Poison Center Reports Involving Kava, and Kava Mixed with Kratom, 2000–2025

Kava (Piper methysticum) is a plant in the pepper family native to the Pacific Islands, where its root has traditionally been made into a water-based drink for religious, cultural, political and social occasions, with relatively low reported risk. It depresses the central nervous system. In the United States, commercial kava appeared in the late 1990s and has grown and diversified since the 2010s — concentrated extracts, capsules, ready-to-drink beverages and kava bars promoted as alcohol-free social spaces, often marketed as a healthy alternative to alcohol and sold near college campuses. Increasingly it is combined with kratom, a psychoactive plant with opioid-like effects.

These commercial products are unregulated and differ from traditional drinks: kavalactones, kava's main active, sedating and anxiety-reducing ingredients, can be 2–10 times more concentrated. Taken without medical oversight, they have been linked to gastrointestinal and neurologic effects, liver toxicity, and drug interactions. The FDA warned in 2002 that kava supplements may cause severe liver injury, and concluded in 2020 that indiscriminate kava use is not safe as a recreational or relaxation drink.

The data

Researchers analyzed all human kava exposures — actual or suspected ingestions for which a poison center was consulted — reported to the National Poison Data System (NPDS), which gathers data from all 53 U.S. poison centers, from January 2000 through December 2025.

Trends

• 3,101 kava-related exposures were reported over the period.
• Before the 2002 FDA advisory there were 298 reports in 2000 and 331 in 2001, about 34 per 100,000 drug exposure reports. After it, reports fell to a low of 42 in 2010 (an 87% drop from 2001), or three per 100,000.
• From 2011 they rose again, from 57 that year to 203 in 2025, and the rate climbed from five to 16 per 100,000 (up 220%).

Kava-related poison center reports by sex (A) and age group (B), 2000–2025. CDC.

Who is affected

In 2000–2001, females made up most reports (56%–57%) and children 12 and younger a substantial share (25%–27%). By 2025 those shares had fallen to 40% and 7%, and since 2013 reports have mostly involved men. Adults 20 and older accounted for the largest share throughout, an annual average of 66% (range 41%–81%).

Outcomes

About 20% of people were hospitalized each year on average (range 14%–30%), with no clear trend. But the share with serious outcomes rose from 12% in 2000 to a peak of 39% in 2024, and was 32% in 2025. Eight deaths were reported — one each in 2000, 2001, 2005, 2017, 2023 and 2024, and two in 2021.

Share of kava-related reports involving hospitalization or serious outcomes, 2000–2025. CDC.

Kratom

Of all reports, 1,347 (43%) involved more than one substance. Alcohol (annual average 7%) and benzodiazepines (5%) were the most common companions until kratom emerged in 2017; by 2019 it had overtaken both, as kava-kratom products became more available. In 2025, 61 kava reports involved kratom, while alcohol or benzodiazepines appeared in 3% of multiple-substance reports.

Share of kava-related reports involving alcohol, benzodiazepines or kratom, 2000–2025. CDC.

Symptoms

Among 1,754 kava-only exposures, the most common effects were vomiting and nausea, drowsiness or lethargy, dizziness, agitation and a fast heart rate. The 128 exposures to kava and kratom alone looked similar but also included seizures, tremor and high blood pressure. Liver injury was less common: moderate liver enzyme elevations occurred in 29 (1.7%) kava-only and 8 (6.3%) kava-kratom exposures, and no acute liver failure was found.

What it means

Poison centers act as an early warning system, and these data show a resurgence of kava exposures alongside the booming non-alcoholic drinks market, despite the FDA's conclusion. Some countries cap kavalactones — for example at 250 mg a day from water-based extracts and 125 mg per tablet or capsule — but U.S. kava and kava-kratom products are unregulated, are advertised with more than 250 mg of kavalactones per 30 ml serving, often with several servings per container, and may contain more. The authors call for stronger surveillance, more clinical awareness, and education telling consumers that these products are unregulated, not recognized by the FDA as safe for recreational use, and linked to harm, especially in large amounts — particularly for young men.

Limits

Poison center data depend on accurate coding; reporting is voluntary, so mild or self-managed cases are missed; repeat reports can't be told apart from first ones; and product codes don't show product type, preparation or dose.

Sources

Based on Towers EB, Williams IL, Holstege CP, Farah R, "Increase in Poison Center Reports Linked to Kratom-Containing Kava Products — National Poison Data System, United States, 2000–2025," MMWR Vol. 75, No. 12, CDC; a work of the United States government in the public domain. The report gives the 2011–2025 rise in reports, from 57 to 203, as 383%, a figure that matches the rise from 2010's 42 instead; it gives kratom's 2025 share as 30% both of all kava reports and of multiple-substance reports; and it calls the rise in serious outcomes, from 12% to 32%, an approximate doubling. Those percentages are not repeated here.