Prevalence and correlates of kratom use among people who use drugs in Vancouver, Canada

A product derived from the Mitragyna speciosa tree, kratom is gaining in popularity for its purported stimulant and analgesic effects and is used with both therapeutic, recreational and harm reduction (e.g., substitution) intent. We sought to identify the prevalence and correlates of lifetime kratom use among people who use unregulated drugs (PWUD). Data were drawn from a cross-sectional survey of PWUD, in addition to cannabis, participating in three open community-recruited prospective cohorts in Vancouver, Canada. We applied logistic regression analysis to identify demographic, behavioural and structural factors associated with ever using kratom. Between 2019 and 2021, 414 individuals were recruited including 111 (28.7%) females; the median age was 43.0 years (interquartile range: 30.2–54.6) and 30 (7.2%) participants reported ever using kratom. In the adjusted analysis, factors significantly associated with kratom use included age (adjusted Odds Ratio [aOR] per five years older = 0.55, 95% confidence interval [CI] 0.41, 0.73), using high potency cannabis products (aOR = 2.82, 95% CI 1.10, 7.23) and using cannabis for harm reduction purposes (aOR = 4.93, 95% CI 1.69, 14.33). In this community-based sample of PWUD set in the context of an ongoing overdose crisis, few endorsed any past use of kratom. For those who had used it, results suggest that kratom was being used therapeutically or as a method of harm reduction among PWUD. Further research is needed particularly to investigate the prevalence and predictors of kratom use, as well as the potential harms and benefits among other populations of PWUD.