At least four groups of kratom consumers in the United States: latent-class analysis of motivations for kratom use

<i>Background:</i> Kratom is a plant with alkaloids acting at opioid, serotonergic, adrenergic, and other receptors. Consumers report numerous use motivations. <i>Objectives:</i> To distinguish subgroups of kratom consumers by kratom-use motivations using latent-class analysis. <i>Methods:</i> From July to November 2022, we utilized convenience sampling and surveyed regular kratom consumers (<i>n</i> = 395, 38.1 years (SD 11.2), 54.9% male, 81.3% White) regarding demographics, lifetime and past-year substance use and preferences, substance use disorder history, healthcare barriers, kratom-use motivations, and general health. We used latent-class analysis to identify subgroups by use motivation and calculated conditional probabilities (P_c) for variables in each class. <i>Results:</i> A four-class model best fit our data. The largest class (32.4%) was characterized by the use of kratom for self-treatment of chronic pain (P_c = .91). The smallest class (19.2%) also reported using kratom for self-treatment, but usually as a long-term replacement for other substances (P_c = .75). The other two classes (24.8% and 23.5%) reported using kratom for management of anxiety (P_c = .87–.95) and depressive symptoms (P_c = .61–.89) and for recreation (P_c = .56- .86). These were distinguished from one another by probability of at least moderate kratom use disorder (P_c = .17 vs. .53), with greater probability observed in the class with greater anxiety (P_c = .13 vs. .50) and depressive (P_c = .34 vs. .82) symptom severity and more likely recreational use motivation (P_c = .56 vs. .86). <i>Conclusion:</i> Kratom consumers can be classified by their use motivations. As with other psychoactive substances, the range of motivations is consistent with the range of likely effects. It is not yet clear whether some motivations might indicate the risk of problems.