Substance Used by 0.7 Percent of U.S. Population and 10.3 Percent of People with Opioid Use Disorder

Kratom as pills, leaves, and tea
© Getty Images

Less than one percent of people in the United States use kratom, a plant-based substance commonly used to manage pain and opioid withdrawal, according to a study published in the American Journal of Preventive Medicine. However, the use of kratom—which is legal but carries the risk of addiction and harmful side effects—is more prevalent among people who use other drugs, particularly those with opioid use disorder.

Derived from a tree native to Southeast Asia, kratom can be taken as a pill, capsule, or extract, or brewed as a tea. It acts on the brain’s opioid receptors; at low doses, kratom is a stimulant, while at higher doses, it can relieve pain. Some people report using kratom as a substitute for opioids in an effort to limit their opioid use and ameliorate withdrawal. Others use kratom recreationally for relaxation or to self-treat pain, anxiety, or depression.  

Kratom is legal at the federal level and in most states, but safety concerns have led to multiple warnings from the U.S. Food and Drug Administration and the Drug Enforcement Administration identifying it as a “drug of concern.” Long-term or frequent use can lead to dependence, and adverse events, ranging from mild to severe, have been reported. Kratom has been linked to thousands of poisonings and hundreds of deaths in the U.S., although most involve the use of other drugs, especially opioids.  

“Few national studies have examined kratom use among the general population, and such studies can give us a better idea regarding who has been using the substance,” said study author Joseph Palamar, PhD, MPH, an associate professor of population health at NYU Grossman School of Medicine and an affiliated researcher with the Center for Drug Use and HIV/HCV Research (CDUHR) at NYU School of Global Public Health.

Using the 2019 National Survey on Drug Use and Health, which captured data on 56,136 adolescents and adults in the U.S., Palamar examined how many people use kratom and what other substances they use. He found that an estimated 0.7 percent of adults and adolescents used kratom in the past year.

Kratom use was more prevalent among people who use other drugs, including cannabis, stimulants, and cocaine, and was particularly common among those who misuse prescription opioids, with 10.3 percent of people with opioid use disorder reporting kratom use.  

Men, white people, and those with depression and serious mental illness were also more likely to report using kratom. Teens and adults over 50 were less likely to report use.

“This study adds to our understanding of kratom’s prevalence and its connection to opioid misuse,” said Palamar. “More research is needed to determine the substance’s effectiveness in treating opioid withdrawal, and more research is needed to determine how safe this substance is when combined with other drugs.”

The research was supported by the National Institute on Drug Abuse, part of the National Institutes of Health (R01DA044207).

The mission of the Center for Drug Use and HIV/HCV Research (CDUHR) is to end the HIV and HCV epidemics in drug using populations and their communities by conducting transdisciplinary research and disseminating its findings to inform programmatic, policy, and grass roots initiatives at the local, state, national, and global levels. CDUHR is a Core Center of Excellence funded by the National Institute on Drug Abuse (Grant #P30 DA011041).  It is the first center for the socio-behavioral study of substance use and HIV in the United States and is located at the NYU School of Global Public Health. For more information, visit

About NYU Langone Health
NYU Langone Health is a world-class, patient-centered, integrated academic medical center, known for its excellence in clinical care, research, and education. Included in the 260+ locations throughout the New York area are six inpatient locations: Tisch Hospital, its flagship acute-care facility in Manhattan; Rusk Rehabilitation, ranked as one of the top 10 rehabilitation programs in the country; NYU Langone Orthopedic Hospital, a dedicated inpatient orthopedic hospital in Manhattan with all musculoskeletal specialties ranked top 10 in the country; Hassenfeld Children's Hospital at NYU Langone, a comprehensive pediatric hospital, also in Manhattan, supporting a full array of children's health services; NYU Langone Hospital—Brooklyn, a full-service teaching hospital and level 1 trauma center located in Sunset Park, Brooklyn; and NYU Langone Hospital—Long Island, a full-service teaching hospital and level 1 trauma center located in Nassau County on Long Island. Also part of NYU Langone Health is the Laura and Isaac Perlmutter Cancer Center, a National Cancer Institute–designated comprehensive cancer center; NYU Grossman School of Medicine, which since 1841 has trained thousands of physicians and scientists who have helped to shape the course of medical history; and NYU Long Island School of Medicine. For more information, go to, and interact with us on FacebookTwitterYouTube, and Instagram.

About NYU School of Global Public Health
At the NYU School of Global Public Health (NYU GPH), we are preparing the next generation of public health pioneers with the critical thinking skills, acumen, and entrepreneurial approaches necessary to reinvent the public health paradigm. Devoted to employing a nontraditional, interdisciplinary model, NYU GPH aims to improve health worldwide through a unique blend of global public health studies, research, and practice. The School is located in the heart of New York City and extends to NYU's global network on six continents. Innovation is at the core of our ambitious approach, thinking and teaching. For more, visit:

Press Contact

Rachel Harrison
Rachel Harrison
(212) 998-6797