Health
Amid kratom overdose claims, groups call for regulation, better testing of drug
As the U.S. weathers its fourth wave of the opioid epidemic crisis, more people are turning to non-opioids — including a natural remedy known as kratom — to combat their pain.
Yet medical examiners and coroners have found that kratom caused 1.5% to 1.7% of overdose deaths between Jan. 2020 and Dec. 2022.
That’s according to data from the State Unintentional Drug Overdose Reporting System (SUDORS) that the Centers for Disease Control and Prevention (CDC) shared with Fox News Digital.
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Here’s a closer look at this important issue.
What is kratom?
“Kratom is derived from the leaves of a Mitragyna speciosa, a Southeast Asian tree found in Malaysia and Thailand,” Lori Karan, M.D., professor of internal and preventive medicine at Loma Linda University in Loma Linda, California, told Fox News Digital.
Medical examiners and coroners have found that kratom — which is often ingested in capsule form — caused 1.5% to 1.7% of overdose deaths between Jan. 2020 and Dec. 2022. (iStock)
The leaves of the tree have more than 40 different active compounds; the most primary is mitragynine, 7-hydroxymitragynine and speciofoline.
The plant is thought to have dual properties.
It produces a stimulant effect at low doses, and an opioid-like analgesic effect when taken in higher amounts, according to Dr. Richard Clark, medical director of the San Diego division of the California Poison Control System.
“It has activity at opioid receptors in the brain (like opioid analgesics), and for that reason has been used as either a substitute for opioid analgesics or a tool to improve symptoms of opioid withdrawal,” Clark told Fox News Digital.
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Americans most commonly use kratom for self-treatment of chronic pain and to help battle opioid withdrawal symptoms, he said.
The drug is banned in six states — Alabama, Arkansas, Indiana, Rhode Island, Vermont and Wisconsin — although people can still buy products prepared from kratom leaves online and in stores across the U.S.
Kratom is derived from the leaves of a Mitragyna speciosa, a Southeast Asian tree found in Malaysia and Thailand. (iStock)
“There are currently no specific laws against possession of kratom in the United States,” Clark noted.
Approximately two million Americans aged 12 and older used kratom in the past year, according to a 2022 national survey on drug abuse.
“There are no drug products containing kratom or its two main chemical components that are legally on the market in the U.S.,” according to the website of the U.S. Food and Drug Administration (FDA).
“FDA has not approved any prescription or over-the-counter drug products containing kratom or its two main chemical components, mitragynine and 7-hydroxymitragynine (7-OH-mitragynine).”
Potential risks of kratom
While vendors may advertise kratom as safe and “all natural,” the composition can vary widely and may not accurately reflect the product labeling, experts caution.
It’s uncommon for kratom to cause major toxic effects, but when people ingest large amounts or combine it with other drugs, they may experience hallucinogenic reactions, convulsions, coma and, in rare cases, death, Clark warned.
“There is also a potential for individuals to develop dependence and withdrawal with heavy kratom use,” he said.
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Other side effects may include nausea, dizziness, confusion and tremors, according to Karan.
“Despite U.S. Food & Drug Administration warnings of the risks of kratom use, the agency continues to receive concerning reports of adverse events associated with its use by the public,” an FDA spokesperson told Fox News Digital.
“The FDA has also warned consumers not to use kratom because of the risk of serious adverse events, including liver toxicity, seizures and substance use disorder (SUD).”
Kratom’s role in overdose deaths
Among the 144,189 overdose deaths between 2020 and 2022, kratom was “detected” in 2,966 cases, according to the SUDORS report, which means some amount of the substance was detected in post-mortem toxicology testing, whether or not it was a cause of death.
(The SUDORS report includes data from 30 states and Washington, D.C.)
Kratom was “involved” in the deaths of 2,343 cases — which means medical examiners and coroners listed it as a cause of death. (iStock)
Kratom was “involved” in the deaths of 2,343 cases, which means medical examiners and coroners listed it as a cause of death.
When kratom is found in post-mortem testing in overdose cases, the deaths almost always occur as a result of multiple medications — not just kratom, experts say.
“Most fatal overdoses occur in persons who have consumed other substances in addition to kratom.”
“Most fatal overdoses occur in persons who have consumed other substances in addition to kratom,” Karan told Fox News Digital.
In many cases, people were also taking fentanyl, alcohol or medication for anxiety or depression.
Advocates speak out against claims
The American Kratom Association, based in Virginia, supports the right of Americans to consume kratom in a safe and responsible way.
Advocates for kratom noted that the substance was found in a small minority of more than 300,000 lethal overdoses in the study.
“Research shows that virtually every death associated with the consumption of kratom involved polydrug use, which is not surprising given that many afflicted with drug use disorders have found kratom helps them to wean off more dangerous drugs,” Mac Haddow, senior fellow on public policy at the American Kratom Association, told Fox News Digital.
When kratom is found in post-mortem testing in overdose cases, the deaths almost always occur as a result of multiple medications, not just kratom, experts say. (iStock)
“While it is possible that a consumer could harm themselves by abusing kratom products, like most consumer products already on the market, those occasions are both rare and not related to the safety profile of kratom when it is responsibly consumed,” he added.
The FDA also said that it’s rare for deaths to occur from kratom use alone, and that these deaths usually occur in combination with other drug use, concluding that “the contribution of kratom in the deaths is unclear,” as stated on its website.
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Cornel N. Stanciu, M.D., director of addiction services at New Hampshire Hospital and assistant professor of psychiatry at Geisel School of Medicine at Dartmouth, told Fox News Digital that to her knowledge, there have been no deaths in which kratom was the only involved substance.
The doctor is currently working on a paper examining overdoses that are attributed to kratom by medical examiners.
One of the FDA’s top priorities as part of its Overdose Prevention Framework is to protect the public from the risks of unapproved drug substances, including kratom, the agency told Fox News Digital. (REUTERS/Andrew Kelly/File Photo)
“So far, what I am seeing is that there is tremendous variability in reporting and testing,” Stanciu said.
Comprehensive testing is lacking among medical examiners, she noted, with most labs not testing for active metabolites of kratom after someone dies.
“Second — and more concerning — I am seeing that even when more toxic substances are found, some may still call it a kratom-only death,” she cautioned.
Calls for regulation in testing
Haddow from the American Kratom Association claimed there is “rampant misinformation” associated with kratom risks — and argues for standardized toxicology testing protocols to better determine the substance’s role in overdoses.
On Feb. 8, he noted, the U.S. District Court for Southern California requested that the FDA present supporting evidence that kratom is dangerous.
Advocates and experts are calling for more regulations and standardization surrounding testing of kratom. (Don Emmert/AFP via Getty Images)
“The FDA refused to attend the hearing and the U.S. attorney explained to the court that the FDA ‘has not yet determined whether kratom is dangerous,’” he told Fox News Digital.
When contacted for comment, the FDA told Fox News Digital that it “does not comment on possible, pending or ongoing litigation.”
The FDA recently conducted a human dose-finding study, which found that no significant adverse events occurred when participants took kratom, even at high doses, Haddow claimed.
“The FDA has warned consumers not to use kratom because of the risk of serious adverse events, including liver toxicity, seizures and substance use disorder.”
The finding, which the FDA presented at a scientific conference in February 2024, was that “kratom appears to be well-tolerated at all dose levels,” Haddow added.
“The FDA’s current pilot study on dose-finding was conducted in a small sample and is still blinded,” an FDA spokesperson noted, cautioning that the data is preliminary and unvalidated.
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“We need to wait until final analysis to draw any definitive conclusion or interpretation of the results,” the FDA spokesperson added.
“Ultimately, we anticipate that the data in this pilot will be informative and can support future studies of botanical kratom.”
Advocates for kratom noted that the substance was found in a small minority of more than 300,000 lethal overdoses in the study. (iStock)
One of the FDA’s top priorities as part of its Overdose Prevention Framework is to protect the public from the risks of unapproved drug substances, including kratom, the agency told Fox News Digital.
“We will continue to collaborate with federal partners to engage proactively in meaningful research to advance science-based, regulatory decision-making,” the FDA spokesperson said.
“As new scientific and validated knowledge emerge that is based on rigorously designed studies, the agency will update the public.”
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A new review suggests that the type of fat you eat may affect your risk of developing type 2 diabetes.
Saturated fats rich in palmitic acid – the most common saturated fatty acid in U.S. foods – appear to make it harder for the body to respond to insulin.
Meanwhile, monounsaturated fats rich in oleic acid — such as those found in olive oil — may help protect against insulin resistance, the review concluded.
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“Palmitic acid is found in meats, dairy products, cocoa butter and in the form of palm oil in foods, including margarine, cereal, sweets, baked goods and fast foods,” Tanya Freirich, a registered dietitian nutritionist in Charlotte, North Carolina, told Fox News Digital. She was not involved in the review.
“Oleic acid, on the other hand, is in higher concentration in foods like olive oil, canola oil, nuts, sunflower seeds, eggs, olive, avocados and also in meats (beef, chicken, pork), milk, cheese and pasta.”
Saturated fats rich in palmitic acid – the most common saturated fatty acid in U.S. foods – appear to make it harder for the body to respond to insulin. (iStock)
The review, which was published in the journal Trends in Endocrinology & Metabolism, was led by researchers from the University of Barcelona and the CIBER Area for Diabetes and Associated Metabolic Diseases (CIBERDEM) in Spain.
The findings suggest that fat quality may be more important than total fat quantity when it comes to metabolic health and diabetes risk.
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This appears to support the idea that diets rich in monounsaturated fats, such as the Mediterranean diet, may contribute to lower rates of type 2 diabetes.
“Palmitic acid promotes several molecular processes that impair insulin action,” study investigator Dr. Manuel Vázquez-Carrera, from the Department of Pharmacology, Toxicology and Therapeutic Chemistry at the University of Barcelona, told Fox News Digital.
“Palmitic acid is found in meats, dairy products, cocoa butter and in the form of palm oil in foods, including margarine, cereal, sweets, baked goods and fast foods,” a nutritionist said. (iStock)
Too much palmitic acid can cause harmful fat byproducts to build up in the body, which can impair the body’s ability to respond to insulin, he warned. This makes it harder to control blood sugar and increases the risk of insulin resistance and type 2 diabetes.
“It also promotes inflammation, oxidative stress, mitochondrial dysfunction and cellular stress responses, which contribute to insulin resistance and β-cell dysfunction,” Vázquez-Carrera added.
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By contrast, oleic acid – a hallmark of the Mediterranean diet – does not have these harmful effects, according to the researcher.
“In fact, oleic acid can counteract many of the detrimental effects triggered by palmitic acid, by promoting the storage of fatty acids in relatively inert triglycerides, preserving mitochondrial function and reducing inflammation,” he said.
“All sources of fat in our diet contain a mix of saturated and unsaturated fatty acids.”
Freirich confirmed that the review is consistent with previous research supporting the use of olive oil in the diet for metabolic benefits.
“Also confirming previous research, the consumption of saturated fats is associated with some negative metabolic changes,” she told Fox News Digital.
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Given the complexity of foods and diets, there is an overlap between foods that contain both types of fatty acids, the nutritionist noted.
“Palmitic acid and oleic acid can both be found in olive oil, baked goods and fast foods, in differing amounts,” she said. “All sources of fat in our diet contain a mix of saturated and unsaturated fatty acids.”
Study limitations
Vázquez-Carrera noted that these findings come from a review of numerous experimental, clinical and epidemiological studies rather than a single clinical trial.
“One important limitation is that much of the mechanistic evidence comes from cell culture and animal studies,” he said.
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“Although these studies provide valuable insights into how specific fatty acids affect insulin signaling, further human intervention studies are needed to confirm the extent to which these mechanisms operate in everyday dietary settings.”
In addition, many of the human studies in the review relied on self-reported dietary intake, which can introduce inaccuracies.
Type 2 diabetes develops over many years, with genetics, lifestyle and environmental factors all playing a role, the researcher noted. (iStock)
“Another challenge is that people consume foods containing complex mixtures of fatty acids and bioactive compounds rather than isolated fatty acids,” Vázquez-Carrera added. “Therefore, it remains difficult to fully disentangle the specific contribution of individual fatty acids in free-living populations.”
Nutritional recommendations
The review’s findings appear to support current dietary recommendations that emphasize replacing part of the saturated fat intake with unsaturated fats, according to Vázquez-Carrera.
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“This means favoring dietary patterns rich in foods such as extra-virgin olive oil, nuts, seeds, legumes, vegetables, fruits and fish, while limiting excessive consumption of foods rich in saturated fats, especially highly processed foods,” he advised.
The review does not suggest that a single nutrient alone determines diabetes risk, the researcher pointed out.
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“Rather, maintaining a healthy body weight, engaging in regular physical activity and following an overall healthy dietary pattern, such as the Mediterranean diet, remain fundamental strategies for preventing insulin resistance and type 2 diabetes.”
Type 2 diabetes develops over many years, with genetics, lifestyle and environmental factors all playing a role, Vázquez-Carrera noted.
Improving the quality of dietary fat intake could prove to be an effective strategy for reducing type 2 diabetes risk, the review suggests. (iStock)
“Future research should move beyond simply classifying fats as ‘good’ or ‘bad’ and instead focus on understanding how specific fatty acids, their dietary sources and their interactions within whole dietary patterns affect metabolic health,” he said.
Improving the quality of dietary fat intake could prove to be an effective strategy for reducing type 2 diabetes risk, according to the researcher.
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“A simple takeaway for consumers is to swap out foods high in saturated fat more often with foods rich in heart-healthy fats, like olive oil, nuts and avocados, to better support blood sugar and metabolic health,” advised New Jersey-based registered dietitian Erin Palinski-Wade, who was also not involved in the review.
Anyone at a higher risk for type 2 diabetes should consult a healthcare provider for personalized guidance on nutrition, exercise and other preventive measures, experts say.
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Just four minutes of daily strength exercises can dramatically improve mobility, balance and leg strength in older adults, per new research from the Penn State College of Medicine.
Standard public health guidelines recommend at least 150 minutes of moderate exercise per week. However, the study suggests that fewer than one in five older adults meet the recommended muscle-strengthening guidelines.
The research team designed a home-based program called Functional Activity Strength Training, or FAST-2. They evaluated 97 sedentary participants 65 and older, with an average age of 74.
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Before entering the study, these individuals were averaging just 18 minutes of total physical activity each week.
The older adults were randomly split into two groups, with one group performing the daily exercise routine and the other serving as a control group that received no intervention, according to the study’s press release.
Just four minutes of daily home strength training can significantly improve mobility, balance and leg strength in older adults, according to a Penn State College of Medicine study. (iStock)
Participants performed four basic movements for 30 seconds each, separated by 30-second rest intervals. The entire routine lasted exactly four minutes. The circuit consisted of push-ups, chair stands, two-arm resistance-band rows and stair stepping.
To keep the routine accessible, researchers provided written explanations and simple modifications. For example, participants could perform push-ups against a kitchen counter or wall, or use their hands on their knees for support during chair stands.
Participants were also given four elastic resistance bands and an adjustable step platform.
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“Exercise is actually really complicated, because you have to decide how many repetitions, how far, how many sets, how much rest and how many times per week,” co-author Smita Dandekar, associate professor of pediatrics at Penn State College of Medicine, said in the press release.
“It’s hard work … so if we can make it short, we’re part [of the] way there.”
The program consisted of four basic movements: push-ups, chair stands, resistance-band rows and stair stepping. (iStock)
As the participants grew stronger, they were encouraged to progress to higher levels of difficulty, such as transitioning away from modifications or increasing the height of the stepper.
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After 12 weeks, the results suggested that a tiny dose of regular exercise could yield noticeable physical benefits. In a 30-second chair-stand test, the exercise group performed an average of 4.2 more repetitions than the control group.
“These indicators … give you a sense of whether or not you’re going to be able to be active in the future.”
The adults doing the exercises also shaved 2.3 seconds off their time during a test measuring how they could stand up and sit down five times consecutively. Furthermore, they extended their one-legged balance time by an average of 3.6 seconds.
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The researchers emphasized that these specific measurements are critical medical indicators of an older adult’s future health.
By keeping the routine ultra-short, researchers eliminated common barriers like time constraints and exhaustion, resulting in an exceptionally high 81% workout completion rate. (iStock)
“These indicators predict your future ability to go into a nursing home, your future likelihood of falling and of developing difficulty walking,” noted lead author Christopher Sciamanna, professor of medicine and of public health at Penn State College of Medicine, in the press release.
“They give you a sense of whether or not you’re going to be able to be active in the future.”
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While traditional home exercise programs generally see low engagement, the participants in this study successfully completed their workouts on 81% of the tracked days, according to the researchers.
After 12 weeks, exercising seniors gained the ability to complete an average of four more chair-stand repetitions than those who did not exercise. (iStock)
The study had several noted limitations. As it tracked a relatively small sample size of fewer than 100 individuals over a brief 12-week time frame, it is unknown whether these mobility gains can be sustained long-term.
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Additionally, the researchers did not specify the exact dropout rates or detail how the routine might affect seniors who already relied on assistive devices like walkers or canes.
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Because the final trial results reflected a specific group of participants who met the entry criteria, further investigation is required to determine whether the short routine can safely benefit older adults facing more severe physical limitations or cognitive decline.
The study was published in the journal PLOS One.
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