Review Highlights Stark Differences in Kratom Use Between East and West

Why it matters

Understanding how kratom is used across different cultural contexts is essential for crafting proportionate regulations — this review reveals that risk profiles differ dramatically between traditional Southeast Asian use and Western commercial consumption.

The big picture

The divergence between kratom's centuries-long safe use in Southeast Asia and the adverse events reported in the West points to product adulteration, polydrug use, and unregulated manufacturing as key risk drivers — not kratom itself.

Key findings

• • In Southeast Asia, kratom is used by day laborers as a stimulant; in the US, typical users are middle-aged, college-educated, and middle-income, primarily seeking pain and withdrawal relief
• • Deaths attributed to kratom in Europe and US have not been reported in Southeast Asia; nearly all Western fatalities involved polydrug exposure
• • Kratom can cause herb-drug interactions, particularly with other CNS-active substances
• • Adulterated or contaminated commercial products pose additional risk not seen with traditional use

What they say

Narrative review published in Substance Abuse and Rehabilitation (2019) by Charles Veltri (Midwestern University) and Oliver Grundmann (University of Florida).

Bottom line

The global divergence in kratom risk profiles — minimal in Southeast Asia, elevated in the West — points to commercial product quality and polydrug use as the primary drivers of adverse events.