Kratom Detection in Drug Testing Doubles Over Nine Years as Stimulant Use Replaces Opioids in SUD Patients

Why it matters

New drug testing data from nearly 1.7 million patients in addiction treatment shows kratom use is growing steadily within substance-use-disorder populations, even as illicit prescription opioid use falls to historic lows — signaling a shift in what substances these patients are turning to.

The big picture

Millennium Health analyzed urine drug tests from nearly 1.7 million SUD patients between 2016 and 2025. The data captures real-world substance use patterns among people actively seeking addiction treatment. The same period saw the share of SUD patients testing positive for both fentanyl and prescription opioids fall from 80% to under 5%.

Key findings

• In 2016, under 1.5% of SUD patients nationally tested positive for kratom alkaloids; by 2025, that figure had roughly doubled to approximately 3%
• The South has the highest kratom detection rates among SUD patients
• Illicit prescription opioid use among fentanyl users has fallen from 80% in 2016 to just 4.9% in 2025
• Provider awareness of kratom has grown sharply: in 2016, only one-third of urine tests included a kratom screen; by 2025, over 77% did
• Stimulant use (methamphetamine, cocaine) is growing among SUD patients as prescription opioid misuse declines
• The shift suggests kratom is increasingly part of the substance use landscape for people in or seeking addiction treatment

What they say

"In 2025 the positivity rate for prescription opioids are at all-time lows in our database. It's about 5 percent." — Eric Dawson, PharmD, Vice President of Clinical Affairs at Millennium Health

Bottom line

Kratom detection among addiction treatment patients has doubled over nine years, even as illicit opioid use falls — confirming kratom's growing presence in the substance-use landscape and the urgent need for standardized clinical guidance.