Kratom (Mitragyna speciosa), a plant native to Southeast Asia, contains the alkaloid mitragynine, which can act as a stimulant at low doses and have some opioid-like effects at higher ones. Its use has grown in the United States, where it is usually sold as a dietary or herbal supplement, and some studies suggest it can lead to dependence and abuse.
- As of April 2019, kratom was not a controlled substance.
- The Food and Drug Administration has acted on kratom several times since 2012, including a public health advisory in November 2017; the Drug Enforcement Administration lists it as a drug of concern.
- From 2011 to 2017, poison centers logged 1,807 calls about kratom exposure.
The study
CDC's State Unintentional Drug Overdose Reporting System (SUDORS) — funded in 32 states and D.C. — collects detailed data on opioid overdose deaths from death certificates and medical examiner and coroner reports, including postmortem toxicology. Kratom isn't an opioid, but deaths involving it are included.
CDC looked at overdose deaths with kratom detected on toxicology, and those where a medical examiner or coroner judged kratom a cause of death, in 11 states from July 2016 to June 2017 and 27 states from July to December 2017.
Findings
- Of 27,338 overdose deaths recorded, 152 (0.56%) tested positive for kratom.
- Kratom was ruled a cause of death in 91 (59.9%) of them — including 7 in which only kratom was detected, though other substances can't be ruled out.
- About 80% of these decedents had a history of substance misuse, and about 90% had no evidence of medically supervised pain treatment.
- Almost all had multiple substances in their system.
| Kratom detected (152) | Kratom a cause of death (91) | |
|---|---|---|
| Male | 76.3% | 75.8% |
| White | 91.5% | 93.1% |
| No supervised pain treatment | 90.8% | 87.9% |
| History of substance misuse | 80.9% | 78.0% |
| Previous overdose | 8.5% | 11.0% |
| Other substances listed as a cause of death: | ||
| Any fentanyl (incl. analogs) | 65.1% | 56.0% |
| Heroin | 32.9% | 25.3% |
| Benzodiazepines | 22.4% | 26.4% |
| Prescription opioids | 19.7% | 24.2% |
| Cocaine | 18.4% | 16.5% |
| Alcohol | 12.5% | 12.1% |
| Methamphetamine | 8.6% | — |
Race percentages are of decedents whose race was known.
What it means
Kratom was found in under 1% of overdose deaths, mostly deaths tied to substance misuse, and almost always with other drugs — fentanyl most often. Because detecting kratom depends on the testing method, and toxicology protocols weren't documented and varied, the count may be low. Knowing which substances appear in kratom-involved deaths can help target prevention, and recording testing protocols would clarify how much kratom contributes to fatal overdoses.
States: Kentucky, Maine, Massachusetts, Missouri, New Hampshire, New Mexico, Ohio, Oklahoma, Rhode Island, West Virginia and Wisconsin for the whole period; Alaska, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Minnesota, New Jersey, North Carolina, Pennsylvania, Tennessee, Utah, Vermont, Virginia and Washington for July–December 2017.
Sources
Based on Olsen EO, O'Donnell J, Mattson CL, Schier JG, Wilson N, "Notes from the Field: Unintentional Drug Overdose Deaths with Kratom Detected — 27 States, July 2016–December 2017," MMWR Morbidity and Mortality Weekly Report, volume 68, Centers for Disease Control and Prevention; a work of the United States government in the public domain.
Licence: CC0 1.0 (public domain) · Adapted from www.cdc.gov
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