Forensic toxicology reports, mortality surveillance, overdose investigations, and severe clinical outcomes associated with kratom and mitragynine exposure.
Click image to enlarge. Source: CDC SUDORS. Annual detections: 866 (2020, 32 jurisdictions) → 1,314 (2023, 42 jurisdictions) → 995 (2024, 43 jurisdictions).
| Year | Total Occurrences | Cause of Death | Present at Death | Cause % | Present % |
|---|---|---|---|---|---|
| 2020 | 246 | 166 | 80 | 67% | 33% |
| 2021 | 305 | 187 | 118 | 61% | 39% |
| 2022 | 308 | 172 | 136 | 56% | 44% |
| 2023 | 274 | 182 | 92 | 66% | 34% |
| 2024* | 224 | 131 | 93 | 58% | 42% |
*2024 interim/semi‑annual report. Across 2020–2024, mitragynine was determined to be a cause of death in the majority of detections each year – more often causal than incidental.
Analysis of 6,860 blood specimens; mitragynine up to 11,000 ng/mL. Co‑positivity with fentanyl (62%) and methamphetamine (19%). High concentrations (>1000 ng/mL) associated with death.
Read Study →One case had postmortem mitragynine 10 mg/L – far above recreational levels. Demonstrates extreme concentrations can contribute to death.
Read Report →Blood concentrations in postmortem cases ranged from 5.4 to 11,000 ng/mL; concentrations >1000 ng/mL are more often associated with death.
Read Study →Two decedents had mitragynine as sole toxicological finding (2,325 and 3,809 ng/mL). Medical examiners ruled acute mitragynine intoxication as cause of death. Kratom alone can be lethal.
Read Study →Mitragynine‑only fatality with central blood 7.5 mg/L; death certified as acute mitragynine intoxication with cardiomegaly.
Read Report →35 kratom‑positive deaths; in one case mitragynine was the sole intoxicant (950 ng/mL). Wide concentration range in fatalities shows no safe dose.
Read Study →CPK 26,989, acute renal failure requiring dialysis, transient cardiomyopathy (EF 31‑35%), multifocal brain infarcts.
Read Case →Mixed liver injury, renal failure requiring dialysis, colitis, liver transplantation, end‑stage renal disease. Long‑term organ damage requiring transplant.
Read Case →Cardiorespiratory arrest after kratom; intralipid temporarily improved condition but patient died. Kratom alone caused fatal respiratory and cardiac failure.
Read Report →Medical examiners listed kratom as a direct cause in 91 deaths (≈60%). Fentanyl/fentanyl analogs present in 65%; heroin 33%; benzodiazepines 22%. Polysubstance common, but kratom contributed causally in most detections.
Read Report →Postmortem showed lethal quetiapine concentration with mitragynine; kratom inhibited quetiapine metabolism, causing death. Herb‑drug interaction fatal.
Read Case →Death with ascites, renal impairment, and mitragynine 560 ng/mL plus hydromorphone. Kratom contributed to toxicity.
Read Report →28‑year‑old collapsed with ventricular fibrillation after smoking kratom; ECG showed type 1 Brugada pattern. Kratom's alkaloids inhibit cardiac ion channels – sudden cardiac death risk.
Read Case →35‑year‑old suffered cardiac arrest after using kratom alone; LVEF dropped to 20% and brain infarcts occurred. Catastrophic cardiovascular event.
Read Case →Middle‑aged man with no cardiac history developed VF after kratom; prolonged QT and pulmonary congestion. Kratom can trigger lethal arrhythmias.
Read Case →Patient developed severe QTc prolongation (552 ms) and Brugada pattern after kratom use, resolving after abstinence. Concentration‑dependent potassium channel blockade.
Read Report →1,807 exposures; 31.8% admitted to healthcare facility, 51.9% serious medical outcome. 11 deaths (2 with kratom alone).
Read Study →Patients required intubation, vasopressors, dialysis, and prolonged ICU stays. Kratom alone can produce critical illness.
Read Report →Patient required orthotopic liver transplantation and remains on dialysis after chronic kratom use.
Read Case →Kratom and mitragynine increasingly appear in overdose surveillance systems, forensic toxicology investigations, and severe clinical outcome reports, including fatal intoxications, cardiac arrest, respiratory depression, multiorgan failure, and polysubstance overdose deaths. Single‑substance fatalities have been documented with postmortem concentrations exceeding 2,000 ng/mL. Polysubstance with fentanyl, benzodiazepines, and stimulants is common, but medical examiners have determined mitragynine to be a causal contributor in the majority of Florida detections and approximately 60% of CDC SUDORS deaths. Severe clinical outcomes include intubation, dialysis, cardiac arrhythmias, and liver transplantation. These patterns indicate that kratom is not a benign botanical but carries meaningful risk of severe and fatal outcomes, particularly in high‑dose and polysubstance contexts.
