CDC Study Warns Against Consuming Kava-Kratom Drinks
/By Pat Anson
For the second time in a week, the CDC has released a study warning of “serious medical outcomes” for people who consume kratom, a controversial supplement used by millions of Americans as a stimulant and pain reliever.
This time, the study focuses on the co-use of kratom with kava, a plant in the pepper family used to make a coffee-like drink that promotes relaxation and improves mood.
Consumption of kava declined after the FDA warned in 2002 that it could cause severe liver injury. But consumption began rising again as drinks such as “Feel Free” — which contains kava and kratom — rose in popularity among young people.
“These commercial products are commonly marketed as healthy alternatives to alcohol, sold near college campuses, and increasingly being combined with kratom, a psychoactive botanical with opioid-like effects, raising safety concerns,” wrote lead author Christopher Holstege, MD, Professor of Emergency Medicine and Pediatrics at the University of Virginia School of Medicine.
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Holstege and his colleagues reported in the CDC’s Morbidity and Mortality Weekly Report (MMWR) that kava-related calls to U.S. poison control centers rose 383% from 2011 to 2025 (from 57 cases to 203). About a third of the kava calls in 2025 also involved kratom.
“These data indicate a resurgence of overall kava exposure reports to poison centers, as well as an increase in kratom-related kava reports, which has coincided with higher rates of serious clinical outcomes. The findings in this report suggest the need for enhanced surveillance for, clinical awareness of, and public education regarding commercial products containing kava,” Holstege said.
Nearly half (43%) of the kava-related calls involve other substances, including ethanol (alcohol) and benziodiazepines. While most adverse effects were minor, such as nausea and dizziness, about a third resulted in hospitalizations or serious outcomes. Eight kava-related deaths were reported during the study period.
Last week the same group of researchers warned in another MMWR report that kratom-related calls to U.S. poison control centers rose by 1,200% over the past decade. While that appears to be a startling increase, it’s a misleading number that represents only a tiny fraction (0.28%) of the estimated 5 million kratom users.
A MMWR report in 2016 was used by the DEA to justify its efforts to have the kratom alkaloids 7-hydroxymitragynine (7-OH) and mitragynine listed as Schedule One controlled substances, a move that would have effectively banned kratom. That report was also based on calls to poison control centers.
The DEA dropped its proposal after a public outcry. A top federal health official in the first Trump administration later admitted the scheduling request was based on “embarrassingly poor evidence & data” from the FDA and could result in “substantial risk to public health” if kratom were made illegal.
The growing controversy over potent forms of 7-OH recently revived efforts by the FDA to have the DEA list 7-OH as a controlled substance, but not natural leaf kratom. The DEA has yet to act on that request.
A controversial drink that combines kava and kratom is Feel Free, made by Oklahoma-based Botanic Gardens. Media stories claimed the drink is addictive, has “opioid-like effects” and is “hooking young people.”
A class action lawsuit was filed against Botanic Gardens that alleged it used misleading advertisements to promote Feel Free as a healthy alternative to alcohol. The company settled the case for $8.75 million, and agreed to put stronger safety warnings on Feel Free bottles and limit sales to people 21 and older.
In 2023, the FDA seized nearly 250,000 bottles of Feel Free, alleging the drink was an adulterated substance and there was inadequate information about its safety. Over a year later, the FDA quietly dropped the case. Botanic Gardens continues to sell Feel Free.
