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Hello colleagues,
How addictive is kratom? As a treatment provider, your sample is enriched with the folks who have tried to stop but cannot. This generates a perception of danger that may or may not be warranted. At the same time, it turns a statistic about how many people develop a use disorder into a textured understanding of what that means for an individual and the people around them.
The article reviewed here- one that includes a few potentially pro-kratom authors- attempts to answer this question. It is one of few clinically relevant studies about kratom, let alone about its more sinister synthetic friends like 7-OH mitragynine and mitragynine pseudoindoxol (with opioid receptor affinities similar to morphine and fentanyl respectively) who are probably not included in this cohort. The dearth of information about kratom is so great that there are no treatment trials. Our management of kratom use disorders (KUDs) is based on an understanding of pharmacology, case reports and expert opinion.
In this mostly US based cross sectional study, drawn from respondents to an online survey, 25.5% of the people met criteria for KUD and 1/3 of those were in the moderate to severe range. The sample was relatively educated – all were at least high school graduates or had a GED, 50% were college educated and half were married; and only 16% reported diagnosis of a separate SUD, perhaps biasing toward a healthier population.
So is 25.5% a lot? It is probably more than for alcohol – among Americans as a whole, the prevalence of an alcohol use disorder is 10-11% (Bailey, et al 2025) and among those who drink at all, it is ~17% (Krist and Bradley, 2025). It is probably on par or less addictive than cocaine. These are challenging comparisons to make across studies, though, as it depends on sampling, inclusion criteria and how the diagnosis was made. With cocaine use for example[1], among those who have used in the past year, the rate of a use disorder is approximately 17% while among weekly users the rate is estimated at 49.9% (Mustaquim et al, 2021 and Cougle et al, 2016).
Is (powder or leaf) kratom use disorder as consequential as other SUDs? In the group studied here, severity was moderate to severe in 1/3 of people with a KUD (and 8.9% overall). A review of the results table pasted below shows that among most people with KUD there is tolerance (81%), withdrawal (68%), craving (57%) and increased use over time (54%). Anecdotally, KUD is manageable with partial opioid agonists and fairly straightforward to stabilize in comparison to fentanyl use and to kratom’s synthetic derivative, 7OH mitragynine.
Kratom – even in its powder or leaf form is addictive. How addictive is a difficult number to pinpoint, but is probably higher than what we read here among the most vulnerable. What we do with that information, as imperfect as it is, depends on where you stand. From a public health and provider perspective it seems that at a minimum, substantial safeguards (age limits, strict labeling and clear messaging about risk and assurance of product integrity) are warranted.
Andrea Truncali, MD MPH
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