Kratom Safety Questions Resurface as Health Canada Reiterates Products Are Unauthorized

Kratom is back in the headlines after packages of the herbal product were found during investigations into the deaths of two University of Mississippi students. Authorities have emphasized that toxicology results are pending and there is no confirmed information that kratom contributed to either death.

What kratom is—and what remains unknown

Kratom is derived from Mitragyna speciosa, a tree native to Southeast Asia. Products may be sold as powders, capsules or liquids. Its constituents can produce stimulant-like effects at lower exposure and opioid-like or sedating effects at higher exposure.

Associated Press reporting says U.S. authorities found kratom products at both locations but had not linked the deaths to each other or to kratom. That distinction matters: the presence of a product is not evidence of causation, and the reporting should not be used to speculate about individual deaths before toxicology findings are available.

Canadian regulatory status is clear

Health Canada states that it has not authorized the sale of any health product containing kratom. Selling a health product without authorization is illegal in Canada.

Health Canada has warned that swallowed or inhaled kratom may cause drowsiness, nausea, vomiting, seizures, liver toxicity and rapid heartbeat. The regulator also notes stimulant- and narcotic-like effects and the potential for abuse and dependence. U.S. officials have similarly warned about substance-use disorder, seizures and liver toxicity, while acknowledging that deaths associated with kratom have often involved other substances and that kratom’s contribution may be unclear.

What pharmacists may encounter

Patients may describe kratom as “natural,” use it for pain, anxiety or mood, or take it in an attempt to self-manage opioid withdrawal. A non-judgmental medication history should therefore include products purchased online, from specialty retailers or while travelling.

Pharmacists should avoid presenting kratom as a proven treatment for opioid use disorder. Patients seeking help with withdrawal or opioid dependence should be connected to evidence-based assessment and treatment. Suspected adverse reactions can be reported through MedEffect Canada, and suspected illegal sales or claims can be reported to Health Canada.

Practice guidance for pharmacists

• Ask specifically about powders, capsules, teas and imported or online “natural” products when taking a medication history.
• Explain that no kratom-containing health product is authorized for sale by Health Canada; an NPN, DIN or DIN-HM should be verifiable in the appropriate federal database.
• Assess for sedation, seizures, liver-injury symptoms, tachycardia, dependence, withdrawal and concurrent use of opioids, sedatives or stimulants.
• Refer patients using kratom for opioid withdrawal or dependence to evidence-based opioid-use-disorder care rather than recommending self-treatment.
• Document counselling and report adverse events or suspected unauthorized products through Health Canada’s reporting channels.