Preventative Medicine: Risk of Death Associated with Kratom Use Compared to Opioids

In recent years, kratom has gained popularity in the United States as an alternative to opioids for pain management and as a recreational substance. As a result, concerns have been raised about the safety of kratom use and its potential for addiction and overdose. However, a recent study published in Preventive Medicine by Jack E. Henningfield, PhD, Oliver Grundman, PhD, Jane K. Babin, PhD, JD, Reginald V. Fant, PhD, Daniel Wang, B.S., and Edward J. Cone, PhD, challenges some of these concerns. The study evaluated the risk of death associated with kratom use compared to opioids, using federal government data on deaths involving opioids and estimates of kratom-associated deaths by the US Food and Drug Administration (FDA). The findings suggest that the risk of overdose death is more than 1,000 times greater for opioids in general than for kratom. This article will delve deeper into the study’s key points and its implications for public health policy.

The study’s authors note that while headlines suggest kratom use is the cause of some deaths, in most cases, the deaths have been due to use of another drug in combination, such as fentanyl, heroin, benzodiazepines, prescription opioids, or cocaine, or to other causes like homicide, suicide, and preexisting diseases. In fact, there has yet to be a verified overdose death from kratom use alone in the US or in Southeast Asia where kratom has been widely used for more than a century. However, this does not mean that overdose death on kratom has not happened or is not possible.

The study evaluated the relative risk of kratom-associated death based on two plausible estimates of the number of US kratom users, which range from approximately 11 to 16 million people. The authors compared “any opioid” to “heroin” based on estimates by the US Centers for Disease Control and Prevention (CDC). The main conclusion drawn from the study is that the risk of overdose death is more than 1,000 times greater for opioids in general than for kratom, and may be many thousand times greater for heroin or “any opioid” as shown in the tables summarizing the basis for comparisons.

The authors acknowledge that some kratom users may have medical conditions that increase their risk of death and/or may assume risks that could greatly increase the possibility of kratom-associated mortality, such as use with opioids, sedatives, alcohol, or other drugs. Thus, more studies of kratom safety are needed, particularly as kratom use appears to be increasing across the US.

The study’s findings have important implications for public health policy. The authors emphasize that because many deaths possibly involving kratom also involved opioids and other drugs that carry a high risk of overdose death, regulation establishing standards for kratom purity, packaging, labeling, and alkaloid content is urgently needed to reduce risks for persons who purchase lawfully marketed products. In this context, it is promising that four states (Arizona, Georgia, Nevada, and Utah) have passed kratom consumer protection laws that include standards for kratom product purity and labeling and requiring registration and oversight. The authors also call on the FDA to set standards for kratom as it does for most foods and manufactured dietary products.

In conclusion, the study suggests that the risk of death associated with kratom use is relatively low compared to opioids, and that regulations are needed to ensure the safety of kratom products. Further research is needed to understand the potential benefits and risks of kratom, particularly as its use continues to grow in popularity.