Kava (Piper methysticum) consumption patterns and conceptualizations: results from an online survey

'Kava,' or 'kava kava,' (Piper methysticum) is a psychoactive plant indigenous to the Pacific Islands. Historical consumption is reported to provide anxiolytic and sedating effects. In regions where kava is native, it has been used in religious and cultural practices, as well as for medicinal purposes. The mechanisms by which kavalactones - the best studied psychoactive constituent of kava - may mediate pharmacological effects include enhancing the GABA_A receptor, blocking of sodium and calcium channels, blocking reuptake of norepinephrine dopamine, and inhibiting MAO-B. In the United States, products containing kava have proliferated in recent years alongside the rise of ethnobotanical tea bars serving kava preparations.

Between December-July 2024, an anonymous online survey on legal psychoactive products was conducted using convenience sampling. Eligible individuals had to be ≥ 18 years old and endorse lifetime use of kratom, kava, tianeptine, and/or akuamma seed.

Of the 368 participants, almost half (n = 180, 48.9%) had used kava during their lifetime. Those who reported lifetime use of kava were younger on average (p = 0.001), more racially diverse (p = 0.041), and had a higher proportion of being employed or in school (p = 0.012) than those where did not use kava in their lifetime. Kava was purchased online (40.6%) or in ethnobotanical tea bars (31.7%). Many reported infrequent consumption (average = 4.4 months/year and 9.1 days/30 days). Lifetime use of alcohol, kratom, and cannabis was common. Approximately one-third of participants had consumed kava more than 100 times, with commonly reported perceived effects from kava experienced in the minutes and hours after consumption included reduced general anxiety (33.7%), improved mood (32.9%), reduced social anxiety (25.5%), and sedation (23.4%). Most respondents had favorable conceptualizations of kava, with only 11.7% characterizing that kava alone as habit-forming. Many (51.7%) conceptualized kava as an alcohol replacement with 18.3% and 16.7% using kava as a short- and/or long-term substitute for alcohol, respectively.

Kava use practices are diverse, though perceived kava effects appear mostly mild. The proliferation and diversification of kava products pre-mixed with other psychoactive botanicals requires study as the benefit-risk profile may change. Clinicians should be aware of kava use for harm-reduction and other purposes.