Abstract
BACKGROUND: The rise of suicidal thoughts and behaviors (STBs) in the United States and their association with substance use disorders, including the emerging concern over Kratom-a psychoactive substance-necessitates an investigation into its role in STBs. This study provides the first epidemiologic assessment of the association between Kratom use and STBs in the United States. METHODS: This study leveraged data from the 2021 National Survey on Drug Use and Health (NSDUH) to examine the association between Kratom use and STBs. The NSDUH was carried out among a representative sample of American individuals. Our study sample comprised 47 291 individuals aged 18 and older across the United States. Lifetime Kratom use was the exposure, while outcomes included past-year suicidal thoughts, plans, and attempts. RESULTS: Persons who use Kratom (PWUK) exhibited higher odds of reporting past-year suicidal thoughts (odds ratio [OR]: 2.14), plans (OR: 1.95), and attempts (OR: 2.50) compared to persons who never used Kratom. The associations also varied by sex and race, with pronounced effects among male and Black individuals. Specifically, subgroup analyses revealed higher odds of suicidal thoughts among Black PWUK (OR: 11.00) and among male PWUK (OR: 2.74). CONCLUSIONS: The findings suggest a significant association between Kratom use and STBs 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 STBs, including whether episodic use differs from addiction, as well as assessing the associations of Kratom use with other mental health conditions. This understanding is crucial for informing the development and implementation of targeted interventions, policies, and programs aimed at addressing Kratom use and its mental health consequences.