Kratom is made from the leaves of a tropical evergreen tree, Mitragyna speciosa. In Southeast Asia it has long been chewed or brewed for pain relief, to lift mood and to ease opioid withdrawal. It contains psychoactive compounds that act on opioid receptors. In the United States it has moved from traditional leaf preparations to a fast-growing market of powders, tablets, gummies and concentrated energy shots — including high-potency products enriched with isolated kratom alkaloids, especially 7-hydroxymitragynine, a μ-opioid receptor agonist that is sold as kratom but differs from the traditional leaf. The Food and Drug Administration has called for regulatory action against these products.
This report analyzed kratom exposure reports — any actual or suspected contact that led someone to consult a poison center — from the National Poison Data System (NPDS), which collects data from 53 U.S. poison centers, for people aged 12 and older from 2015 to 2025.
A steep rise
Poison centers received 14,449 kratom exposure reports over the 11 years. The 3,434 in 2025 were a record, about 1,200% more than the 258 in 2015. The rate per million drug exposure reports climbed from 412 to 4,445: rising steadily through 2019, leveling off from 2020 to 2024, and then surging in 2025 — from 2,171 in 2024 to 4,445.
Kratom exposure reports to poison centers, overall and by single- or multiple-substance report, 2015–2025. CDC, MMWR.
The 2025 jump coincides with the arrival of high-potency, semisynthetic products such as 7-hydroxymitragynine. National survey data show that although yearly kratom use held steady from 2019 to 2023, the number of people who had ever used it rose from 4 million to 5 million, and a 2025 FDA import alert addressed the large volume of kratom products entering the country.
Who is exposed
- Mostly men: 65%–71% of single-substance and 67%–76% of multiple-substance reports each year. From 2015 to 2025 the rate among males rose about tenfold for single-substance reports (709 to 7,955 per million) and elevenfold for multiple-substance reports (825 to 9,945); among females it rose about ninefold (190 to 1,937) and tenfold (239 to 2,664).
- Mostly young adults aged 20–39 — but reports among adults aged 40–59 rose most sharply, nearly matching the younger group by 2025.
Mixing substances is most dangerous
Most reports (62%) involved kratom alone, but the 5,513 reports involving kratom plus other substances — 38% of the total — were the most harmful:
| Kratom alone | Kratom with other substances | |
|---|---|---|
| Rate per million comparable drug reports | 388–4,045 | 467–5,442 |
| Share hospitalized each year | 24%–29% | 44%–56% |
| Share with serious outcomes each year | 41%–49% | 57%–66% |
The substances most often combined with kratom were alcohol (22%), opioids (16%), benzodiazepines (15%), antidepressants (14%), cannabis and cannabinoids (12%) and stimulants (11%).
From 2015 to 2025, hospitalizations rose from 43 to 538 for single-substance reports and from 40 to 549 for multiple-substance reports; serious outcomes rose from 76 to 919 and from 51 to 725. Of 233 kratom-associated deaths, 184 (79%) involved more than one substance. Opioids were involved in 62% of deaths, benzodiazepines and stimulants in 20% each and alcohol in 19%.
Kratom exposure reports resulting in hospitalization, serious outcomes and death, 2015–2025. CDC, MMWR.
Why people used it
Intentional misuse was the most common reason (56% of single-substance and 49% of multiple-substance reports). Suspected suicide attempts made up 23% of multiple-substance reports but 6% of single-substance ones. Earlier studies found that about a third of kratom users met criteria for another substance use disorder and about two-thirds used kratom to manage depression or anxiety — a link between kratom and mental health crises.
Combining kratom with alcohol, opioids, benzodiazepines, stimulants or antidepressants may raise the risk by adding to their effects on the central nervous system and by interactions that increase the body's exposure to them — a concern sharpened by semisynthetic products that bind more strongly to opioid receptors.
What it means
Kratom-related harm is growing in number and complexity. Poison centers can serve as an early-warning system, and continued surveillance, education and clinical attention — especially to multisubstance use — could help. As the FDA moves to regulate 7-hydroxymitragynine but not whole-leaf kratom, surveillance should distinguish between product types.
Limitations: poison center data are voluntary and self-reported and likely undercount milder cases; repeat callers are included and some substances or outcomes may be misclassified; the data don't show whether a product was leaf or a concentrated formulation; and when several substances were involved, it wasn't possible to tell which caused the effects.
If you or someone you know is thinking about suicide, call or text 988 to reach the 988 Suicide & Crisis Lifeline in the United States.
Sources
- Towers EB, Thomas YT, Holstege CP, Farah R. "Increases in Kratom-Related Reports to Poison Centers — National Poison Data System, United States, 2015–2025." MMWR 75(11). CDC.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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