Kratom is a plant with psychoactive properties that, when taken at high doses, can produce effects similar to opioids. A new study published in Addiction has found that kratom use – measured as kratom exposures reported to US poison centers – and cases of severe medical outcomes linked to kratom use have surged in the US over the past decade.
The study found that kratom exposures reported to America's Poison Centers increased from 19 cases in 2010 to 1,242 cases in 2023, a more than a 65-fold (6,500%) increase.
Kratom exposures that included severe outcomes increased from zero cases in 2010 (2012 was the first year in which a severe outcome was reported) to 158 cases in 2023. The authors of the study defined a severe medical outcome as one entailing life-threatening effects, significant residual disability, or death.
US states with kratom bans consistently showed lower rates of exposure, severe outcomes, and healthcare use compared with states using consumer‑protection approaches or no regulation.
Senior author Dr. Ryan Feldman, of the Medical College of Wisconsin, comments: "Kratom is not scheduled under the US Controlled Substances Act or approved for medical use by the FDA, which leaves US states to set their own regulations. Or not: several US states do not regulate kratom at all, and they consistently had worse outcomes in this study than states that banned kratom use.
"Evidence shows kratom can cause serious health effects like seizures, irregular heart rhythms, liver damage, and breathing problems. Nearly one in seven cases reported to a poison center with a single-substance kratom exposure were admitted to a hospital, and one in 16 were admitted to a critical care unit. If kratom is used in combination with other drugs, as it often is, kratom's tendency to interfere with metabolic pathways can heighten the risks of the accompanying drugs.
"As kratom use rises, and concerns over kratom and its risks increase, legislatures across the country are debating the best ways to regulate its use. Ongoing policy debates reflect limited high‑quality evidence, highlighting the need for more rigorous, unbiased research to guide legislation. As our research here shows, the kratom problem is not going away anytime soon."
