(11) Kratom (Mitragyna speciosa) and Polysubstance Use Patterns: A Latent Class Analysis

Background: Kratom (Mitragyna speciosa) is an herbal supplement with partial opioid agonist effects that is widely available and gaining popularity in the United States [1-2]. Used primarily to self-treat pain and psychiatric conditions – largely opioid use disorder and associated withdrawal symptoms – it is crucial to understand kratom trends and patterns of use [3]. Recent advances in the field have reported that individuals endorsing kratom use often report using other substances as well, however there is a dearth of available literature on polysubstance use among kratom users [4]. This study identified latent classes of polysubstance use among kratom users in the United States using a nationally representative sample.

Methods: Data from the 2019 National Survey on Drug Use and Health was used to analyze responses from 448 participants aged 18 and older that reported using kratom in the past 12-months. Past 12-month kratom use was assessed (yes/no), as was use of tobacco, alcohol, marijuana, cocaine, heroin, hallucinogens, methamphetamines, and inhalants, as well as non-medical use of prescription pain relievers, stimulants, and benzodiazepines (yes/no). Latent class analysis was used to identify unique classes of polysubstance use among kratom users and chi-square tests for independence were used to identify sociodemographic and health-related covariates associated with each class.

Results: Three latent classes were identified among individuals with past 12-month kratom use, including one with diverse polysubstance use (19.9%), one with alcohol/marijuana/tobacco use (48.4%), and one with alcohol/tobacco use (31.7%). Non-significant differences were reported for majority of socio-demographic characteristics, including sex, race/ethnicity, educational attainment, health status, and past 12-month insurance coverage. However, a significant difference was reported among the classes by age cohort, with younger cohorts more likely identifying with the diverse polysubstance use class and older cohorts identifying more frequently with the alcohol/tobacco class (p < 0.0001).

Conclusions: This study has identified that there is great heterogeneity among those using kratom, with the majority using legal substances, if any. Findings from this study suggest kratom trends may align closely with other substance use trends – with younger cohorts reporting higher rates of recreational use and older cohorts using for self-treatment of physical and mental ailments. Future research is needed to study these hypotheses, and consideration should be given to use within past 12-months vs. concurrent use of substances.

References: 1. Palamar J. J. (2021). Past-Year Kratom Use in the U.S.: Estimates From a Nationally Representative Sample. American journal of preventive medicine, 61(2), 240–245. https://doi.org/10.1016/j.amepre.2021.02.004

2. Schimmel, J., Amioka, E., Rockhill, K., Haynes, C. M., Black, J. C., Dart, R. C., & Iwanicki, J. L. (2021). Prevalence and description of kratom (Mitragyna speciosa) use in the United States: a cross-sectional study. Addiction (Abingdon, England), 116(1), 176–181. https://doi.org/10.1111/add.15082

3. Smith, K. E., Rogers, J. M., Schriefer, D., & Grundmann, O. (2021). Therapeutic benefit with caveats?: Analyzing social media data to understand the complexities of kratom use. Drug and alcohol dependence, 226, 108879. https://doi.org/10.1016/j.drugalcdep.2021.108879

4. Xu, K. Y., Mintz, C. M., Borodovsky, J. T., Glaser, P., Bierut, L. J., & Grucza, R. A. (2021). Prevalence of Kratom Use and Co-Occurring Substance Use Disorders in the United States. The primary care companion for CNS disorders, 23(4), 21br02930. https://doi.org/10.4088/PCC.21br02930

Diversity, Equity, and Inclusion: Diversity, Equity and Inclusion: We considered racial/ethnic, sex-related, and age-related differences among individuals reporting past 12-month kratom use. Data from the National Survey on Drug Use and Health is supported by the Substance Abuse and Mental Health Services Administration (SAMHSA) and is nationally representative.