They take kratom to ease pain or anxiety. Sometimes, death follows.
Keifer Geers was born with a hole in his diaphragm that led to painful surgeries in adulthood. Despite physical challenges that included deafness, Geers graduated from Texas A&M University with a degree in biomedical engineering. He hoped to one day create medical devices for disabled children and wounded veterans.
On a spring day as Geers walked with his mother through an airport in Midland, Tex., he stumbled, then collapsed into a seizure, his face contorted in shock. Geers, 33, was pronounced dead at a hospital. His mother later found inside his suitcase several packages of powder kratom, an herbal product he consumed to manage pain from surgeries. Patricia Geers said she was stunned when an autopsy concluded that her son died from the toxic effects of kratom - levels in his blood were more than nine times what some experts believe can prove lethal.
The death of Keifer Geers was hardly an isolated episode. A Washington Post review of federal and state statistics shows that medical examiners and coroners are increasingly blaming deaths on kratom - it was listed as contributing to or causing at least 4,100 deaths in 44 states and D.C. between 2020 and 2022. The vast majority of those cases involved other drugs in addition to kratom, which is made from the leaves of tropical trees. Still, the kratom-involved deaths account for a small fraction of the more than 300,000 U.S. overdose deaths recorded in those three years.
Dozens of wrongful death lawsuits involving kratom have been filed nationwide - including by Geers’s mother, who in February sued a Nevada retailer. The suits illustrate increased scrutiny of deaths involving products made from kratom, which is banned in six states but remains widely available online and in vape and convenience stores despite health warnings from federal authorities.
Public health officials express alarm because companies sell products that contain kratom concentrates far more potent than the leaves plucked from trees. Some come packaged with insufficient warning labels, experts said, and with uncertain health consequences.
Users consume kratom in the hopes of relieving pain, easing anxiety, boosting energy or weaning themselves off opioids or other drugs. Nearly 2 million people 12 and older had used kratom within the past year, according to a 2022 federal estimate.
Kratom advocates insist that death statistics are misleading because the cases nearly always involve other drugs that can be lethal. They blame Food and Drug Administration warnings for spurring medical examiners to include kratom among the causes of death. But they agree the marketplace needs broader national regulation.
The American Kratom Association, an advocacy group that has publicly fought federal efforts to prohibit kratom because of its potential health hazards, insists the herb is safe and that if there are dangerous products, they’re coming from unscrupulous companies.
“What we have to do is regulate it so that the labeling is clear so that when you purchase a kratom product, you know that the contents of that product are within the guidelines set for a typical dietary supplement or botanical supplement product,” said Mac Haddow, spokesman and lobbyist for the association, which has pushed legislative proposals to regulate the industry at national and state levels.
Health officials have for years expressed concern over kratom’s potential harms. The Centers for Disease Control and Prevention found kratom was a cause of death in 91 overdose cases in 27 states from July 2016 through December 2017. Experts say the number of cases involving kratom are probably undercounts because not all coroners and medical examiners test for the substance.
The CDC’s latest analysis, drawn from state overdose fatality records and completed at the request of The Post, found that kratom was implicated - at least in part - in 846 fatal overdose cases in 30 states and D.C. in 2022, the last full year for which data is available. That was up from 834 in 2021 and 663 in 2020. Most cases involved other substances. Kratom was listed as the sole substance causing death in 56 people in 2022, 68 in 2021 and 58 in 2020. The CDC analysis did not include several populous states.
Records from those other states are not uniform but add to the toll of deaths blamed at least in part on kratom, according to The Post’s review of data requested from state health departments.
In Texas, the number of deaths between 2020 and 2022 was 224. In Michigan, the total for that three-year span was 253 fatal cases, all in conjunction with other drugs such as opioids. In California, according to a health department analysis completed at The Post’s request, kratom was implicated in 242 deaths in those three years, with 27 blamed solely on the herb. In Florida, state statistics show, kratom was a factor in 525 deaths during that period.
Kratom comes from the tropical tree Mitragyna speciosa, native to Indonesia, Malaysia and Thailand. Kratom products in the United States began proliferating in the mid-2000s as the opioid crisis, fueled by prescription pain pills, escalated, spurring users to seek alternatives for pain or relief from withdrawal symptoms.
Misty Brown, a 44-year-old mother of three from Thornton, Colo., said she was hooked on painkillers for 11 years, then switched to cocaine to numb her depression. Nearly five years ago, she watched a documentary about kratom, then drove to a smoke shop to buy capsules. They “pressed pause” on cravings, she said. Today, she takes only kratom. “I’ve been reborn into the mother that I was before I started on that addiction path,” said Brown, an activist who advocates for the herb on social media.
Kratom acts as a stimulant when taken in small doses. At higher doses, it can result in sedation - kratom contains compounds that can cause euphoria in the brain similar to opioids, albeit in a less potent form than many legal painkillers.
It contains dozens of compounds known as alkaloids, the most prominent being mitragynine. In leaves harvested from trees, that compound is in a concentration of 1 to 2 percent, said Oliver Grundmann, a researcher at the University of Florida College of Pharmacy. In kratom concentrates, that number can be as high as 40 percent and poses a much more significant risk to human health, he said.
Through metabolism, mitragynine is converted into a more potent compound known as 7-hydroxymitragynine, which produces an opioid-like effect in the brain, Grundmann said.
Researchers say kratom may also interfere with enzymes that break down other medications, potentially enhancing the effects of certain prescription medications. Just how significant that interaction is - and how it might contribute to lethal outcomes - remains unclear. Researchers at Washington State University are launching a clinical trial to explore how kratom-infused tea affects the processing of the painkiller oxycodone.
Daniel Bregger, 33, of Denver, died in August 2021 of a combination of mitragynine and diphenhydramine, a common antihistamine used in over-the-counter cold medications, according to a coroner’s report. His father, David Bregger, said he believes his son - who struggled with alcoholism - used kratom for anxiety and may have taken a cold medicine to sleep.
“I view kratom as an extremely dangerous product that is unregulated. I just don’t understand how we can let this product infiltrate the country,” said David Bregger, who said he plans to push state lawmakers in New Hampshire, where he lives, to ban kratom.
Experts say kratom doesn’t generally interfere with breathing in the same way as an opioid overdose. And they caution that kratom may not always play the chief role in death in “polydrug” overdoses, particularly when potent opioids are involved. In Michigan, for instance, 73 percent of kratom-involved deaths between 2020 and 2022 also included synthetic opioids such as fentanyl, records show.
“It is hard to separate the effects of kratom when it’s mixed in with other drugs,” said Justin Brower, a toxicologist with NMS Labs, a Pennsylvania company that conducts testing for medical examiners and coroners across the country.
“I think a lot of these kratom deaths are really due to misuse, not so much abuse,” Brower said. “You take enough kratom, you can put yourself in harm’s way and die.”
The kratom industry in the United States is worth more than an estimated $1 billion, and researchers stress that not all products are created equal. The herb is sold as powder consumed in capsules and teas, but also increasingly as powerful tablets and shots. The Tampa Bay Times, in a December report on the industry, submitted 20 kratom products for testing by University of Florida researchers. Their analysis found the labeling on many products did not disclose the potency of the products.
Eleven states have passed kratom regulations, including age restrictions and labeling requirements, according to the American Kratom Association. There are no similar federal regulations. In 2016, the Drug Enforcement Administration announced plans to classify kratom compounds as controlled substances but shelved the idea after fierce backlash. The next year, the Department of Health and Human Services recommended restricting kratom - a recommendation that was later withdrawn.
The FDA considers kratom, depending on how it is marketed, an unapproved drug or a dietary ingredient whose safety has not been proved. The agency can seize kratom imports. In May 2023, the FDA and U.S. marshals in Oklahoma confiscated $3 million in products from a company that sells kratom-infused drinks. The firm, Botanic Tonics, is fighting in court for return of its products.
Founder JW Ross said his company’s drinks use only whole leaves. Labels have been updated to note that the product could “interact” with certain medications and to offer a warning to people with a history of substance abuse. Ross is part of a new organization, the Leaf Kratom Coalition, that advocates for limiting potency in kratom products.
“We’re setting the stage to place regulations before the industry shoots itself in the foot,” Ross said.
The FDA declined to make officials available for interviews on kratom. In a statement, the agency said it continues to “warn consumers not to use kratom and have communicated the risk of serious adverse events, including liver toxicity, seizures, and substance use disorder and that, in rare instances, kratom has been associated with death.”
The agency, however, has declined to assist federal counterparts in highlighting that message. In a case against a San Diego businessman who pleaded guilty to importing kratom disguised as a botanical soil conditioner, a federal judge ordered a hearing to assess the dangers of kratom. The FDA refused to provide to federal prosecutors documents that led to its warnings or to make expert witnesses available.
“The reason they gave was that they have not yet made a determination regarding whether kratom is dangerous,” San Diego Assistant U.S. Attorney Melanie K. Pierson wrote to a defense attorney in an email entered into the court file.
In court filings, the U.S. attorney’s office, seeking about a year in prison for the kratom importer, has repeatedly cited the risk to public health. Prosecutors plan to present independent experts to testify about the dangers of kratom at the hearing scheduled for April 17. The FDA said it does not comment on ongoing litigation. The importer’s attorneys declined to comment.
During the past year, juries in civil cases have sided with families suing for wrongful death, awarding $2.5 million to the family of a Washington state man who died after using kratom tea for back pain and $11 million to relatives of a Florida mother who died after ingesting a kratom powder dubbed Space Dust.
The American Kratom Association has pushed back on claims that kratom itself kills, demanding retractions on media stories involving deaths and publishing “guidelines” for medical examiners.
That group has funded a lawsuit against Ohio county officials that seeks to overturn a death ruling, underscoring the lengths to which the group will go to challenge medical examiners and coroner findings. In that case, a coroner ruled that 26-year-old Avram Wimer-Farr died of a heart disruption and mitragynine intoxication. He’d turned to kratom after grappling with heroin, said his mother, Jayne Richeson.
“We were bracing for a really rocky road going through withdrawals, and it never happened,” Richeson said.
Relatives discovered Wimer-Farr, a garden nursery worker, dead inside his Yellow Springs, Ohio, apartment in September 2021. Richeson said her son was a kratom advocate, and she reached out to the association because she did not believe the coroner’s finding. Instead, Richeson believes her son’s heart issues stem from an earlier bout with covid-19.
“All I want is a corrected death certificate to say his heart stopped and that’s all we know,” Richeson said.
In Texas, Keifer Geers’s mother also challenged investigators - who initially ruled that her son died on April 14, 2022, from his preexisting health conditions. She requested an autopsy after finding kratom in his suitcase. Officials later amended his death certificate: mitragynine toxicity. He used kratom for more than a decade for pain stemming from surgery for an abdominal hernia, his mother said.
Geers is suing a Nevada company, Kratom King, alleging it misled consumers by promoting its products as “safe, beneficial and intended to treat pain, anxiety and other health problems,” according to the federal lawsuit filed by attorneys Jason Gibson and Casey Gibson in the Western District of Texas.
The company’s attorneys, in a statement, noted that kratom is legal to sell in Texas and the lawsuit “lacks legal or factual support.” Attorneys Jeremy Monthy and Derek Hollingsworth said the product cited in the lawsuit was a “natural plant” - not a synthetic, extract or compound - and that the company included labels within “applicable guidelines and industry standards.”
Patricia Geers said Keifer assured her kratom was safe, although she recalls wondering if his hands jittered because of it. She did not know kratom could be lethal until her son’s death.
“I was shocked because I didn’t know you could go into a store and buy something that could just kill you,” Patricia Geers said. “It may not hurt everyone, but it may kill some.”
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