Kratom + Opioid Use Disorder Doubles Rate of Serious Mental Illness in 3 Years, National Survey Finds

Why it matters

People who use kratom alongside opioids are experiencing rapidly worsening mental health outcomes, suggesting kratom is not a safe opioid substitute for those with existing substance use disorders. This finding has direct implications for clinicians treating patients who self-medicate with kratom during the ongoing opioid crisis.

The big picture

Kratom use has grown as a self-treatment strategy for pain and opioid withdrawal, often marketed as a natural and safer alternative. However, this peer-reviewed analysis of more than 139,000 Americans found that when kratom is used concurrently with opioids, the mental health toll compounds dramatically. As federal and state policymakers debate how to regulate kratom, understanding its interaction with co-occurring substance use disorders is increasingly urgent.

Key findings

• Among adults with both opioid use disorder (OUD) and kratom use, predicted prevalence of serious mental illness (SMI) rose from 20% in 2021 to 50% in 2023 — a 150% increase in just three years
• SMI rates remained relatively stable for people with OUD alone, kratom alone, or neither substance
• The study used the National Survey of Drug Use and Health (2021–2023), covering 139,524 adults nationwide
• Roughly 6% of all U.S. adults met SMI criteria in the study period
• Authors warn the multiplicative relationship between kratom, OUD, and SMI places additional strain on already overwhelmed treatment systems

What they say

The authors wrote: "Over a short period of 3 years, SMI more than doubled among those with concurrent kratom use and OUD. At a time of strained US treatment systems, high overdose rates, and a mental health crisis, we stress the multiplicative association between kratom, opioid use disorder, and SMI."

Bottom line

**For patients using kratom to self-treat opioid use disorder, the mental health risks may be far more severe than recognized — clinicians should screen for concurrent kratom use in all OUD patients.**