The Rise of Kava: A Growing Public Health Concern
Kava, a plant-based drink traditionally used in Pacific Island ceremonies, has gained popularity as a natural alternative to alcohol. Marketed as a hangover-free option, it is now being sold in trendy cafes and vape shops across the United States. However, this surge in availability has led to a significant increase in poisonings linked to kava.
Researchers from the University of Virginia Health’s Blue Ridge Poison Center have observed a dramatic rise in calls related to kava. Between 2011 and 2025, the number of poison center calls involving kava increased by 256 percent, rising from 57 to 2023 cases. This sharp increase highlights a growing public health issue that experts are closely monitoring.
The Potency Problem
One of the main concerns with kava is its potency. Commercial products often contain two to ten times the concentration of active ingredients known as kavalactones compared to traditional forms. This high concentration can lead to serious health effects, including rapid heartbeat, severe vomiting, neurological issues, and liver injury.
The shift in who is affected by kava poisonings is also notable. In the early 2000s, most cases involved young children and women. However, today, the majority of exposures involve men aged 20 and older. This change reflects the aggressive marketing of kava near college campuses and in vape shops, which has made it more accessible to adults.
Kava and Kratom: A Dangerous Combination
Another alarming 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. This combination has been linked to severe outcomes such as seizures, hypertension, and tremors.
Early Warning System
Poison center data serves as an early alert system for dangers associated with new or reemerging substances. Following a steep drop in kava-related reports after 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 the increase in calls is due to new kava products entering the market, including those mixed with other substances like kratom that can cause adverse interactions.
The report, published in the CDC’s Morbidity and Mortality Weekly Report, relied on data from the National Poison Data System, which collects information from all 53 US poison centers. Every call about a possible kava exposure, whether from a child who accidentally swallowed something or an adult who took too much, was logged in the database.
Tracking the Trends
Between 2000 and 2025, poison centers recorded 3,101 kava-related calls. Before the FDA’s 2002 liver warning, calls were high—331 in 2001—then dropped 87 percent to 42 in 2010. The following year, reports began to rise again, likely due to new product formats, aggressive wellness marketing, and wider availability.
The types of people calling also changed. While women and young children made up most cases in the 2000s, by 2025, women accounted for 40 percent of calls and children under 12 for just seven percent. Adults 20 and older consistently made up about two-thirds of all reports.
Increasing Severity of Outcomes
Serious outcomes, including life-threatening effects, hospitalization, or significant disability, 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. Eight deaths were reported over the 25-year period.
Single-substance kava exposures typically caused vomiting, drowsiness, dizziness, and rapid heartbeat. However, when combined with kratom, 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
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 and are marketed as a way to feel social without the hangover, which helps explain why young adults now make up the majority of exposure reports.
Unlike other countries that cap kava doses—such as Australia, which limits daily intake to 250 mg of kavalactones—the US has no such regulations. Kava and kava-kratom products are completely unregulated in the US, yet some manufacturers advertise 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.
Ongoing Public Health Concern
According to the researchers, 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. As kava continues to gain popularity, it is crucial for consumers to be aware of the potential risks and for regulators to consider implementing stricter guidelines to protect public health.
