Kratom exposures and severe cases are rapidly increasing in the US, with stricter regulations linked to better outcomes. Significant health risks and limited research complicate policy decisions.
Kratom has quietly moved from a niche herbal product to a widely used substance in the United States, drawing increasing scrutiny from scientists and regulators.
Derived from a Southeast Asian tree, it is often marketed for pain relief or mood enhancement, but at higher doses, it can act on the body in ways similar to opioids. Now, a study published in Addiction suggests that as kratom’s popularity has grown, so too have reports of harm, with poison center data revealing a sharp rise in exposures and serious health complications over the past decade.
According to the findings, reported kratom exposures surged from just 19 cases in 2010 to 1,242 in 2023, an increase of more than 65-fold (6,500%), highlighting the substance’s expanding reach.
Surge in Poison Center Reports and Cases
Cases involving severe outcomes also grew significantly. There were no such cases reported in 2010, and the first appeared in 2012. By 2023, that number had reached 158. Researchers defined a severe outcome as one involving life-threatening conditions, lasting disability, or death.
States that have banned kratom consistently recorded lower exposure rates, fewer severe cases, and reduced healthcare use compared with states that rely on consumer protection measures or have no regulations.
Health Risks and Policy Debate Intensify
Senior author Dr. Ryan Feldman of the Medical College of Wisconsin explains, “Kratom is not scheduled under the US Controlled Substances Act or approved for medical use by the FDA, which leaves US states to set their own regulations. Or not: several US states do not regulate kratom at all, and they consistently had worse outcomes in this study than states that banned kratom use.
“Evidence shows kratom can cause serious health effects like seizures, irregular heart rhythms, liver damage, and breathing problems. Nearly one in seven cases reported to a poison center with a single-substance kratom exposure were admitted to a hospital, and one in 16 were admitted to a critical care unit. If kratom is used in combination with other drugs, as it often is, kratom’s tendency to interfere with metabolic pathways can heighten the risks of the accompanying drugs.
“As kratom use rises and concerns over kratom and its risks increase, legislatures across the country are debating the best ways to regulate its use. Ongoing policy debates reflect limited high‑quality evidence, highlighting the need for more rigorous, unbiased research to guide legislation. As our research here shows, the kratom problem is not going away anytime soon.”
Reference: “Association between state-level kratom regulations and poison center-reported severe medical outcomes and healthcare use: A United States national analysis” by Grant Comstock, Anthony P. Gulotta, Lisa E. Rein and Ryan Feldman, 6 March 2026, Addiction.
DOI:10.1111/add.70416
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