Survey: 75% of Kratom Users at Tea Bars Report Adverse Reactions, Often Linked to Empty Stomach and Mixing Substances

Why it matters

With an estimated millions of Americans using kratom regularly and the product largely unregulated, understanding what triggers adverse reactions — and what harm reduction strategies real users employ — is essential for clinicians, public health officials, and consumers alike.

The big picture

Most harm-focused kratom research has relied on poison control data, emergency department reports, or online surveys of heavy users — populations that may overrepresent severe harms. This study took a different approach, surveying actual kratom consumers at ethnobotanical tea bars in Northern Colorado, a real-world venue where kratom is consumed socially. The study is among the first to collect field data on adverse reactions and user-reported mitigation strategies in a naturalistic setting.

Key findings

• 75.5% of 102 survey participants at kratom tea bars reported experiencing at least one adverse reaction to kratom at some point
• Most common triggering contexts: consuming kratom on an empty stomach, alongside certain foods, with insufficient hydration, or mixed with other substances
• Users self-reported a range of mitigation strategies including slowing consumption, adjusting food and fluid intake, stopping use, and resting
• Adverse reactions occurred across a wide range of kratom doses — not only at high doses — complicating simple dose-based warnings
• Study authors note that the efficacy of user-reported harm reduction strategies has not been formally tested

What they say

"More data are needed to understand the causes and consequences of adverse reactions to kratom, and to better understand potential harm reduction strategies for reducing adverse experiences," the study authors concluded. "More research could also shed light on the extent to which serving size and product formulations are predictive of adverse effects."

Bottom line

Three in four kratom users at real-world tea bars have experienced an adverse reaction — and the most common triggers are not high doses, but situational factors like an empty stomach and substance mixing.