Mapping the Evidence on Kratom Use, Health Outcomes, and Policy Gaps in the United States: A Scoping Review.

BACKGROUND

Kratom (Mitragyna speciosa) is increasingly used by U.S. adults for pain management, mental health symptoms, and substance withdrawal, yet remains minimally regulated and poorly integrated into clinical guidance. This scoping review characterized patterns and motivations for kratom use, associated health outcomes, and regulatory and social factors shaping access and perception among U.S. adults.

METHODS

A scoping review was conducted following Joanna Briggs Institute (JBI) methodology and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-SCR) guidelines. Searches of PubMed/MEDLINE, Embase, CENTRAL, and the Cochrane Library identified peer-reviewed studies published between 2015 and 2025. Studies involving U.S. adults that examined kratom use patterns, health outcomes, or regulatory and social factors were included. Screening and data extraction were conducted using Covidence, and qualitative content analysis was used to identify key themes and research gaps.

RESULTS

Of 1,887 records identified, 43 studies met inclusion criteria. Most studies were cross-sectional, with sample sizes ranging from small laboratory cohorts to nationally representative surveys. Common motivations for kratom use included pain relief, self-treatment of mental health conditions, mitigation of substance withdrawal, and enhancement of energy or mood. Reported outcomes were primarily behavioral and psychological, including polysubstance use, cravings, tolerance, and perceived symptom improvement, alongside physical effects such as gastrointestinal symptoms and withdrawal. Regulatory factors included legal variability, limited federal oversight, inconsistent product labeling, marketing practices, and stigma.

CONCLUSION

Kratom use among U.S. adults reflects unmet healthcare needs within a fragmented regulatory environment. Coordinated regulation, improved clinical education, standardized surveillance, and stigma-reduction efforts are needed to mitigate harm and support informed decision-making.