First U.S. Epidemiologic Study Links Kratom Use to More Than Doubled Risk of Suicidal Thoughts

Why it matters

This is the first national epidemiologic study to quantify the association between kratom use and suicidal thoughts and behaviors in the U.S., finding a more than twofold increase in risk - a critical finding for clinicians and policymakers as kratom use continues to rise.

The big picture

Kratom use in the U.S. has grown substantially over the past decade, with millions reporting lifetime use. While researchers have studied kratom's effects on pain, opioid receptors, and withdrawal, mental health associations - particularly suicidality - have remained understudied. This Johns Hopkins-affiliated study fills a major gap using nationally representative survey data from 47,291 adults.

Key findings

• Kratom users showed 2.14x higher odds of past-year suicidal thoughts, 1.95x higher odds of suicidal plans, and 2.50x higher odds of suicide attempts compared to non-users
• Associations were stronger in subgroups: Black kratom users had 11x higher odds of suicidal thoughts, and male kratom users had 2.74x higher odds
• Data came from the 2021 National Survey on Drug Use and Health (NSDUH), a nationally representative sample of 47,291 adults
• The study is observational and cannot establish causality - kratom use may reflect pre-existing mental health vulnerabilities
• Authors call for further research on whether episodic versus addictive use patterns differ in their mental health consequences

What they say

The findings suggest a significant association between Kratom use and suicidal thoughts and behaviors in the U.S. adult population, with variations by sex and race. These results highlight the need for further research examining the causal relationships between Kratom use and these outcomes. - Sharron et al., Substance Use and Addiction Journal, 2025

Bottom line

Kratom users in national survey data report more than twice the rate of suicidal thoughts and attempts as non-users - clinicians should screen for suicidality in patients who use kratom, while recognizing that causality has not been established.