Kratom is an opioid derived from a plant native to Southeast Asia. It can be consumed in pills, powder, or tea.



On Friday, the Centers for Disease Control issued its fourth warning in just over a month that the drug, often called an "herbal supplement," has been linked to salmonella, bringing the total number of sick people to 132.

Data from CDC labs and field investigations points to kratom as the most likely source of the outbreak.



The Food and Drug Administration calls it a dangerous opioid, but kratom advocates call their pill of choice a life-saving supplement. Either way, it's been linked with a growing salmonella outbreak that has now sickened over 100 people from 38 states.

Kratom is a psychoactive drug derived from the leaves of Mitragyna speciosa, a plant in the coffee family that is native to Southeast Asia. Research suggests the drug taps into some of the same brain receptors as opioids do, spurring the FDA to classify it as one this February.

On Friday, the Centers for Disease Control reported 45 additional cases of salmonella linked to kratom, bringing the total number of cases to 132. It was the CDC's fourth warning for kratom in just over a month for the bacteria, which can cause diarrhea and abdominal pain lasting up to a week.

'Imminent health risk'

Kratom pills Psychonaught/Wikimedia Commons Kratom is increasingly raising eyebrows among several regulatory agencies, including the CDC and the Food and Drug Administration.

Earlier this week, the FDA issued its first-ever mandatory recall of kratom products after those produced by Las Vegas-based Triangle Pharmanaturals were found to be contaminated with salmonella.

As with any unregulated supplement, kratom may be dangerous and even deadly. There's no way to verify what pills labeled "kratom" actually contain.

Nevertheless, some marketers tout kratom as capable of boosting strength, delivering feelings of euphoria, relieving pain, and improving focus. Untainted kratom is also sometimes hailed as a way to treat opioid addiction, which some addiction experts have said is not entirely unreasonable given its opioid-like qualities.

But unlike most opioids, which either are illegal or must be prescribed by a doctor, kratom is widely available online. It was even sold for a time out of an Arizona vending machine.

In his statement about the recall earlier this week, FDA commissioner Scott Gottlieb added to the sense of urgency surrounding kratom, saying the products produced by Triangle posed an "imminent health risk."

Evidence points to kratom as the most likely source of the outbreak

It's not unusual for the CDC to issue salmonella warnings liked to products like kratom, but this particular outbreak appears to have been spreading for some time.

Since the first kratom-related illnesses were reported in January of last year, the CDC has been continuing to update its total case count and to conduct interviews with sick people across the US.

So far, 57 of 78 people (73%) interviewed reported consuming kratom in pills, powder, or tea in 38 states.

"At this time, CDC recommends that people not consume any brand of kratom in any form because it could be contaminated with Salmonella," the agency wrote in a statement on Friday, adding, "evidence indicates that kratom is the likely source of this ... outbreak," but "no common brands or suppliers of kratom products have been identified at this time."

Kratom is banned in Australia, Malaysia, Myanmar, Thailand, and several US states (Alabama, Arkansas, Indiana, Tennessee, and Wisconsin). Across the US, several reports of deaths and addiction led the Drug Enforcement Administration to place kratom on its list of "drugs and chemicals of concern." In 2016, the DEA proposed a ban on kratom but backtracked under pressure from some members of Congress and an outcry from kratom advocates who said it could help treat opioid addiction.

"I want to be clear on one fact: there are currently no FDA-approved therapeutic uses of kratom," Gottlieb said in November.