Kratom Rarely the First Substance Used, New Survey Finds — But Most Users Tried It After Opioids or Other Drugs

Why it matters

Understanding when and why people turn to kratom — before or after other drugs — helps policymakers craft more accurate public health messaging and treatment protocols rather than assuming kratom is a gateway substance.

The big picture

Kratom advocacy groups and researchers have long debated whether kratom serves as a gateway to other drugs or an exit from them. This survey, disseminated to members of the American Kratom Association and Global Kratom Coalition, provides rare quantitative data on the sequence of substance use and medical treatment relative to kratom initiation. The results carry limitations — the sample is drawn from advocacy organizations, which skews toward positive experiences — but the temporal data add meaningful nuance to existing debates.

Key findings

• Of 161 respondents, 95.7% were current kratom users at time of survey
• Most common form: whole-leaf products (90.3%); 38.3% used concentrated extracts; 16.9% single alkaloid isolates
• Therapeutic use motives included pain (86.2%), mental focus (52.3%), mental health (46.9%), sleep (43.1%), and substance use disorder (27.7%)
• Only 3–10% of respondents with prior substance use history tried kratom before other substances
• Most users initiated kratom concurrently with or after discontinuing other substances or medical treatment — rarely before

What they say

The authors conclude: "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."

Bottom line

Most kratom users in this survey came to the plant after — not before — other drugs or medical treatments, challenging assumptions that kratom is a typical gateway substance.