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Kratom Fatalities

Kratom is a tropical evergreen tree (Mitragyna speciosa) native to Southeast Asia. Its leaves contain compounds that can have psychotropic effects.Two compounds in kratom leaves, mitragynine and 7-α-hydroxymitragynine, interact with opioid receptors in the brain. At low doses, kratom acts as a stimulant, making users feel more energetic. At higher doses, it reduces pain and may bring on euphoria. At very high doses, it acts as a sedative. Kratom takes effect after five to 10 minutes, and its effects last two to five hours. Rarely, chronic use of Kratom is associated with cholestatic liver disease.

Kratom is not considered to be an illegal substance and is readily available by the following names: Biak, Ketum, Kakuam, Thang and Thom. People who use kratom believe it is safe because it is plant-based and natural. Most people take kratom as a pill, capsule, or extract. Some people chew kratom leaves or brew the dried or powdered leaves as a tea. Sometimes the leaves are smoked or eaten in food.

Millions of Americans take kratom and the industry is estimated to be worth approximately $1.5 billion. The Drug Enforcement Administration includes kratom on its Drugs of Concern list, which includes substances that are not currently regulated by the Controlled Substances Act, but that pose risks to persons who abuse them. The number of kratom exposures reported to United States Poison Control centers increased almost 5000% from 2011 to 2017. A high percentage of kratom exposures require admission to a healthcare facility and had serious medical outcomes.

Medical examiners and coroners listed kratom as a contributing factor or the cause of at least 4,100 deaths in 44 states and Washington D.C. between 2020 and 2022. The CDC reported that kratom was implicated in 663 fatal overdose cases in 30 states and Washington D.C. in 2020, 834 deaths in 2021, and 846 deaths in 2022.

Many of the kratom-associated deaths have resulted from adulterated products or taking kratom with other potent substances such as illicit drugs, opioids, benzodiazepines, alcohol, gabapentin, and over-the-counter medications. Kratom supplements may be highly concentrated or laced with other compounds that contribute to deaths.

Despite these statistics, the American Kratom Association insists the herb is safe and has fought federal efforts to prohibit kratom.


Dorman C, Wong M and Khan A. Cholestatic hepatitis from prolonged Kratom use: a case report. Hepatology 2015;61:1086

Connor O’Neill-Dee, et al. (2019) Natural psychoactive substance-related exposures reported to United States poison control centers, 2000–2017, Clinical Toxicology, DOI: 10.1080/15563650.2019.1688341

Freund H. Et al. Deadly Dose Part 1: Hundreds died using kratom in Florida. It was touted as safe. Tampa Bay Times, December 7, 2023.


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