all states if we are serious about protecting our children,” McCabe said. “Five million people is more than the entire population of the six smallest states in the U.S. combined:––Wyoming, Vermont, Alaska, South Dakota, North Dakota and Delaware.”

Kratom use is likely under-reported in clinical settings because it does not show up on standard drug tests and requires specialized testing, McCabe said. At the same time, rules about kratom vary widely across the U.S.—some states regulate it, while others do not—which can complicate public health and policy decisions, he said.

The study analyzed data from the National Survey on Drug Use and Health collected from U.S. households from 2021 to 2024. It was supported by grants R01DA031160 and R01DA043691 from the National Institute on Drug Abuse of the National Institutes of Health.

Co-authors include: Ralph Bogan and Nathan Menke, U-M Medical School; Vita McCabe, DASH and U-M Medical School DASH; Kara Dickinson, DASH and Rush University; and Ty Schepis, Texas State University.

Study: Kratom use and associations with mental health in the U.S., Journal of Addiction  Medicine, DOI: 10.1097/ADM.0000000000001701