VA Researchers Propose First Standardized Kratom Use Disorder Screening Framework for Veterans

Why it matters

Veterans face disproportionately high rates of chronic pain, PTSD, and substance use disorders—conditions that drive kratom and 7-OH use as self-medication. A new peer-reviewed framework from VA New England Healthcare System clinicians would help the Veterans Health Administration systematically identify and treat kratom dependence before it escalates.

The big picture

Despite rising kratom use in the U.S., no standardized clinical screening tool exists for kratom use disorder, and the DSM-5-TR does not yet formally classify it. Kratom also does not appear on standard urine toxicology panels, making detection largely dependent on patient disclosure—which rarely occurs. Veterans are especially vulnerable because they are more likely to self-manage unmet pain and mental health needs with alternative substances, and clinicians often lack awareness of kratom's pharmacology and risks.

Key findings

• Kratom acts as a partial opioid receptor agonist producing dose-dependent stimulant effects at low doses and opioid-like sedation and analgesia at high doses
• Veterans frequently use kratom to self-manage chronic pain, PTSD symptoms, mood disorders, and opioid withdrawal
• Kratom is not detected by standard urine toxicology panels, leaving most VHA providers unaware of use without direct screening
• Chronic use can produce opioid-like dependence and withdrawal (irritability, insomnia, muscle pain, cravings)
• Authors propose a five-domain DSM-5-TR-informed screening tool: Exposure, Motivation, DSM Criteria, Severity, and Medication Safety
• A scoring range of 0-1 (negative) to ≥6 (severe use disorder) parallels existing SUD assessment frameworks

What they say

The authors conclude: "Given the rising incidence of kratom use among Veterans and associated clinical risks, implementation of a standardized screening within the VHA is an appropriate intervention. Incorporating DSM-5-TR-informed criteria into structured assessments can help improve early identification, enhance patient safety, and support evidence-based treatment strategies."

Bottom line

VA clinicians from New England have developed a practical, five-domain kratom screening tool that could be integrated into VHA electronic health records—filling a major gap in veteran addiction care.