Kratom use in adolescents and college students: a systematic review of prevalence, patterns, and risk factors across community and rehabilitation settings

<i>Background:</i> Kratom (Mitragyna speciosa), a Southeast Asian plant, has gained global prominence for its pharmacological properties and widespread use, particularly among vulnerable adolescents and youth, raising concerns about its impact.<i>Objective:</i> We reviewed existing studies to provide a comprehensive understanding of kratom use among adolescents and college students.<i>Methods:</i> We conducted a systematic review of studies published up to October 2024, using PubMed, Scopus, Web of Science, and Google Scholar databases. Search terms included "Kratom" or "Mitragyna speciosa" combined with terms related to adolescents and college students.<i>Results:</i> Six eligible studies conducted in Malaysia, Thailand, and the United States were identified. Distinct regional differences in patterns of kratom use were observed, shaped by cultural traditions in Southeast Asia and commercialization in the United States. Kratom use was more prevalent among males across regions, with variations shaped by socioeconomic status, psychosocial influences and recreational use. Available studies were limited to college students and those enrolled in a drug treatment program (one study). Generally, kratom was commonly used to self-manage withdrawal symptoms from opioids (heroin) and methamphetamines. Polydrug use emerged as a consistent theme across all studies, underscoring the complexity of kratom consumption in this population.<i>Conclusion:</i> The rising prevalence of kratom use among adolescents and college students demands attention. While kratom may hold potential as a harm reduction tool, evidence on its safety, efficacy, and long-term outcomes remain limited, highlighting the importance of distinguishing traditional practices from emerging recreational trends. This review points the need for targeted interventions, education, and regulatory frameworks.