We know of no documented deaths directly attributable to kratom, but some products sold as kratom have resulted in death. One death documented in a 2011 paper described a kratom product that also had O-desmethyltramadol (a synthetic pharmaceutical) added to it. 1 According to Pascal Tanguay, from the Thailand offices of PSI, a Washington DC-based global health organization that promotes harm reduction among drug users, "There's never been a single death associated with kratom. People have been chewing this for thousands of years with no cases of overdose, psychosis, murder, violent crime. Never in all of recorded history." 2