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

ABSTRACT

Limited research has resulted in conflicting views on the risks versus benefits associated with kratom use. Despite no federal policy in the United States, individual states have implemented diverging policies through kratom bans, and legalization and regulation through Kratom Consumer Protection Acts (KCPAs). The Survey of Non-Medical Use of Prescription Drugs (NMURx) Program employs nationally-representative, repeated cross-sectional surveys on drug use. In 2021, weighted prevalence of past−12 month kratom use was compared across three state legal frameworks: no overarching state policy, KCPAs, and state bans. There was lower estimated prevalence of kratom use in banned states (prevalence: 0.75% (0.44, 1.06) relative to states with a KCPA (1.20% (0.89, 1.51)), and relative to states with no policies (1.04% (0.94, 1.13), though odds of use were not significantly associated with policy type. Kratom use was significantly associated with medicated treatment for opioid use disorder. While there were observed differences in the prevalence of past−12 month kratom use by state policy type, low uptake mitigated meaningful distinctions by limiting statistical precision, and potentially confounding effects, such as accessibility online. Future kratom-related policy decisions should be informed through evidence-based research.

KEYWORDS:

• Kratom
• opioid use disorder
• United States
• state drug policy

Acknowledgments

This work was performed using the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System. The RADARS System is supported by subscriptions from pharmaceutical manufacturers, government, and non-government agencies for surveillance, research and reporting services. RADARS System is the property of Denver Health and Hospital Authority, a nonprofit political subdivision of the State of Colorado. Denver Health retains exclusive ownership of all data, databases and systems. No subscriber participated in the conception, analysis, drafting, or review of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The work was supported by the Denver Health and Hospital Authority [Unrestricted].