An Initial Survey Assessing the Temporal Relationship of Kratom Initiation With Medical Treatment and Substance Use

Intro Kratom use is growing for both therapeutic and non-therapeutic effects. This survey assessed the temporal relationship between kratom initiation and prior, subsequent, or concurrent substance use or medical treatment. Methods This cross-sectional, anonymous electronic survey was disseminated to American Kratom Association and Global Kratom Coalition members from 3/2025-9/2025. Adults aged ≥18 years who reported past or current kratom use were eligible. A novel questionnaire was generated assessing: kratom and other substance use characteristics; pursuit of medical treatment for selected diagnoses; and temporal relationships between kratom use and substance use or medical treatment. Results Of 161 respondents included, most (95.7%) currently versus previously used kratom. Whole-leaf product use was reported most often (90.3%), with 38.3% reporting concentrated kratom extracts and 16.9% single alkaloid isolates. Reasons for kratom use were therapeutic (50.3%), non-therapeutic (16.1%), or both (33.5%). Therapeutic (self-treatment) use was most commonly cited for pain (86.2%), mental focus (52.3%), mental health (46.9%), sleep (43.1%), and substance use disorder (27.7%). Most respondents had used ≥1 other psychoactive substance in their lifetime, including cannabis (74.3%), alcohol (68.2%), stimulants (43.2%), sedatives (33.1%), non-prescribed opioids (26.4%), or tobacco (6.1%); 10.1% reported no prior substance use besides kratom. Whether used for non-therapeutic or therapeutic purposes, kratom was rarely initiated first. Among those with a substance use history, only 3-10% reported trying kratom prior to other substances reported. Among those with pertinent medical conditions, 0-20% initiated kratom before receiving medical care for their reported conditions. Conclusion This study builds on previous research assessing kratom use motivations, providing insight into the temporal relationship between kratom initiation and substance use or medical treatment. Kratom was rarely the first substance or therapeutic treatment tried, but rather most individuals initiated it concurrently with or after discontinuing other substances or medical care. Larger follow-up studies are warranted to confirm these results.