Clinically characterizing adults who use kava or kratom: Substance use disorder assessment challenges for increasingly popular botanical products.

Background: Kratom ( Methods: We conducted an online survey of US adults who have used kava or kratom. Diagnostic and Statistical Manual-5 (DSM-5) substance use disorder (SUD) criteria were used to assess symptoms related to past-year kratom and/or kava use. Respondents were also asked to report on the compatibility of kava and kratom effects with daily living. Results: Of the 367 participants, 91.3 % reported lifetime kratom use and 49.0 % reported lifetime kava use. There was substantial overlap of lifetime use of both substances (40.3 %). Past-year SUD diagnostic criteria for kratom were met by 38.1 % of participants; when this group was dichotomized by past-year kava use, those who also co-used kava had higher proportions of endorsing symptoms of "using more kratom than intended" and "needing to use larger amounts to feel the same effect" than those who used kratom without kava (p = 0.032 and p = 0.011, respectively). Meeting SUD criteria for kava was uncommon among those reporting past-year use (7.5 %), regardless of past-year kratom use. Kratom effects were perceived as helpful and compatible with daily living, though fewer reported this for kava effects. Conclusions: Assessment of patients using kratom or kava may become challenging due to co-use. The relative rewarding and reinforcing effects of these botanicals alone or combined requires systematic study. SUD for either is possible but should be contextualized by patient-level factors including other substance use.