Observational studyAddiction (Abingdon, England)2026
Association between state-level kratom regulations and poison center-reported severe medical outcomes and healthcare use: A United States national analysis.
Observational study in Addiction (Abingdon, England), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
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Who cites it
3 citing papers in PubMed.
- Commentary on Comstock et al.: Here we go again-Kratom and the failure to learn from the opioid crisis.Addiction (Abingdon, England) · 2026Article
- Association between state-level kratom regulations and poison center-reported severe medical outcomes and healthcare use: A United States national analysis.Addiction (Abingdon, England) · 2026Observational
- A Review of Kratom Product Evolution and Its Associated Health Outcomes.Substance abuse and rehabilitation · 2026Review
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
BACKGROUND AND
aimsKratom use in the United States (US) has increased. Kratom is not federally scheduled; regulation is heterogenous and determined at the state level. Strategies include no regulation, bans and kratom consumer protection acts (KCPA) such as age limits, product purity or labeling requirements. Public health data informing these policies remain limited. This study aimed to compare rates of poison center (PC) reported kratom exposures, including those associated with severe medical outcomes and healthcare use, across US states with differing regulatory frameworks, and to characterize national trends in kratom exposures over time.
designRetrospective observational study of kratom exposures reported to the National Poison Data System from 2010 to 2023.
settingAll 50 US states and the District of Columbia.
participantsA total of 8919 kratom-related exposures were reported to PCs during the study period, including 5452 single-substance exposures (61%). Most cases involved adult males (69%), aged ≥18 years (8133; 91%). MEASUREMENTS: States were classified by kratom regulatory status into four categories: unrestricted (no regulations), KCPA, local restrictions (KCPA in 1 or more county, but no state regulation) or banned (retail sale illegal). The primary outcome was the incidence of severe medical outcomes defined as exposures coded by America's Poison Centers criteria as major effect (life-threatening or resulting in significant residual disability) or death. Secondary outcomes included rates of exposure, hospitalization and healthcare use (defined as hospital admission or evaluation in an emergency department, urgent care or primary care).
findingsKratom exposures increased from 19 cases in 2010 to 1242 cases in 2023 [incidence rate ratio (IRR) = 69.0 compared with 2010; 95% confidence interval (CI) = 39.6-120; P < 0.001]. Severe medical outcomes increased from zero cases in 2010 to 158 cases in 2023; 2012 was the first year in which a severe outcome was reported (2023 IRR = 56.9 vs 2012; 95% CI = 14.7-221; P < 0.001). Overall, 13% of kratom exposures resulted in a severe medical outcome. Compared with states where kratom was banned, statistically significantly higher rates of exposures (IRR = 2.49; 95% CI = 1.89-3.28), severe medical outcomes (IRR = 3.19; 95% CI = 1.78-5.70), healthcare use (IRR = 2.44; 95% CI = 1.66-3.60) and hospitalization (IRR = 2.45; 95% CI = 1.81-3.30, P < 0.001) occurred (all P < 0.001). No statistically significant differences were identified between other regulatory categories.
conclusionKratom exposures and severe medical outcomes reported to United States poison centers are increasing nationally, though states with bans in place have experienced less pronounced increases.
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