Kratom Usage - The rapidly diversifying reasons

Since kratom began growing in popularity in North America, researchers have tried to understand how and why people are using it. Much research focuses on people using the plant to ease the symptoms of opioid withdrawal, since the Southeast Asian plant works on similar neurotransmitter receptors to opioids. One 2020 study, for instance, found that 41 percent of nearly 3,000 respondents used kratom for this purpose.

The National Institute on Drug Abuse (NIDA), which funds something like 80 percent of the world’s drug research, has sometimes been criticized for its overwhelming focus on “drug abuse and addiction” at the expense of pleasure and benefits. However, new research out of the US federal institute suggests that people’s reasons for using kratom have changed and expanded.

To look into this, the research team re-contacted respondents from a previous study (which ran between September 2020 and March 2021 and surveyed people who used alcohol, opioids, or stimulants in the prior six months) who had reported past kratom use. The respondents in the past study had been recruited using Amazon Mechanical Turk, an online crowdsourcing platform.

The kratom research team reached out to 289 people, of whom 129 took the survey about their kratom use. All were located in the United States, and aged 18 or over. It was “essentially a convenience sample, but it had greater diversity in terms of use experiences compared to a lot of the other online kratom surveys,” Dr. Kirsten Smith, a NIDA researcher and one of the paper’s authors, told Filter.

Interestingly, the mean age at which respondents first tried kratom was 29.9—older than is the case for most other drugs.

Of the respondents, 48.5 percent ranked kratom as a “preferred substance.” And while previous NIDA research points to men using illicit drugs at higher rates than women, a slight majority of the kratom sample were women. The sample was mostly white, which speaks to the need for more targeted research into other demographics.

The paper notes that in the US, kratom use increased from around 2007, but remained rare until 2015. Many of the respondents reported trying kratom for the first time after 2015. And interestingly, the mean age at which respondents first tried kratom was 29.9—older than is the case for most other drugs studied (buprenorphine, a drug prescribed for opioid use disorder, is one exception).

Smith said that this warrants more research. However, she believes that as kratom grows in popularity, the age at which people try it for the first time may decrease. “People who are younger will now know about it,” she said.

While some believe kratom could act as a “gateway drug” to opioids, Smith said that this seems unlikely based on what she’s heard anecdotally and the fact that kratom, in the US, is relatively new.

On the other hand, there are many reported cases of people using kratom to wean themselves off opioid use, to replace opioids, or to stave off opioid withdrawal symptoms while opioids are unavailable to them, as Smith acknowledged. Many of the study respondents reported using kratom as an opioid substitute, but also as a substitute for alcohol or stimulants.

Fascinatingly, in this context, the study found that the other drug with the “strongest association with past-year kratom use” was vaped nicotine, which is typically used as a harm reduction substitute for tobacco. Past-month kratom use, meanwhile, was most strongly associated with past-month use of cannabis, which is itself sometimes described as an “exit drug” for opioids.

In the research, 48.1 percent of respondents said kratom boosts energy. And some people take it before working out , Smith said.

However, people also use kratom for various completely different reasons—and the number of reasons for kratom use appears to be growing. “The motivations are so important to understand the kratom story,” Smith said.

In the research, 48.1 percent of respondents said kratom boosts energy. And some people take it before working out, Smith said. Others may look at it as a herbal supplement, considering 29.5 percent of respondents reported purchasing kratom at herbal/vitamin stores. People also simply use kratom to relax enjoyably, vaguely similar to how people might drink wine after work—48.8 percent of respondents said they used it this way. Other people might want to use kratom to address pain, or to take it before work just to feel a little better.

Others still may use it to self-treat things like ADD, anxiety symptoms or chronic fatigue—as such, some people are using it to address gaps in health care, Smith said. She doesn’t believe that these groups represent the majority of kratom users at the moment, but the nature of how most people use the drug may change going forward.

“You have people who are the early adopters getting it online … The first cohort of users in the United States were very much in that self-treatment kind of group,” Smith said. “And then you start to see a shift as products become commercially available in all these different forms, and marketed in different ways.”

Kratom grows in various Southeast Asian countries like Indonesia and Thailand. It is regularly sold as a powder made from leaves of the plant, as capsules filled with the powder, or as tinctures, among other formulations.

If the motivations Smith emphasized are to be fully understood, a lot more research will be needed.

The most abundant chemical in kratom is mitragynine, which is largely considered the compound that produces the relatively mild high. However, one study suggests that there are around 40 different alkaloids present in kratom leaves, and they can vary wildly from strain to strain—or even plant to plant, depending on numerous factors like where the plant is grown, when it is harvested, etc. This makes gauging the subjective and chemical effects of kratom difficult.

Kratom exists in a kind of legal gray zone in the United States, as it has not been approved for consumption by humans by the FDA, but is not federally illegal to sell. However, some states, such as Alabama, have made it illegal. There are myriad websites that sell kratom online, but in some parts of the US, it can also be purchased in brick-and-mortar shops.

The NIDA paper provides a glimpse into people’s rapidly diversifying reasons for kratom use, but if the motivations Smith emphasized are to be fully understood, a lot more research will be needed. Further, considering the sheer breadth of potentially psychoactive compounds in the plant, the dearth of research on withdrawal and other knowledge gaps, there’s a great deal more to learn.

Kratom Usage - The rapidly diversifying reasons