A Retrospective Case Series of Kratom-Related Deaths Reported by Medical Examiners in Select New England States

Introduction: We investigated the characteristics and contributing factors of overdose fatalities associated with kratom by examining descriptive data and toxicology findings from medical examiners in select New England states. Methods: We contacted medical examiner offices in 6 New England states to request forensic data on overdose deaths attributed to kratom from January 2015 through July 2024. Primary outcomes were postmortem toxicology and autopsy findings, and secondary outcomes were descriptive case details. Results: In 2 cases for which toxicology findings were available, concurrent substances were detected in the deceased individuals. Postmortem mitragynine amounts were 890 ng/mL and 23 ng/mL. Autopsy findings revealed no significant abnormalities. A third case was identified; however, the only detail disclosed was a history of atherosclerotic cardiovascular disease. Discussion: The findings revealed that fatalities often involve polysubstance co-ingestions or underlying conditions, with kratom's contribution remaining complex and multifactorial. Limitations included a small sample size, variability in toxicology testing, and incomplete data. Conclusions: Rigorous standardized protocols are needed to elucidate kratom's role in overdose deaths.