Study authors Kirsten Smith and David Epstein
Featured Paper of the Month – July 2024
Published in Jama Network Open by Kirsten Smith and David Epstein, et al. of the NIDA IRP Real-world Assessment, Prediction, and Treatment Unit.
Summary
This was the first-ever study to use real-time, app-based monitoring of patterns and consequences of kratom use, in 357 people who used kratom daily or almost daily. Kratom products, which are legal in most US states, are used by millions of US adults for energy and for self-management of problems such as pain, depression, ADHD, and substance-use disorders. Kratom’s bioactive alkaloids have actions including mu opioid partial agonism, kappa and delta opioid antagonism, alpha-2 adrenergic agonism, 5-HT1A agonism, and perhaps adenosinergic antagonism, along with a complex array of dopaminergic actions (some possibly antidopaminergic). In surveys, most regular consumers report considerable satisfaction and few adverse effects beyond physical dependence (which, per their reports, typically sounds no more disruptive than physical dependence on caffeine). We monitored 13,501 kratom-use events (across 15 days per participant) to probe for unwanted effects that might be minimized in responses to retrospection-based surveys. Our real-time findings were, instead, concordant with survey findings, dominated by satisfaction and successful integration of kratom use into daily responsibilities. We used a statistical technique called clustering to divide participants into five data-driven categories reflecting lowest through highest frequencies of use per day, to assess whether the highest-use participants seemed to be losing control over their use. Instead, it appeared that they had “titrated” their use (i.e., adjusted their dosage patterns) to match their goals. Each of our five “clusters” mostly said that kratom was helping them with their daily responsibilities, not hindering them. Kratom-associated problems were exception, not the rule, in this sample. We view this dataset as a detailed picture of kratom use in consumers who have found the right products and dosage patterns for themselves. It does not negate other aspects of the story of kratom; that story is complex, and we have published other papers on what happens when kratom use goes badly. The data in this paper, however, provide the most extensive available real-time assessment of what may be called instrumental use: use of a potentially addictive drug for a specific purpose, successfully, with benefits appearing to outweigh problems, at least during the time frame assessed.
Publication Information
Ecological Momentary Assessment of Self-Reported Kratom Use, Effects, and Motivations Among US Adults Journal Article
In: JAMA Netw Open, vol. 7, no. 1, pp. e2353401, 2024, ISSN: 2574-3805.
