Associations Between Kratom-Related State Policy Environments and Kratom Use in a Nationally Representative Population in the United States

Ellis, Matthew S.; Buttram, Mance E.; Forber, Alyssa; Black, Joshua C.

doi:10.1080/02791072.2023.2223622

Cited by 4 publications

(4 citation statements)

References 22 publications

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“…As noted, our sample does not represent everyone who uses kratom, particularly those who regularly use extracts rather than whole-leaf products. These data are one piece of what must be a multidisciplinary effort to inform US clinical practice, research, and policy . One complication is that some kratom products are not labeled with recommended serving amounts, warnings, or alkaloid content .…”

Section: Discussionmentioning

confidence: 99%

“…These data are one piece of what must be a multidisciplinary effort to inform US clinical practice, research, and policy. 30 , 31 One complication is that some kratom products are not labeled with recommended serving amounts, warnings, or alkaloid content. 32 , 33 , 34 , 35 In future studies, we will present further results in the context of laboratory assays of the products our participants used.…”

Section: Discussionmentioning

confidence: 99%

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Ecological Momentary Assessment of Self-Reported Kratom Use, Effects, and Motivations Among US Adults

Smith,

Panlilio,

Feldman

et al. 2024

JAMA Netw Open

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ImportanceKratom products, which are sold legally in most of the US, contain alkaloids with opioidergic, adrenergic, and serotonergic activity. Millions of people use kratom to relieve pain, improve mood, or self-manage substance use disorders (SUDs). Kratom use has primarily been examined via surveys, in which recall biases among satisfied users may lead to minimization of transient negative outcomes. Further prospective study of kratom use, such as with ecological momentary assessment (EMA), is needed.ObjectiveTo characterize proximal motivators, effects, and patterns of kratom use and to assess whether use frequency is associated with motivations, effects, past-year criteria for SUD for kratom (KUD), or other substance use.Design, Setting, and ParticipantsFor this prospective cross-sectional study, an intensive longitudinal smartphone-based EMA in which participants’ current behaviors and experiences were repeatedly sampled in real time was conducted between July 1 and October 31, 2022. Participants comprised a convenience sample of US adults who used kratom at least 3 days per week for at least 4 weeks at the time of online screening. Criteria for past-year KUD were based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Data analysis was performed between November 2022 and November 2023.ExposureThe exposure was 13 401 kratom-use events across 15 days.Main Outcomes and MeasuresA baseline survey covering demographics, health, kratom attitudes and behaviors, use motivations, other substance use, and KUD was administered before EMA. Data for the following EMA entries were then collected: event-contingent entries for kratom use (product, dose, and proximal motivations), follow-up entries (short-term effects and consequences of use events), random-prompt entries (mood), beginning-of-day entries (effects of kratom on sleep), and end-of-day entries (daily subjective descriptions of kratom effects). Bayesian regression was used to estimate means and credible intervals.ResultsA total of 357 participants completed the EMA. Their mean (SD) age was 38.0 (11.1) years; more than half were men (198 [55.5%]). Participants reported overall motivators of use on the baseline survey that involved managing psychiatric and SUD problems, but proximal motivators evaluated during the EMA involved situation-specific needs such as increasing energy and productivity and decreasing pain. Acute effects were considered congruent with daily obligations. Use patterns, despite having some distinguishing features, were generally similar in their motivators and effects; participants used kratom predominantly during the daytime and seemed to find use frequencies that suited their needs. Higher use patterns were associated with symptoms of physical dependence (eg, withdrawal or tolerance). Co-used substances included caffeine, nicotine, vitamins, and cannabis.Conclusions and RelevanceMost participants in this study reported using kratom in a seemingly nonproblematic way. When such use appeared problematic, the key element was usually that withdrawal avoidance became a proximal motivator. Longitudinal studies examining changes in kratom use patterns and effects over time are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Ecological Momentary Assessment of Self-Reported Kratom Use, Effects, and Motivations Among US Adults

Smith,

Panlilio,

Feldman

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

show abstract

“…This complexity may heighten the risk of using compositions that contain the more potent metabolite 7-hydroxymitragynine ( 26 ). While federal regulation and oversight are lacking, the US kratom industry has been left to regulate itself, primarily at the state level ( 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…Kratom products in the US are estimated to be used by as many as 15 million adults depending on the source of the estimate ( 3 , 4 ). While unregulated at the federal level in the US, kratom is regulated and considered an illicit novel psychoactive substance in several European and Southeast Asian nations ( 5 , 6 ). Some of the pharmacological actions of kratom alkaloids, including kratom’s major alkaloid, mitragynine, are mediated through weak agonist activity at opioid receptors, although alpha-adrenergic and serotonergic receptors are also involved ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Commentary: Presence of kratom in opioid overdose deaths: findings from coroner postmortem toxicological report

Grundmann,

Smith,

Prozialeck

et al. 2024

Front. Psychiatry

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Associations Between Opioid and Kratom Use in the USA: Differences by Race/Ethnicity and Sexual Orientation

LoParco,

Bone,

Berg

et al. 2024

J. Racial and Ethnic Health Disparities

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Associations Between Kratom-Related State Policy Environments and Kratom Use in a Nationally Representative Population in the United States

Cited by 4 publications

References 22 publications

Ecological Momentary Assessment of Self-Reported Kratom Use, Effects, and Motivations Among US Adults

Ecological Momentary Assessment of Self-Reported Kratom Use, Effects, and Motivations Among US Adults

Commentary: Presence of kratom in opioid overdose deaths: findings from coroner postmortem toxicological report

Associations Between Opioid and Kratom Use in the USA: Differences by Race/Ethnicity and Sexual Orientation

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