Kratom Poisonings Have Surged More Than 65-Fold In 14 Years, With Men Hit Hardest

Is Kratom Safe? New Data on 9,000 Poisonings Suggests Lawmakers Need to Take a Harder Look

Fourteen years ago, U.S. poison centers handled 19 kratom-related calls. Last year, they handled 1,242. That more than 65-fold climb tracks alongside a surge in Americans turning to the Southeast Asian plant as a self-treatment for pain, anxiety, and opioid withdrawal, often with little idea of what a serious exposure can actually look like.

Kratom is sold in gas stations, smoke shops, and online stores across most of the country, typically as a powder, capsule, or tea. At low doses it works like a stimulant. At higher doses it mimics opioids. Federal law doesn’t regulate it, leaving rules, or the absence of them, entirely up to individual states. Advocates call it a useful harm-reduction tool. The poison center data tells a more complicated story.

Researchers at the Medical College of Wisconsin spent 13 years tracking those calls nationally, and their findings, published in the journal Addiction, suggest that the type of kratom regulation a state adopts is closely linked to differences in how harmful those outcomes turn out to be.

A Kratom Poisoning Surge That Shows No Sign of Slowing

From 2010 to 2023, poison centers across all 50 states and Washington, D.C. logged 8,919 kratom-related exposures. Adult men dominated the data, with 69% of exposures occurring in males and 91% in adults 18 or older. Many cases involved people in their 20s and 30s, with a median age of 31. Severe medical outcomes, defined as life-threatening events, permanent disability, or death, climbed from zero cases in 2010 to 158 in 2023. Overall, 13 out of every 100 kratom exposures reported to a poison center resulted in one of those severe outcomes. More than a third of all cases required hospitalization, and nearly half of those patients ended up in a critical care unit.

Those numbers raise serious questions about how safe kratom is often perceived to be. It can cause liver damage, dangerous heart rhythms, and seizures. It also interacts with the enzymes the body uses to process other drugs, which may help explain the higher severe outcome rate seen in cases where kratom was combined with other substances, 13%, compared to 8.7% when kratom was the only drug involved.

Young Men Dying Suddenly, Often Without Clear Warning

Among all single-substance kratom exposures in the study, 27 deaths were reported. Researchers also examined a subset of those cases in detail, identifying six deaths judged as probably or definitively caused by kratom alone. Five of those six involved men younger than 30.

Most were found unresponsive or in cardiac arrest, with a documented history of kratom use and no clear warning signs reported beforehand. Four of the five showed no symptoms in the hours leading up to collapse. One man suffered a seizure during intercourse before going into cardiac arrest. A woman in her 50s became unresponsive after ingesting kratom, inhaled fluid into her lungs, developed a severe infection, and died three days later.

Based on this small but detailed set of cases, the pattern is sobering: a substance sold openly, often marketed as natural and safe, associated with sudden cardiac events in otherwise young, adult men. The authors noted that the six reviewed narratives represent only the cases where kratom was judged the probable or definitive cause, and that the full single-substance death toll in the dataset was 27.

How State Kratom Laws Are Linked to Who Ends Up in the Hospital

As lawmakers across the country debate how to handle kratom, a central question has been whether consumer protection measures, things like age restrictions and labeling requirements, are enough to reduce harm without resorting to an outright ban. Based on this study’s associations, the answer appears to be no.

Researchers sorted states into four categories: completely unrestricted, local restrictions only, consumer protection laws, or full bans on retail sale. States with bans reported lower rates across every outcome measured. Compared to ban states, all others combined were associated with more than twice the rate of poison center exposures, more than three times the rate of severe medical outcomes, and roughly 2.5 times the rates of hospitalization and overall healthcare use. Consumer protection laws, often promoted by kratom advocacy groups as the responsible middle ground, were linked to outcomes statistically indistinguishable from states with no rules at all in this dataset.

Kratom is widely available at retail in states without bans regardless of what consumer protections are technically on the books, the researchers noted. Bans may reduce harm partly by removing kratom from store shelves and limiting the advertising that drives awareness and access, though the study cannot establish that directly.

This is observational research, and the authors were careful to frame their findings as associations rather than proof of cause and effect. Under-reporting in ban states, where users may hesitate to call poison control out of fear of legal consequences, could also be affecting the comparison. Those are real limitations. But the association held across every outcome and every year of the 14-year dataset.

What makes the stakes particularly sharp is that the legislative tide is moving away from bans. Since 2023, several states have moved toward or passed consumer protection frameworks, including Florida, Maryland, Nebraska, and South Carolina. For adult men in their 20s and 30s who use kratom regularly, the question of what replaces a ban, and whether it offers any meaningful protection, is one the data has not yet answered reassuringly.

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Disclaimer: This article is based on an observational study and does not establish that kratom directly causes the outcomes described. Findings reflect associations reported in peer-reviewed research and should not be interpreted as medical advice. Anyone with questions about kratom use or its health effects should consult a qualified healthcare provider.

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