NIDA Study: Kratom Users Who Also Use Opioids Are Twice as Likely to Have Serious Mental Illness

Why it matters

The first nationally representative analysis of kratom use patterns among people with opioid histories finds that kratom is frequently part of a polydrug picture — and that those combining kratom with opioids carry significantly elevated mental health risk, a finding that has direct clinical implications.

The big picture

As kratom use continues to spread among people seeking alternatives to or relief from opioid withdrawal, these data highlight that the kratom-using population is not monolithic: a subset is deeply embedded in polydrug use with significant mental health needs that standard kratom policy debates rarely address.

Key findings

• • Among US adults with lifetime nonmedical opioid use: 67.6% used only opioids; 4.6% used opioids + kratom; 24.7% used opioids + methamphetamine; 3.2% used all three
• • The opioid + kratom group had 2.27× higher odds of past-year serious mental illness, 1.89× higher odds of suicidality, and 1.88× higher odds of psychological distress vs. opioid-only users
• • The opioid + methamphetamine + kratom group showed the highest risk overall: 2.65× for serious mental illness, 2.06× for psychological distress, and 2.03× for unmet mental health treatment needs
• • Kratom was used in the context of existing opioid use patterns, not as a safe standalone alternative — complicating simple narratives about kratom as an opioid off-ramp
• • Drug injection, opioid withdrawal, and perceived treatment need were elevated across all polydrug groups

What they say

Secondary analysis of 2019 National Survey on Drug Use and Health (NSDUH) nationally representative data; NIDA Intramural Research Program and Johns Hopkins University School of Medicine; Journal of Psychoactive Drugs, 2022.

Bottom line

Kratom may play a therapeutic role for some opioid users, but among those with polydrug histories and serious mental illness, it appears embedded in a more complex and higher-risk substance use picture that requires coordinated mental health and addiction treatment.