Kratom Toxicity Cases Surged 60-Fold From 2010 to 2023, With Nearly Half of Hospitalized Patients in Critical Care

Why it matters

A comprehensive analysis of nearly 9,000 poison center reports confirms that kratom toxicity is rising sharply and producing life-threatening neurological and cardiac outcomes — yet standard drug screens don't detect it, leaving emergency physicians flying blind.

The big picture

Researchers analyzed 8,919 US poison center exposure reports from 2010 through 2023, covering a period during which kratom use expanded dramatically. The findings reveal a public health burden that exceeds what is commonly reported, with more than a third of exposures resulting in hospital admission and nearly half of admitted patients requiring critical care. The study also found that polysubstance use — present in 39% of cases — significantly increases the risk of life-threatening outcomes.

Key findings

• Kratom-related poison center cases grew from 19 per year in 2010 to 1,242 in 2023 — a 60-fold increase
• Over 72% of reported individuals required formal medical evaluation in healthcare facilities
• 34% of all exposures resulted in hospital admission; 44.5% of admitted patients required critical care
• Fatal outcomes occurred in 174 cases, including 27 single-substance ingestions
• Polysubstance use appeared in 39% of reports and was associated with higher rates of major life-threatening effects
• Standard toxicological drug screens do not detect mitragynine, creating significant diagnostic challenges

What they say

According to the study as summarized by EMJ Reviews, "clinicians evaluating unexplained seizures, acute altered mental status, or sudden cardiovascular collapse should proactively consider kratom toxicity, investigate potential supplement use, and prepare for intensive supportive care" — particularly because kratom is invisible to standard drug screens.

Bottom line

Kratom-related hospitalizations and critical care admissions have exploded over the past decade, and because standard toxicology screens miss it entirely, emergency physicians must explicitly ask patients about kratom and 7-OH use in any unexplained neurological or cardiac event.