Calls About Kratom to U.S. Poison Control Centers Surge

By Pat Anson

In what could be part of a new federal effort to ban kratom nationwide, the CDC has released a new study pointing to an exponential increase in kratom-related calls to U.S. poison control centers over the past decade.

There was a 1,200% increase in kratom-related reports to the National Poison Data System, from 258 in 2015 to 3,434 in 2025, including a “marked surge” last year. 

There was a similar 1,200% increase in kratom-related reports that resulted in adverse events and hospitalizations, from 43 cases in 2015 to 538 in 2025.

Over that 11-year period, there were a total of 233 kratom-related deaths. Most of the deaths and hospitalizations involved other drugs, such as alcohol, opioids, cannabis, stimulants and benzodiazepines. 

About half of the exposure reports were considered “intentional misuse” or suspected suicide attempts, researchers reported in the CDC’s Morbidity and Mortality Weekly Report (MMWR).

“Kratom-related adverse effects are increasing in number and complexity in the United States. Increasing use, the availability of high-potency kratom, and frequent multiple-substance exposure reports contribute to hospitalizations from physical as well as psychiatric causes,” wrote lead author Christopher Holstege, MD, Professor of Emergency Medicine and Pediatrics at the University of Virginia School of Medicine.

Last summer, the FDA said it would seek to have the kratom alkaloid 7-hydroxymitragynine (7-OH) – but not whole leaf kratom – classified as an illegal Schedule One controlled substance. 

7-OH occurs naturally in kratom in trace amounts, but some kratom vendors are selling concentrated versions of 7-OH that boost its potency as a pain reliever and mood enhancer. The surge in poison control cases in 2025 is mainly attributed to the growing use of 7-OH products. 

“As FDA moves to regulate 7-hydroxymitragynine but not whole-leaf kratom products, surveillance should distinguish product types to assess risks. Building this evidence base is essential to promoting safe kratom use, identifying high-risk combinations of substances, and guiding public health action to prevent future health effects in this rapidly evolving drug landscape,” said Holstege. 

Misleading Numbers

It’s important to note that the surge in kratom-related calls to poison control centers has more to do with kratom’s growing popularity in the United States. 

Kratom comes from the leaves of a tree in Southeast Asia, where it has been used for centuries as a natural stimulant and pain reliever. Kratom’s use began growing in the U.S during the 2010’s, as restrictions were placed on opioid analgesics and pain patients sought other ways to get relief. 

According to the MMWR, about 5 million Americans have used kratom, although some estimates are as high as 20 million..

Even using the conservative estimate, the 14,449 kratom-related calls to poison centers over the 11-year period represents only a tiny fraction (0.28%) of the estimated 5 million kratom users.

Critics say calls to poison control centers are “notoriously unreliable” and an imperfect way to measure the risks associated with a substance, since most calls involve minor symptoms such as upset stomachs or dizziness.

The number of calls can also be misleading. For example, a study of poison control data from 2000 to 2017 found there were more calls about exposure to nutmeg than there were about kratom.  

Nevertheless, the poison control data is often used by federal health officials and law enforcement agencies to seek changes in the legal status of a substance.  In 2016, the DEA and FDA cited another MMRW study to justify their efforts to have 7-OH and the alkaloid mitragynine listed as Schedule One controlled substances, in the same category as heroin. Such a move would have effectively banned kratom.

“Evidence from poison control centers in the United States also shows that there is an increase in the number of individuals abusing kratom, which contains the main active alkaloids mitragynine and 7-hydroxymitragynine. As such, there has been a steady increase in the reporting of kratom exposures by poison control centers,” the DEA said in 2016, citing the earlier MMRW study.

The DEA dropped its proposal to schedule mitragynine and 7-hydroxymitragynine after a public outcry, saying a ban on kratom would have “significant risk of immediate adverse public health consequences.” 

A top federal health official later admitted the FDA and the DEA based their scheduling request on “embarrassingly poor evidence & data.”

The growing controversy over 7-OH has revived efforts to restrict or ban sales of kratom and 7-OH at the state and local level. It may only be a matter of time before the DEA joins that movement, by renewing its effort to schedule 7-OH, mitragynine, and perhaps kratom itself.

Cannabis Poisoning Calls Rise, Particularly for Children

By Pat Anson, PNN Editor

A new analysis of calls to U.S. poison control centers suggests that more regulation is needed of cannabis products to protect consumers – and children in particular — from adverse health consequences.

Researchers found a significant increase in cannabis-related calls to poison centers from 2017 to 2019, about half of them from a healthcare facility.

Most of the 28,630 calls involved someone ingesting cannabis flower or buds, but a growing number involved manufactured cannabis products such as edibles, vaporized liquids and concentrates. About a third of the calls were considered serious.

Cannabis-Related Calls to U.S. Poison Control Centers

JAMA NETWORK OPEN

Most of the calls about manufactured cannabis products involved underage children. Twenty-seven percent involved children under the age of 10 and about a third (34.5%) involved youths between 10 and 20 years of age. Edibles were involved in about two-thirds of those calls.

“Children may be at particular risk for exposure to edible products, such as cookies or candy,” wrote lead author Julia Dilley, PhD, Oregon Health Authority, in JAMA Network Open.

“Although we did not see more serious health outcomes for manufactured product exposures compared with plant products overall, most cannabis plant exposures involved polysubstance use, whereas most cases for manufactured products were for those products alone, suggesting that exposure to manufactured products alone may be relatively more likely to generate adverse events.”

Dilley and her colleagues say cannabis products are riskier for children because they may not know they are consuming THC (tetrahydrocannabinol), the psychoactive ingredient in cannabis. Even when they are labeled, research has found that the amount of THC in cannabis products is often inaccurate.

The study did not distinguish between medical and recreational cannabis. Interestingly, the rate of calls to poison centers from states where cannabis is legal was slightly higher than those where cannabis is still illegal, suggesting that legalization does not increase the level of safety.  

“Market factors may drive the industry to continue developing novel products, which could present additional health risks. Applying regulatory controls to market-driven innovations in potency and additives is key. Novice cannabis users are often advised to ‘start low, go slow’; this guidance may be equally applicable to regulating new retail cannabis markets and products,” researchers said.

Some cannabis companies are intentionally marketing their products as candy and snacks to make them more attractive to children. The Food & Wine website reports the Wrigley Company recently filed three lawsuits against cannabis manufacturers, alleging they produced THC-spiked products that resemble Wrigley candies such as Skittles, Life Savers and Starbursts   

“We take great pride in making fun treats that parents can trust giving to their children and children can enjoy safely," a Wrigley spokesperson told Reuters. "We are deeply disturbed to see our trademarked brands being used illegally to sell THC-infused products."

One cannabis company, THC Living, recently took a “snortable” cannabis candy off the market after complaints on social media. According to Leafly, the packaging and marketing of “Cannabis Bumps” were designed to make the powdered candy look like cocaine. Each package contained a hefty dose of 600mg of THC.    

Gabapentin Linked to Growing Number of Suicide Attempts

By Pat Anson, PNN Editor

We’ve reported several times about the abuse and lack of effectiveness of gabapentin, a nerve medication increasingly prescribed to treat fibromyalgia, neuropathy and other types of chronic pain.

It turns out gabapentin is also involved in a growing number of attempted suicides.

In a large new study published in the journal Clinical Toxicology, University of Pittsburgh researchers looked at over 90,000 calls involving medications to U.S. poison control centers. They found that calls about gabapentin and the muscle relaxant baclofen increased significantly just as opioid prescriptions began declining.

“Gabapentin and baclofen are two medications that have seen increased availability to patients as alternatives to opioids for the treatment of acute and chronic pain. With greater accessibility, poison center exposures have demonstrated a marked increase in toxic exposures to these two medications,” wrote lead author Kimberly Reynolds of the University of Pittsburgh.

“As poison center data do not represent the totality of cases in the United States, the steep upward trends in reported exposures reflect a much larger problem than the raw numbers would suggest.”     

Between 2013 and 2017, calls involving the abuse and misuse of gabapentin went up nearly 120 percent, while reports of baclofen being abused or misused rose nearly 32 percent from 2014 to 2017.

Even more concerning is that calls about attempted suicides involving gabapentin rose 80 percent, while calls about attempted suicides with baclofen increased 43 percent. Co-ingestion of sedatives and opioids were common for both medications.

Only 19 deaths involving gabapentin were identified as possible suicides during the five-year study period, but there were thousands of gabapentin-related calls each year coded as attempted suicides — including over 10,000 calls in 2017 alone.

SOURCE: CLINICAL tOXICOLOGY

“It would be anticipated that patients who are prescribed gabapentin and/or baclofen would be more likely to be treated for mood disorders and pain as they are frequently comorbid and therapy overlaps significantly,” researchers said.

“Gabapentin has specifically been recognized for its misuse and diversion potential, synergistic effect with opioid use, and contribution to use disorders. Baclofen misuse has not been as frequently described but is anecdotally observed and associated with severe toxicity, physical dependence, and complicated withdrawal.”

Gabapentin was the 10th-most widely prescribed drug in the U.S. in 2017. Calls to poison control centers about gabapentin were highest in Kentucky and West Virginia, two of the states hardest hit by the opioid crisis. Calls about baclofen were highest in Kentucky, Maine and New Mexico.

The researchers recommend that patients who are prescribed gabapentin or baclofen be prescreened for substance use disorders, mood disorders and suicidal ideation.

FDA Gabapentin Warning

The Food and Drug Administration warned in 2008 that all patients being treated with gabapentin or ten other antiepileptic drugs should be informed about the risks of suicidal thoughts and actions.

The FDA reviewed 199 clinical trials of the drugs and found that patients who received them had almost twice the risk of suicidal behavior or ideation (0.43%) than patients on a placebo (0.24%). That means there would be one additional case of suicidal thinking or behavior for every 530 patients treated with an antiepileptic drug.

“All patients who are currently taking or starting on any antiepileptic drug for any indication should be monitored for notable changes in behavior that could indicate the emergence or worsening of suicidal thoughts or behavior or depression,” the FDA said.

Gabapentin (Neurontin) and its chemical cousin pregabalin (Lyrica) belong to a class of nerve medication called gabapentinoids. Both drugs were originally developed to treat epileptic seizures, but are now widely prescribed off label to treat a variety of chronic pain conditions.    

A recent Swedish study found that patients taking gabapentinoids had higher rates of overdose, suicide and suicidal behavior than the general population. The risks were strongest in teens and young adults.

A recent clinical review found little evidence that gapapentinoids should be used off-label to treat pain and that prescribing guidelines often exaggerate their effectiveness. The CDC’s controversial 2016 opioid guideline, for example, calls gabapentin and pregabalin “first-line drugs” for neuropathic pain.

In a new draft report being funded by the CDC, researchers say gabapentin showed only “small improvements” in pain for people with diabetic peripheral neuropathy and fibromyalgia. The study by the Agency for Healthcare Research and Quality (AHRQ) is expected to finalized in early 2020.

Kratom vs. Nutmeg: Which Is More Dangerous?

By Pat Anson, PNN Editor

Here’s a trick question for you. Which substance is more dangerous – kratom or nutmeg?

News reports about a recent study that analyzed calls to U.S. poison control centers leave little room for doubt:

“Life-threatening kratom exposures rose by 5000% in 6 years,” is how the Daily Mail reported it.

“Poison Control Centers See Spike in Calls About Kratom Exposure,” was the headline used by WOSU Public Media.

While the headlines are technically accurate, the study published in the journal Clinical Toxicology did not focus solely on kratom. The herbal supplement was one of many naturally occurring psychoactive substances that resulted in over 67,000 calls to U.S. poison control centers from 2000 to 2017.

Marijuana was involved in about half of those calls, followed by plants and mushrooms that act as stimulants or cause hallucinations. Kratom ranked 7th on the list, behind substances like peyote and nutmeg. Yes, nutmeg.

POISON CONTROL CALLS (2000-2017)

1. Marijuana (31,628)

2. Anticholinergic Plants (14,236)

3. Hallucinogenic Mushrooms (10,482)

4. Morning Glory Plants (3,643)

5. Nutmeg (1,962)

6. Peyote (1,717)

7. Kratom (1,631)

8. Kava Kava (1,331)

9. Salvia (622)

10. Absinthe (65)

11. Khat (52)

In most cases, the calls to poison centers involved minor symptoms like upset stomachs or dizziness, but some were serious enough to result in hospitalizations and even deaths. Researchers said marijuana is particularly concerning because it is being sold in candies, cookies and other edibles that a child could get their hands on.

“These substances have been associated with a variety of serious medical outcomes including seizures and coma in adults and children,” said co-author Henry Spiller, director of the Central Ohio Poison Center at Nationwide Children’s Hospital.  “As more states continue to legalize marijuana in various forms, parents and health care providers should treat it like any other medication: locked up, away, and out of sight of children.

Why Did Kratom Calls Spike?

There were only 1,631 calls involving kratom made to poison control centers over an 18-year period. But the numbers started to rise sharply in recent years as more Americans discovered kratom — from 13 kratom calls in 2011 to 682 calls in 2017 — that’s where the 5,000% spike comes from.

The American Kratom Association estimates several million Americans now use kratom to treat chronic pain, addiction, anxiety and other medical conditions.

Side effects from kratom are relatively rare. But researchers say a high percentage of the calls to poison control centers about kratom resulted in hospital admissions and serious medical problems. The chief complaint for many of the calls, according to another study, was that kratom caused agitation, tachycardia (rapid heartbeat), drowsiness, vomiting and confusion.

Kratom comes from the leaves of a tree that grows in southeast Asia, where it has been used for centuries as a natural stimulant and pain reliever. Critics say calls to U.S. poison control centers are misleading and a poor choice for research.

“The data drawn from the Poison Control Centers are notoriously unreliable, inasmuch as they are anecdotal reports from the public that are gathered and reported in an unscientific fashion,” said Max Karlin, a spokesman for the Kratom Information & Resource Center. “In the absence of good data, you just end up with a garbage-in, garbage-out situation.”

Kratom has been banned in a handful of states, but is widely available online and in smoke shops. Spiller and his colleagues say it should be regulated in all 50 states.

“The continued rise in kratom usage coupled with the serious medical outcomes identified in our study support the need for federal regulation of kratom along with further research on this public health problem,” they concluded. “While rates of exposure to most natural psychoactive substances decreased during the study period, rates for marijuana, nutmeg, and kratom increased significantly.”

The study offered no explanation for the significant increase in nutmeg calls. Nor did it suggest that nutmeg be regulated.

Nutmeg is a spice known for its pungent fragrance and sweet taste, but in large doses it can also have a psychoactive effect.

As far back as the Middle Ages, people used nutmeg as a medicine and to get high. There is even a page for nutmeg on Reddit, where drug users swap stories and try to figure out the best way to ingest it.

“Do I need to ground them up to a powder or can I just make little pieces and swallow them with water? Can I smoke nutmeg? Can I snort it?” asked a nutmeg newbie.  Most people who tried nutmeg said it made them sleepy, nauseated and wasn’t worth the effort.

While any call to a poison control center is concerning, the number of calls about kratom and nutmeg that came in over an 18-year period pales in comparison to the calls that come in every day about children ingesting hand sanitizers, laundry detergent packets and other toxic products.

Which brings us back to our original question. Is kratom or nutmeg more dangerous?  When used in moderation and with common sense, millions of people will tell you neither one is.