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TOPLINE:

Kratom (a plant-derived psychoactive substance) exposures reported to US poison centers increased from 19 in 2010 to 1242 in 2023, new research showed. However, states that banned kratom had significantly lower rates of exposures and severe medical outcomes compared with states with the Kratom Consumer Protection Act (KCPA) or no regulation.

METHODOLOGY:

• A retrospective observational study included data for nearly 9000 kratom-related exposures reported between 2010 and 2023 to the National Poison Data System.
• Overall, 61% of the cases involved single-substance exposure; 91% occurred in adults, and 69% occurred in men.
• US states were classified by kratom regulatory status into four categories: unrestricted (no regulations), KCPA, local restrictions (KCPA in at least one county but no state regulation), or banned (retail sale illegal).
• The primary outcome measure was incidence of severe medical outcomes, defined as major effects or death. Secondary outcomes included exposure rates, hospitalization, and healthcare use.

TAKEAWAY:

• Kratom use increased more than 65-fold, from 19 cases in 2010 to 1242 in 2023 (incidence rate ratio [IRR], 69.0; P < .001). Overall, 72.5% of kratom exposures were evaluated in healthcare settings; 34% required hospitalization, of which 44.5% needed critical care; and the total mortality rate was 2%.
• Severe outcomes increased from 0 cases in 2012 to 158 cases in 2023 (IRR, 57; P < .001). Severe medical outcomes were more likely with use of kratom along with other substances (13%) vs use of kratom alone (9%).
• Compared with states where kratom was banned, states of all other categories combined were associated with increased incidence rates of poison center-reported exposure (IRR, 2.5), severe outcomes (IRR, 3.2), healthcare use (IRR, 2.4), and hospitalization (IRR, 2.45; P < .001 for all).
• No significant differences in outcomes were found between the other state regulatory categories.

IN PRACTICE:

“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,” study investigator Ryan Feldman, PharmD, Medical College of Wisconsin, Milwaukee, said in a press release.

“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,” Feldman added.

SOURCE:

The study was led by Grant Comstock, MD, Medical College of Wisconsin, Milwaukee. It was published online on April 21 in Addiction.

LIMITATIONS:

State-level misclassification could not be ruled out. The adverse outcomes were not fully attributable to kratom in polysubstance use cases. Additionally, poison center data relied on passive reporting, were encounter-based rather than patient-based, were subject to potential under-reporting, and may not have represented population incidence accurately.

DISCLOSURES:

The study received no funding, and the investigators reported no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.