Resurgence of Medically Attended Kava-Related Exposures: An Observational Study, 2000-2024
E. B. Towers, I. L. Williams, C. P. Holstege, R. FarahIntroduction
Kava ( Piper methysticum ), traditionally consumed in Pacific Island ceremonies, is now widely marketed as an alcohol alternative in concentrated extracts, capsules, and ready-to-drink beverages. These products are increasingly sold in vape shops near college campuses and often combined with other psychoactive substances such as kratom. This emerging trend raises significant safety concerns, yet recent patterns of kava-related toxicity remain poorly characterized, underscoring the need for ongoing surveillance.
Objectives
To characterize recent trends in medically attended kava-related exposures in the United States (U.S.), including changes in demographics, clinical severity, and patterns of substance co-use.
Methods
A retrospective analysis of kava-related exposures was conducted using data from the U.S. National Poison Data System between January 1 st , 2000 and July 31 st , 2025. Analyses assessed temporal trends, demographic shifts, clinical outcomes, and substances reported in combination with kava.
Results
Medically attended kava-related exposures declined sharply in the early 2000s, from 296 in 2000 to 82 in 2004, reaching a low of 42 in 2010 (Figure 1A). Since 2016, exposures have risen steadily, reaching 180 in 2024. Both waves predominantly involved college-aged and young adults (20–39 years), but demographics shifted: the first wave was mostly women, whereas recent exposures primarily involve men (Figure 1B). Hospitalizations remained relatively stable (14–29%; Figure 2A). However, the proportion of exposures with serious clinical outcomes has more than doubled, from about 14% to over 30%. This increase coincides with rising co-use of kratom, reported in more than one quarter of cases in 2024 and one third in the first half of 2025 (Figure 2B).
Image 1: Long description.