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79% of Kratom Deaths Involved Another Drug. Here’s What CDC Data Reveal About the Deadliest Combinations.
In A Nutshell
- Kratom-related poison center reports surged 1,200% over the past decade, hitting an all-time record of 3,434 in 2025 alone.
- Nearly 4 in 5 kratom-associated deaths over the study period involved people who had combined kratom with another substance.
- Multi-substance cases were consistently more dangerous, with hospitalization rates roughly double those seen when kratom was used alone.
- Reports are expanding beyond young adults, with Americans aged 40 to 59 now approaching the same exposure rates as the 20-to-39 age group.
A supplement sold alongside vitamins at gas stations and smoke shops across America has been driving a sharp rise in poison center reports over the past decade. Kratom, derived from a tropical tree native to Southeast Asia, prompted a record-breaking 3,434 reports to U.S. poison centers in 2025 alone, roughly 1,200% more than the 258 reports logged just a decade earlier, according to a new analysis published by the Centers for Disease Control and Prevention.
What makes the 2025 spike especially alarming is its speed. Reports more than doubled in a single year, blowing past every previous record. Researchers say the surge coincides with a wave of high-potency, lab-modified kratom products now flooding the market, particularly those containing 7-hydroxymitragynine, which acts on the same receptors as opioids and is more concentrated in some newer products than in traditional leaf preparations.
Perhaps the most consequential finding: nearly four out of five kratom-associated deaths over the study period involved people who had combined kratom with another substance. Alcohol, opioids, sedatives, and antidepressants appeared again and again in the most severe cases, pointing to a product whose gravest risks may emerge not in isolation, but in combination with drugs many Americans already use every day.
How the Study Was Conducted
Published by the CDC, the analysis was led by researchers at the University of Virginia and Baylor College of Medicine. Drawing on data from the National Poison Data System, which collects reports from all 53 U.S. poison centers in near real time, the team examined every kratom-related report involving people aged 12 and older from January 2015 through December 2025. Each time someone calls a poison center about a kratom exposure, whether symptoms developed or not, the case is logged. Investigators tracked age, sex, substances involved, care received, and medical outcome. Over the full 11-year window, poison centers documented 14,449 kratom exposure reports.
Reports climbed steadily from 2015 through 2019, leveled off during the early 2020s, then spiked sharply in 2025. Researchers note the surge coincides with the rise of semisynthetic kratom formulations, a connection that is correlational rather than proven causal, but one the authors treat as significant given the timing and scale of the jump.
Kratom Poison Center Reports Are Spreading Across Age Groups
Males accounted for roughly 65% to 76% of kratom-related reports throughout the study, and adults aged 20 to 39 were consistently the most-reported age group. A demographic shift is underway, however. Reports among adults aged 40 to 59 climbed so steeply that by 2025, their rates nearly matched those of the younger group. Teenagers and adults 60 and older also saw sharp increases.
Additional national data referenced in the report add context: while the percentage of Americans using kratom in any given year held relatively steady from 2019 to 2023, the total number of people who had tried it at least once grew from 4 million to 5 million, indicating a growing pool of first-time users. FDA import data point in the same direction, with a 2025 import alert flagging the high volume of kratom products entering the country.
Why Mixing Kratom With Other Drugs Is So Dangerous
About 38% of all kratom reports over the study period, more than 5,500 cases, involved multiple substances. Those cases were consistently far worse than reports involving kratom alone.
Between 44% and 56% of people in multiple-substance cases required hospitalization in any given year, compared with about one quarter of those who used kratom by itself. Serious outcomes, defined as effects that were life-threatening, caused lasting harm, or required treatment, occurred in 57% to 66% of multiple-substance cases annually, versus 41% to 49% of single-substance cases. Among 233 kratom-associated deaths reported over the study period, 184, or 79%, involved other substances. Opioids appeared in 62% of fatal cases; benzodiazepines, stimulants, and alcohol each appeared in roughly one in five deaths.
Intentional misuse was the most commonly reported reason for exposure across both groups. A deeply troubling pattern also emerged around mental health: suspected suicide attempts accounted for about 23% of multiple-substance reports, compared with just 6% of single-substance cases. Prior research cited in the study found that roughly one third of kratom users met criteria for another substance use disorder, and about two thirds reported using kratom specifically to manage depression or anxiety.
Regulators Are Playing Catch-Up With Kratom
FDA has called for regulatory action targeting products containing 7-hydroxymitragynine, but whole-leaf kratom remains outside that action. Researchers noted that current poison center data cannot distinguish between traditional leaf products and concentrated formulations, making it impossible to pin specific risks to specific product types. Building that distinction into future surveillance, they argued, is a necessary next step.
Kratom is no longer a fringe product used by a narrow slice of the population. It is mainstream, it is growing, and when mixed with other substances, particularly opioids, sedatives, and alcohol, it is increasingly linked to hospitalizations and, in some cases, deaths at rates that have climbed for a decade. In 2025, those trends became difficult to ignore.
Disclaimer: This article is based on observational surveillance data reported to U.S. poison centers. Because multiple substances were frequently involved in the same exposure, it is not possible to determine which substance was most responsible for any given medical outcome, including death. The findings reflect reported exposures and do not establish direct causation.
Paper Notes
Limitations
This study has several important caveats. Because the National Poison Data System relies on voluntary, self-reported information, milder cases that never prompted a call to a poison center are likely undercounted. Reports may include repeat callers, and some substances or outcomes could have been misclassified despite standardized coding. Critically, the data do not indicate whether the kratom involved was a traditional leaf product or a concentrated, lab-modified formulation such as those containing 7-hydroxymitragynine, limiting conclusions about product-specific risks. When multiple substances were reported in a single case, determining which was most responsible for the medical outcome, including death, was not possible.
Funding and Disclosures
All authors completed conflict-of-interest disclosure forms. Ynhi T. Thomas reported receiving support from the Food and Drug Administration through a cooperative agreement for a human abuse potential study of kratom, outside the submitted work. Eleanor Blair Towers reported receipt of a Medical Scientist Training Program grant and a Pharmacological Science Training grant from the University of Virginia, along with travel awards from the National Institute on Drug Abuse, the American College of Neuropsychopharmacology, and the College on Problems of Drug Dependence, among others. No other potential conflicts of interest were disclosed.
Publication Details
Title: Increases in Kratom-Related Reports to Poison Centers — National Poison Data System, United States, 2015–2025 | Authors: Eleanor Blair Towers, PhD; Ynhi T. Thomas, MD; Christopher P. Holstege, MD; Rita Farah, PhD | Affiliations: Department of Emergency Medicine, Division of Medical Toxicology, University of Virginia, Charlottesville, Virginia; Medical Scientist Training Program, University of Virginia; Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas; Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Department of Veterans Affairs Medical Center, Houston, Texas | Published in: Morbidity and Mortality Weekly Report (MMWR), Vol. 75, No. 11, March 26, 2026, U.S. Centers for Disease Control and Prevention | Corresponding author: Christopher P. Holstege, [email protected]
Too much conflation of things, self reporting, etc to know much about kratom. I have used it, it is powerful and doesn’t come with warning label, maybe it should. I had a condition where standing up quickly would cause my heart to stop momentarily, the kratom extended the time before it would start up again and I would pass out briefly, once I was so far gone that all the messages from my vagus nerves were in my consciousness! I had all this stuff that seemed so important and so unintelligable at the same time going like a big theatre experience then I came back to boring reality