Kratom, an herbal supplement derived from the leaves of the Mitragyna speciosa tree, has been linked to multiple Salmonella outbreaks in the United States. Despite its growing popularity for self-managing pain, anxiety, or opioid withdrawal, the unregulated nature of kratom production poses significant contamination risks. In 2018, the FDA and CDC investigated a multistate Salmonella outbreak tied to kratom products, ultimately identifying 199 cases across 41 states and 54 hospitalizations. Epidemiologic data revealed that 74% of interviewed patients had consumed kratom in powder, pill, or tea form, with most purchasing it online or from retail stores.
Contamination Pathways
Salmonella contamination likely occurs during kratom’s cultivation, harvesting, or processing in countries like Indonesia. Genetic testing of Salmonella isolates from contaminated products showed significant diversity, indicating widespread contamination across multiple supply chains rather than a single source. This heterogeneity complicates traceback efforts, as kratom’s fragmented supply chain involves unregistered distributors and international shipments often mislabeled as “potpourri” or “incense”. Laboratory analyses confirmed these risks: FDA testing found Salmonella in 55% of kratom samples (42 of 76), while an independent study detected Salmonella in 3 of 16 commercial products.
Regulatory Challenges
The FDA prohibits kratom’s sale as a dietary supplement, drug, or food additive due to safety concerns and inadequate quality controls. However, enforcement remains difficult, as kratom is sold in gas stations, vape shops, and online marketplaces with minimal oversight. A 2022 survey found that >80% of tobacco/vape shops in states where kratom is legal sold the product, often without safety labeling or age restrictions. This regulatory vacuum leaves consumers vulnerable to contaminated batches, as seen in 2018 when the FDA issued its first mandatory recall for kratom products linked to Salmonella.
Health Implications
Salmonella infections from kratom can cause severe gastrointestinal illness, with symptoms including fever, diarrhea, and abdominal cramps. During outbreaks, hospitalization rates reached 40%. Vulnerable populations, such as infants, elderly individuals, or immunocompromised patients, face higher risks of complications. Notably, standard drug screens do not detect kratom alkaloids, potentially delaying diagnosis during outbreaks.
Ongoing Concerns
Despite recalls, contamination incidents persist due to inconsistent testing and lax import controls. Public health agencies continue to warn against kratom consumption, emphasizing that boiling or treating powders may not eliminate pathogens. Researchers advocate for standardized federal regulations mandating product testing, safety warnings, and minimum purchase ages. Until then, the kratom conundrum remains unresolved: an unregulated product posing preventable public health threats.
