Liver Injury Associated With Kratom (Mitragyna speciosa): A Systematic Review

Liver Injury Associated With Kratom (Mitragyna speciosa): A Systematic Review

Published: November/December 2026
Journal Article

Overview

This one-hour, journal article-based activity examines liver injury associated with kratom (Mitragyna speciosa) use. Learners will explore the clinical presentation and patterns of reported liver injury, including changes in liver enzymes and function, and outcomes following cessation of kratom use. The article also examines challenges in assessing the relationship between kratom exposure and liver injury, including variability in exposure reporting, concomitant substance use, and limitations in the available evidence.

The target audience for this intermediate continuing education activity includes physicians, nurse practitioners, physician assistants, and other clinicians, researchers, students, and policymakers. 

This activity addresses the following ACGME Core Competencies: Patient Care, Medical Knowledge, and Practice-Based Learning and Improvement. 

Abstract

Aims 

Kratom (Mitragyna speciosa) is a psychoactive herbal product increasingly used for pain, anxiety, and opioid withdrawal. Although marketed as a natural dietary product, concerns have emerged regarding adverse effects like cardiotoxicity, seizures, opioid-like physical dependence, and, particularly, liver toxicity.

Methods

We conducted a systematic review following PRISMA 2020 guidelines of all studies on kratom use and liver toxicity.

Results

Thirty-one studies were included, comprising 32 cases of kratom-associated liver injury. Most reports originated from the United States and were single-patient case reports. Most patients were adult males, with frequent co-occurrence of polysubstance use and comorbid conditions. Concomitant exposures were commonly reported but variably characterized across studies. Baseline liver disease was present in 3 patients (9%). Kratom dose, form, frequency, and duration were inconsistently reported. Only 7 cases (22%) provided complete exposure details, whereas the remainder lacked one or more elements. Kratom use was temporally associated with the onset of liver injury, commonly presenting with jaundice and elevations in liver enzymes. The patterns of injury were predominantly cholestatic. In most cases, liver enzymes and function improved after cessation of kratom use. In 4 cases, the patient's liver function did not improve and progressed to liver transplantation. Although formal causality assessments were inconsistently reported, many reports supported an association based on exclusion of alternative etiologies and, in some cases, rechallenge episodes.

Conclusion

Further research is needed to better characterize kratom’s mechanisms of liver injury and to inform clinical decision-making and public health policy.

Learning Objectives

Upon completion of this activity, learners will be able to:

1. Describe the clinical presentation and patterns of liver injury reported in association with kratom use.  
2. Assess outcomes associated with cessation of kratom use among individuals with reported liver injury. 
3. Evaluate factors that limit interpretation of the association between kratom exposure and liver injury. 

Registration Rates

*Residents, Fellows-in-training, Interns, and Students must join ASAM to receive a discounted registration rate. Click here to become an ASAM member. National and Chapter membership dues apply. There is no charge for Students to become a Member, but verification of student status is required.

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Refunds & Cancellations

All ASAM eLearning Center refund requests must be made in writing to [email protected] within 90 days of purchase. Those requesting refunds for courses that are in progress will receive partial refunds or eLearning Center credit. Automatic full refunds will be made for any course with a live-course component that has been canceled.

Open Registration: 11/03/2026 - 02/10/2029

Close Access Date: 02/10/2029

Course Instructions

1. Click on the Contents tab to begin this activity.
2. Click Download Journal Article in the box titled Journal Article and read the journal article in its entirety. 
3. Click Complete Post-Test to answer multiple-choice questions. You will have 10 attempts to pass and must answer 2 out of 3 questions correctly.
4. Click Complete Evaluation to provide valuable activity feedback. Scroll down on all questions, as there may be answer options that expand past the size of the window.
5. Click the button Claim Medical Credits in the box titled Claim Credits & Certificate. Choose the type of credit and click submit. Click the button View/Print Certificate to save or print your certificate. You can view/print your certificate at any time by visiting the ASAM eLearning Center, clicking Dashboard, and clicking Transcript/Achievements.

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Accreditation & Credits

Joint Accreditation Statement

In support of improving patient care, the American Society of Addiction Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

Credits Available

• Physicians: 1.00 Credit
• Nurses & NPs: 1.00 Nursing Contact Hour
• PAs: 1.00 Credit
• Interprofessional Continuing Education: 1.00 Credit
• Certified Counselors: NBCC Contact Hours Not Offered
   American Society of Addiction Medicine has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7062. Programs that do not qualify for NBCC credit are clearly identified. American Society of Addiction Medicine is solely responsible for all aspects of the programs.

Maintenance of Certification (MOC)/Continuing Certification Program (CCP)

This activity is designed to meet the requirements for MOC/CCP for several primary physician boards and for state licensing CME requirements. MOC Credit is only reported and designated for ABA, ABP, ABIM, and ABS. By completing the online credit application and evaluation, the learner permits ASAM to report credits to the appropriate Board. Learn more.

• ABIM MOC Points: 1.00 Medical Knowledge
• ABP MOC: 1.00 Lifelong Learning & Self-Assessment
• ABS Continuing Certification: 1.00 Accredited CME
• ABA MOCA 2.0®*: 1.00 Lifelong Learning MOCA 2.0® is a trademark of the American Board of Anesthesiology®. This activity contributes to the CME requirement for Part II: Lifelong Learning and Self-Assessment of the American Board of Anesthesiology's (ABA) redesigned Maintenance of Certification in Anesthesiology Program® (MOCA®), known as MOCA 2.0®. Please consult the ABA website, https://www.theaba.org/, for a list of all MOCA 2.0 requirements.

Additionally, this activity has been designed to satisfy the requirements of the following primary physician board certification requirements. Please confirm with your individual Board.

• American Board of Preventive Medicine (ABPM)
• American Board of Psychiatry and Neurology (ABPN)
• Royal College of Physicians and Surgeons of Canada (RCPSC)

Certificates for other professions

All participants may request a certificate of participation upon completion of the activity and an online evaluation confirming their participation. Learners are strongly advised to contact their professional licensing board or professional association to confirm this certificate will be accepted as evidence supporting continuing education requirements.

Disclosure Information

In accordance with the disclosure policies of ASAM and Joint Accreditation, the effort is made to ensure balance, independence, objectivity, and scientific rigor in all accredited continuing education activities. These policies include identifying and mitigating all relevant financial relationships with ineligible companies for those involved in the creation and dissemination of accredited continuing education. 

See the attached article and pdf for a list of disclosures