Increase in Poison Center Reports Linked to Kratom-Containing Kava Products — National Poison Data System, United States, 2000–2025

Results

During the entire study period (2000–2025), a total of 3,101 kava-related exposures were reported. Before the 2002 FDA advisory, 298 and 331 annual case exposures were reported during 2000 and 2001, respectively, corresponding to approximately 34 kava-related exposure reports per 100,000 drug exposure reports (Figure 1). Coinciding with the advisory, annual exposure reports began to decline, reaching a low of 42 in 2010 (87% decrease during 2001–2010), before beginning to rise in 2011, increasing 383% by 2025 (from 57 to 203). Exposure report rates in 2010 declined to three per 100,000 drug exposure reports, but began to rise in 2011, increasing 220%, from five to 16 per 100,000 drug exposure reports in 2025.

Demographic Characteristics of Persons with Kava Exposures

In 2000–2001, females accounted for the majority of exposure reports (56%–57%), and a substantial proportion (25%–27%) involved children aged ≤12 years (Figure 1). During 2002–2025, the percentages of all exposures involving females and children aged ≤12 years declined, reaching 40% and 7%, respectively, in 2025. During both periods (2000–2001 and 2002–2025), adults aged ≥20 years accounted for the largest percentage of exposure reports (annual average = 66%; range = 41%–81%).

Outcomes

Across the analytic period (2000–2025), an average of 20% of exposed persons were hospitalized each year (range = 14%–30%), with no apparent temporal trends (Figure 2). In contrast, the percentage of exposures associated with serious medical outcomes increased from 12% in 2000 to a high of 39% in 2024. Eight deaths were reported during the analytic period, including one each in 2000, 2001, 2005, 2017, 2023, and 2024, and two in 2021 (fatality rate = 0.25%).

Substance Co-Exposure

During 2000–2025, a total of 1,347 (43%) kava-related exposure reports involved multiple substances. The most common co-involved substances were ethanol (annual average = 7%; range = 3%–13%) and benzodiazepines (annual average = 5%; range = 2%–14%) (Figure 3). However, in 2017, kratom emerged as a common co-exposure and, by 2019, kratom surpassed ethanol and benzodiazepines in multiple-substance kava-related exposures. This coincided with increasing availability of products containing kava and kratom (Supplementary Figure 1). In 2025, co-use of ethanol or benzodiazepines accounted for 3% of multiple-substance exposures, and kratom accounted for 30%.

Reported Clinical Effects

The most common clinical effects among single-substance exposures (1,754) were gastrointestinal (vomiting and nausea), neurologic (drowsiness or lethargy, dizziness or lethargy, and agitation), and cardiovascular (tachycardia) signs and symptoms (Supplementary Figure 2). Multiple-substance exposures involving only kava and kratom (128) had similar symptomatology; however, neurologic effects included seizures and tremor, and cardiovascular effects included hypertension. Liver injury was less common for both exposure types. Moderate elevations in aspartate transaminase or alanine transaminase (>100 to ≤1,000 IU/L) were reported in 29 of 1,754 (1.7%) single-substance exposures and eight of 128 (6.3%) multiple-substance exposures involving kava and kratom.