An increasing number of Americans are turning to kratom, a Southeast Asian plant often marketed as a natural remedy, with new data revealing that more than 5 million people in the U.S. Have used the substance in their lifetime. The findings, part of the first known national study to examine usage patterns alongside mental health and addiction, suggest a troubling trend toward higher prevalence among young adults, and adolescents.
The research, published in the Journal of Addiction Medicine, indicates that kratom use in the US is reaching an all-time high. Between 2021 and 2024, the share of Americans ages 12 and older who reported having used kratom rose from 1.6% to 1.9%. While the percentages may seem small, the raw numbers are significant: the total user base now exceeds the combined populations of the six smallest U.S. States.
As a physician, I find the most concerning aspect of this data to be the intersection of substance use and psychological distress. The study found that a majority of kratom users also report cannabis use or struggle with a substance use disorder. Many users reported experiencing major depression and serious psychological distress, raising critical questions about why people are seeking out this unregulated plant.
The demographic shift and adolescent risk
While kratom is available in various forms—including powders, teas, pills, and liquid shots—its popularity is not evenly distributed. Adults between the ages of 21 and 34 represent the highest usage bracket, with approximately 3.4% reporting lifetime use and about 1% using it within the past year.
Of particular concern to public health officials is the accessibility of the plant to minors. The study found that more than 100,000 children between the ages of 12 and 17 have used kratom. Because the substance is frequently sold online and in smoke shops without stringent age verification, it has become an accessible alternative for teenagers seeking self-medication or recreational effects.
| User Group | Key Finding |
|---|---|
| Total U.S. Lifetime Users | Over 5 million people |
| Adolescents (12-17) | Over 100,000 users |
| Young Adults (21-34) | 3.4% lifetime prevalence |
| Overall Trend (2021-2024) | Increase from 1.6% to 1.9% |
The rise of high-potency synthetic derivatives
The landscape of kratom use is evolving beyond the raw plant. Researchers have highlighted the emergence of 7-OH, or 7-hydroxymitragynine, a synthetic derivative of the plant’s primary psychoactive chemical, mitragynine. These products are often sold in gas stations and online as gummies, tablets, or drinks, and are sometimes marketed under the guise of “legal morphine.”
The danger of 7-OH lies in its concentration. These derivatives can be five to 50 times more potent than standard kratom leaf. This extreme potency increases the risk of adverse reactions and accelerates the potential for dependency, moving the substance further away from its “natural” image and closer to the profile of high-potency opioids.
The U.S. Food and Drug Administration (FDA) has not approved kratom for any medical use and has issued repeated warnings regarding its potential for addiction and serious side effects. Similarly, the Drug Enforcement Administration (DEA) has flagged the substance as a chemical of concern.
Clinical gaps and regulatory confusion
One of the most significant hurdles in treating kratom-related addiction is that the substance is largely “invisible” in standard medical settings. According to Sean Esteban McCabe, a professor at the University of Michigan School of Nursing and the study’s principal investigator, kratom does not appear on standard drug screens. Identifying its use requires specialized testing that is not common in most clinics or emergency rooms.
This clinical gap is compounded by a fragmented legal landscape. Currently, about half of U.S. States have some form of ban or regulation on kratom, while others leave it entirely unregulated. This patchwork of laws makes it difficult for healthcare providers to provide consistent guidance and for policymakers to implement national safety standards to protect children.
Understanding the mental health link
The study notes a strong association between kratom use and mental health struggles, including major depression. However, researchers emphasize a critical distinction: the data shows a correlation, not necessarily causation. Because the survey provides a snapshot in time, it is unclear whether kratom use leads to mental health issues or if individuals with existing depression and anxiety are more likely to use kratom to manage their symptoms.
Regardless of which comes first, the findings suggest that kratom is often used as a proxy for professional mental health care. This underscores the urgent need for expanded access to evidence-based addiction treatment and psychological support, rather than relying on unregulated botanical supplements.
Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
As federal agencies continue to monitor the prevalence of 7-OH and other derivatives, the next critical checkpoint will be the potential for further FDA regulatory actions or the introduction of federal legislation to standardize the sale and age-restriction of kratom products across all 50 states.
Do you have experience with kratom or thoughts on how it should be regulated? Share your perspective in the comments below.
