By Kristen Rogers, CNN
(CNN) — Calls to poison centers in the United States about the widely available herb kratom increased more than 1,200% between 2015 and 2025, new research has found.
“This data reflects a concerning trend,” study coauthor Dr. Christopher Holstege , director of the Blue Ridge Poison Center at the University of Virginia, said in a news release.
The research was published Thursday in the US Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report.
Kratom is an herb from the leaves of the tropical tree Mitragyna speciosa native to Southeast Asia. It has both stimulant and sedative effects and carries a risk of addiction due to how it interacts with the brain, Dr. Oliver Grundmann , a leading kratom researcher and clinical professor in the department of medicinal chemistry at the University of Florida, told CNN in an August story.
The psychoactive herb isn’t federally regulated and thus isn’t “lawfully marketed in the U.S. as a drug product, a dietary supplement, or a food additive in conventional food,” according to the US Food and Drug Administration. But in states that haven’t banned kratom, it’s sold at gas stations, smoke shops and convenience, grocery and health food stores in various forms, including powders, loose-leaf teas, capsules, tablets and concentrates. Some states allow people of any age to buy it.
The herb is consumed by at least nearly 2 million Americans, according to a 2024 paper Grundmann coauthored.
“We are experiencing a marked increase in kratom associated products being sold in the U.S. market,” Holstege said. He and the other researchers analyzed data from the National Poison Data System and found that calls steadily increased from 2015 to 2019, plateaued from 2020 to 2024 and surged in 2025.
Signs of kratom poisoning can include high blood pressure, vomiting, heart attack, tremors, seizures, delusions, hallucinations, liver damage and an increased heart rate, known as tachycardia. That can cause heart palpitations, dizziness or lightheadedness, shortness of breath, fainting and chest pain.
Last year, there were 3,434 kratom poisoning reports in the US, a record number, up from only 258 calls in 2015, the researchers found. This rise corresponded with a nearly equal uptick in hospitalizations linked to kratom alone, from 43 admissions in 2015 to 538 in 2025. Hospitalizations linked to combined use of kratom and other substances, such as illicit drugs or antidepressants, jumped 1,300% over the 10-year period, from 40 admissions to 549. (All these numbers may include repeat patients, the authors said.)
Meanwhile, 233 people died from kratom use during this time, with 184 of those deaths also involving other substances. Most kratom exposures were among men in their 20s and 30s, but there were also significant increases among people ages 40 to 59.
The findings may reflect kratom’s increasing availability and potency, the authors said.
Kratom and the brain
Kratom leaves have more than 40 alkaloids, organic compounds that naturally occur in plants. Alkaloids contain nitrogen and may have pronounced physiological effects on humans.
One of the most abundant psychoactive alkaloids in kratom is mitragynine, Dr. Kirsten Smith, another leading kratom researcher and a former assistant professor at Johns Hopkins University, told CNN in August.
In the body, mitragynine metabolizes into 7-hydroxymitragynine, an alkaloid commonly known as 7-OH. That same alkaloid is also in kratom products as a result of the drying phase of the manufacturing process, Grundmann said — typically 1% to 2% or less of the total content of leaf kratom products and some extracts.
Mitragynine and 7-OH can bind to the brain’s mu opioid receptors, which help regulate pain, breathing, gastrointestinal activity and more. That binding — along with effects similar to those of opioid drugs such as heroin, fentanyl or oxycodone — has led some experts and politicians to refer to kratom as an opioid. But because the alkaloids may not fit the receptors as well or bind to them as tightly as typical opioids do, they may have a weaker biological effect.
Some case reports show that kratom overdoses have been responsive to naloxone, the opioid overdose antidote, psychiatrist Dr. Lief Fenno, chairman of the American Psychiatric Association’s Council on Addiction Psychiatry, told CNN in August. But kratom largely hasn’t been associated with the slowed or shallow breathing that comes with overdoses on traditional opioid drugs.
Kratom poisonings are probably underestimated due to the reliance on self-reports and because of insufficient testing, the study researchers and other experts agreed.
Regardless of the differences between kratom and classic opioids, some people have found themselves with mild to severe addictions to kratom products. There are also people who formerly had opioid use disorder and use kratom as a potentially less harmful alternative or a way to manage opioid withdrawal symptoms, Grundmann said.
Others use kratom to self-treat chronic pain, to get a relaxing high or to self-treat mental health issues such as anxiety, depression or post-traumatic stress disorder. All these treatment uses lack scientific backing.
Alongside the natural kratom market are products made of semisynthetic and concentrated 7-OH, which have been available for nearly three years in the US.
The new research doesn’t have details on whether kratom use involved traditional leaf products or semisynthetic or concentrated products, the authors said — so they don’t know whether poisoning and death risks may depend on a product being natural or semisynthetic.
Given their findings, the authors urge more research on both natural kratom and semisynthetic 7-OH.
“Building this evidence base is essential to promoting safe kratom use, identifying high-risk combinations of substances, and guiding public health action to prevent future health effects in this rapidly evolving drug landscape,” they wrote.
Crackdowns on kratom and its derivatives
Government regulators at the federal and state levels have been cracking down on semisynthetic 7-OH, natural kratom or both to varying degrees.
Rhe US Department of Health and Human Services recommended in July that only semisynthetic 7-OH be classified as a schedule I controlled substance — the category the federal government uses for illicit substances with “no currently accepted medical use and a high potential for abuse,” including heroin and LSD. (It did not release data supporting the decision at the time.)
The government’s move effectively modified its previous stance of the past decade, which included efforts to classify naturally occurring mitragynine and 7-OH as schedule I substances on an emergency temporary basis, following reports of kratom abuse and poisonings. The FDA had also said kratom qualified as an opioid and discouraged consuming it.
Some states have followed in the federal administration’s footsteps by either classifying semisynthetic 7-OH as a schedule I substance or otherwise restricting the substance, including Florida, Ohio, Kentucky and California.
Smith, the leading kratom researcher, has said the emphasis on semisynthetic 7-OH is odd because there is no evidence justifying it, and because the natural kratom alkaloid mitragynine still converts to 7-OH during manufacturing and in the body.
Natural kratom is regulated in at least 22 states and has been banned in eight of those states, including Alabama, Connecticut, Ohio and Vermont.
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