The Rise of Kava: A Natural Alternative with Unseen Risks
Kava, a plant-based drink marketed as a natural and hangover-free alternative to alcohol, is gaining popularity in trendy cafes and vape shops across the United States. However, this surge in demand has coincided with a dramatic increase in poisonings linked to kava consumption.
Researchers from the University of Virginia Health’s Blue Ridge Poison Center have observed a 256 percent rise in calls to poison centers involving kava, from 57 cases in 2011 to 2023 in 2025. This alarming trend highlights the growing risks associated with the widespread use of kava products.
Historical Use and Modern Market Trends
Kava, native to the Pacific Islands, has been used for centuries in traditional ceremonies. In the US, it is sold as unregulated concentrated extracts, capsules, and ready-to-drink beverages, often promoted as a healthy way to relax without the dangers of alcohol. However, experts warn that the potency of commercial kava products can be significantly higher than traditional forms.
Commercial kava products may contain two to ten times the concentration of active ingredients called kavalactones, which increases the risk of severe side effects such as rapid heartbeat, severe vomiting, neurological issues, and liver injury.
Shift in Demographics and Product Combinations
The profile of those affected by kava-related poisonings has also changed over time. In the early 2000s, most calls involved young children and women. Today, the majority of exposures involve men aged 20 and older, reflecting aggressive marketing near college campuses and in vape shops.
Another concerning trend is the increasing combination of kava with kratom, a psychoactive plant with opioid-like effects. By 2025, kratom was involved in 30 percent of kava-related poison center calls, leading to severe outcomes such as seizures, hypertension, and tremors.
Poison center data serves as an early warning system for emerging or reemerging substances. After a steep decline in kava-related reports following the FDA’s 2002 warning about its link to liver injury, cases began to rise again since 2011. Dr Chris Holstege, director of the Blue Ridge Poison Center, noted that new kava products entering the market, including those mixed with other substances like kratom, are contributing to the increase in calls.
Study Findings and Data Analysis
The study, published in the CDC’s Morbidity and Mortality Weekly Report, analyzed data from the National Poison Data System, which collects information from all 53 US poison centers. Researchers examined every kava-related call made between January 2000 and December 2025, a total of 25 years.
For each call, they recorded details such as the person’s age and sex, whether kava was taken alone or with other substances, the symptoms experienced, the severity of the outcome, and whether hospitalization was required. They also tracked how the number of calls changed year by year and whether outcomes were becoming more or less severe.
Serious outcomes included life-threatening effects, hospitalization, or significant disability. Between 2000 and 2025, poison centers logged 3,101 kava-related calls. Before the FDA’s 2002 liver warning, calls were high — 331 in 2001 — then dropped 87 percent to a low of 42 in 2010. The following year, reports began to rise again, driven by new product formats, aggressive wellness marketing, and wider availability.
The demographics of those calling poison centers have shifted significantly. While women and young children made up most cases in the 2000s, women accounted for 40 percent of calls and children under 12 for just seven percent in 2025. Adults 20 and older consistently represented about two-thirds of all reports.
Serious outcomes have become more common. In 2000, only 12 percent of kava exposures led to severe medical problems. By 2024, that figure had jumped to 39 percent, with eight deaths reported over the 25-year period.
Single-substance kava exposures typically caused vomiting, drowsiness, dizziness, and rapid heartbeat. However, when combined with kratom, which occurred in 128 cases, the effects were more dangerous, including seizures, tremors, and high blood pressure. Liver enzyme elevations were also more common with kava-kratom combinations than with kava alone.
Regulatory Gaps and Public Health Concerns
The rise in kava-related poison center calls mirrors the broader boom in nonalcoholic beverages, as more people seek alcohol-free alternatives. These products are often sold online and in vape shops, marketed as a way to feel social without the hangover, which helps explain why young adults now make up the majority of exposure reports.
Holstege emphasized the need for public awareness regarding the potential complications of consuming these products. Unlike countries like Australia, which caps kava doses, the US has no such regulations. Kava and kava-kratom products are completely unregulated in the US, with some manufacturers advertising more than 250 mg of active ingredients per single 30 ml serving, often with multiple servings per container.
Because there is no standardized manufacturing or content verification, the actual potency could be even higher. Health experts warn that chronic use of these high-potency products has been linked to liver damage, seizures, rapid heartbeat, and high blood pressure.
Researchers concluded that continued promotion of these products without adequate verification of product content, consumer education regarding potential adverse health effects, and clinical awareness of evolving exposure patterns represents an ongoing public health concern.
