EPP145
Rising Kratom Use and Toxicity: An Observational Study, 2015-2024
E. B. Towers 1,*, Y. T. Thomas 2, C. P. Holstege 3, R. Farah 3
1Medical Scientist Training Program, University of Virginia, Charlottesville, 2Henry J.N. Taub Department of Emergency Medicine, Baylor College of Medicine, Houston, 3Department of Emergency Medicine, Division of Medical Toxicology, University of Virginia, Charlottesville, United States
Introduction: 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.
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Conclusions: Kratom use in the U.S. is rising, with medically attended exposures peaking in 2024 alongside the introduction of high-potency formulations enriched with 7-hydroxymitragynine. Hospitalizations and severe outcomes are largely tied to polysubstance use involving psychoactive drugs. These findings highlight the urgent need for enhanced surveillance, regulation of high-potency products, and targeted education to reduce harm in a rapidly evolving drug landscape.
Disclosure of Interest: None Declared