Akuamma Seed (Picralima nitida) Use in the U.S.: Findings from a Web-Based Survey

Indigenous to West Africa, akuamma seed (Picralima nitida) is used in traditional medicine and demonstrates opioidergic activity. Little is known about its role in management of pain or other ailments among people in the United States. This study presents findings from a web-based survey conducted between December 2023 and July 2024. Summary statistics characterized individuals reporting lifetime akuamma seed use, including demographics, substance use history, pain severity, and motivations. Between-group comparisons were conducted for those with and without lifetime akuamma seed use. Among 369 participants, 28 (7.6%) reported lifetime akuamma seed use. Those with lifetime akuamma seed use were older (44.7 years, p = .04), females (64.3%, p = .004), or currently disabled (32.1%, p < .001). They reported less alcohol (p = .033), more kava (78.6%, p = .001) and Delta-8 THC (71.4%, p < .001) use; all had tried kratom. Those who had tried akuamma seed indicated greater pain severity and reported use for pain management and opioid substitution; 60.7% reported pain relief from akuamma seed. No participants met DSM-5 criteria for akuamma seed-related substance use disorder modified. Akuamma seed may be used in the United States alongside other unscheduled psychoactive substances, particularly, psychoactive botanical-derived products. Additional research is needed to evaluate safety, efficacy, and health outcomes associated with akuamma seed.