Kratom exposures reported to US poison centers rose from 19 cases in 2010 to 1,242 in 2023, an increase of roughly 6,500%, and severe medical outcomes went from zero to 158 over the same stretch, according to a national analysis published in the journal Addiction. States that banned retail sale of kratom had lower rates of exposures, severe outcomes and hospital use than states that regulated it or left it alone, and the laws sold as the responsible middle path, Kratom Consumer Protection Acts, did not measurably beat having no rules at all.
Key takeaways
- Poison center kratom cases climbed 65-fold between 2010 and 2023, and 13% of all exposures ended in a life-threatening effect, lasting disability or death.
- About 6 in 10 of those exposures (61%) involved kratom by itself, with no other substance reported.
- Bans tracked with the lowest rates. Consumer protection statutes showed no clear advantage over states with no kratom regulation.
What the study found
Researchers led by Grant Comstock and senior author Dr. Ryan Feldman of the Medical College of Wisconsin pulled every kratom exposure reported to the National Poison Data System from 2010 through 2023, across all 50 states and the District of Columbia: 8,919 exposures in all. About 61% (5,452) involved kratom by itself, 69% were adult males, and 91% were 18 or older.
Severe outcomes, defined as life-threatening effects, significant lasting disability or death, went from none in 2010 to 158 in 2023. The first severe case did not appear until 2012. There is less than a 1 in 1,000 chance either trend is coincidence.
The researchers sorted states into four buckets: no regulation, Kratom Consumer Protection Acts (age limits, purity and labeling rules), local restrictions only, and outright bans on retail sale. Measured against banned states, rates elsewhere were about 2.5 times higher for exposures (149% higher; incidence rate ratio 2.49, very likely between 89% and 228% higher) and about 3.2 times higher for severe medical outcomes (219% higher; rate ratio 3.19, very likely between 78% and 470% higher). Hospitalization and overall healthcare use ran about 145% higher. Each of those has less than a 1 in 1,000 chance of being a fluke.
The line that matters: no statistically significant differences turned up between any of the other regulatory categories. Consumer protection laws did not separate themselves from doing nothing.
Dr. Kumar’s take
This is poison center data, which means it is passive and observational. Nobody was randomly assigned to a state. Reporting is voluntary, so a ban can lower the count both by shrinking the market and by making people less willing to call. Causation is not established.
Set that caveat aside and the null result still stands on its own. If purity standards, labeling and age limits worked as advertised, states with them should have looked better than states with nothing. They did not. Andrew Kolodny of Brandeis, writing a commentary in the same journal, titled his piece “Here we go again: Kratom and the failure to learn from the opioid crisis,” which is roughly where I land. A supplement label is not a safety mechanism. It is a marketing category.
The pharmacology is the part that gets lost. Mitragynine, kratom’s main alkaloid, is an opioid receptor agonist with both stimulant and opioid effects. It does not show up on a routine urine drug panel; catching it takes a dedicated mitragynine test that somebody has to order on purpose. Kratom is also almost never on an intake questionnaire. So when a patient arrives with a new seizure, an arrhythmia or unexplained respiratory depression, the exposure is invisible unless someone asks out loud. Feldman also flags that kratom interferes with metabolic pathways, which raises the risk of whatever else the person is taking, and nearly 4 in 10 of these reported exposures involved more than kratom.
US drug policy tends to arrive years after the market has moved, from insulin pricing to the broken incentives around new antibiotics. Kratom is that story on a shorter clock.
What it means for you
If you take kratom, tell your clinician, and say the word kratom rather than “an herbal supplement.” It will not appear on a standard drug screen, and it changes how other drugs are cleared. That matters most if you are on sedatives, other opioids, or anything with a narrow safety margin.
If someone using kratom has a seizure, chest symptoms, confusion or slowed breathing, treat it as an emergency and name the substance to the treating team. US Poison Control is 1-800-222-1222.
Kratom is not scheduled federally and is not FDA approved for any medical use, which is why the rules change at every state line. “Regulated” does not mean vetted. On the evidence so far, it does not appear to mean safer either.