Salmonella outbreaks in the United States – possible links to consumption of kratom-containing products

Published: April 25, 2018

The United States (US) Centers for Disease Control and Prevention (CDC) in conjunction with the Food and Drug Administration (FDA) are investigating a multi-state outbreak of salmonella linked to consumption of kratom products¹. Kratom is a drug that originally comes from the leaves of a tree grown in South-East Asia. At low doses it has a stimulant effects, similar to cocaine, at higher doses it has a sedative effect, similar to narcotics. It comes in leaves, powder and resin form and can be chewed, smoked or made into tea². It is a controlled drug in Ireland under the Misuse of Drugs Act³ and according to the 2016 Psychoactive Substances Act 2016, it is illegal to produce, supply, offer to supply, sell, import, and export kratom in the United Kindom⁴. However, it is readily available for purchase on the internet. Currently kratom continues to be a legal substance in most states in the US.

Since January 11th 2018, 132 people have been infected with outbreak strains of salmonella across 38 states in the US. The age-range of cases is 1 to 73 years and 38 (29%) cases required hospitalisation¹. Symptoms of salmonella include diarrhoea, fever, vomiting and abdominal pain. Salmonella outbreak strains include Salmonella I 4,[5],12:b:-, Salmonella Javiana, Salmonella Okatie and Salmonella Thompson¹. Fifty-seven of 78 people (73%) specifically asked about kratom reported consuming kratom before getting sick¹. As of April 5 2018, thirty-seven different kratom-containing products have been tested and reported positive for salmonella¹. Genetic analysis is ongoing on isolates from these substances and from ill cases to identify possible links¹.

The US FDA has warned consumers not to consume any kratom-containing products¹. There have been several voluntary recalls of kratom-containing products by manufacturers in the US. In one instance the FDA issued a mandatory recall order for all products containing powdered kratom manufactured, processed, packed, or held by a certain US-based company after several of these products were found to contain salmonella¹. The outbreak investigation is ongoing.

References

1. United States Food and Drug Administration. FDA Investigates Multistate Outbreak of Salmonella Infections Linked to Products Reported to Contain Kratom. Available at: https://www.fda.gov/Food/RecallsOutbreaksEmergencies/Outbreaks/ucm597265.htm Accessed 16/04/2018
2. Drugs.ie. Kratom. Available at: http://www.drugs.ie/drugtypes/drug/kratom_opiate Accessed 16/04/2018 
3. Irish Statute Book. S.I. No. 551/2011 - Misuse of Drugs Act 1977 (Controlled Drugs) (Declaration) Order 2011
4. Psychoactive Substances Act 2016. Available at: https://www.legislation.gov.uk/ukpga/2016/2/contents  Accessed 16/04/2018