Rising Kratom Use and Toxicity: An Observational Study, 2015-2024
E. B. Towers, Y. T. Thomas, C. P. Holstege, R. FarahIntroduction
Kratom ( Mitragyna speciosa ), a botanical native to Southeast Asia, was traditionally consumed for pain relief and opioid withdrawal. Today, it is marketed as a “natural wellness” product and sold in gas stations, vape shops, and online with minimal oversight. Its shift from whole leaf to high-potency formulations, still labeled as kratom but often enriched with 7-hydroxymitragynine, has raised growing concerns about toxicity.
Objectives
To determine recent changes in kratom use and medically attended kratom-related exposures in the United States (U.S.).
Methods
A retrospective analysis of kratom use and kratom-related exposures was conducted using data from the U.S. National Survey on Drug Use and Health (NSDUH; 2019–2023) and the U.S. National Poison Data System (NPDS; 2015–2024). Analyses included individuals aged 12 years and older in the U.S. and assessed trends in demographics, clinical outcomes, and substances co-used with kratom.
Results
From 2019–2023, NSDUH estimated lifetime kratom use rose from 4.0 to 5.1 million, while past-year (1.6–2.1 million) and past-month use (0.83–1.14 million) remained stable (Figure 1). Males comprised 50–67% of users. NPDS recorded 11,015 medically attended exposures during 2015–2024, increasing from 258 to 1,524 (Figure 2A); 35–43% involved co-use. Most exposures occurred in males (66–76%) and adults aged 20–39, but exposures are rising among older adults (40–59 and >60) and adolescents (Figure 2B). Compared with kratom-only exposures, co-use exposures had nearly double the hospitalization rate (44–56% vs. 24–28%) and more frequent critical care admissions (20–31% vs. 9–12%; Figure 3A). Serious outcomes, including death, were also more common with co-use (56–65%) than kratom alone (42–49%; Figure 3B). Deaths totaled 204, including 169 with co-use. Common co-used substances (ethanol, opioids, benzodiazepines, stimulants, and antidepressants) were also most frequent in hospitalizations and serious outcomes, with opioids predominating in fatalities.
Image 1: Long description.