Kratom is a plant that is indigenous to Southeast Asia and has recently attracted attention in the United States; its primary active alkaloid mi-tragynine has stimulant effects at low doses and sedative effects at high doses. The purpose of this study was to provide updated information on the characteristics, clinical effects, treatment and patient outcomes of kra-tom exposure. Methods: This was a retrospective analysis of kratom exposures reported to two statewide poison control centers between January 2016 and June 2020. Subjects who reported coexposure to other substances of abuse or intentional xenobiotic overdoses were excluded. The data were stratified by the consumption of kratom alone and with nonoverdose exposure to other medications. Results: In total, 153 kratom exposures were included. Patients were clas-sified into 3 groups according to kratom use within the past 24 hours: low dose (1–5 g; 45.1%), moderate dose (>5–15 g; 17.0%) and high dose (>15 g; 12.4%) groups. The two common clinical effects were central nervous system excitation (kratom, 32.3%; coexposure, 53.3%) and tachycardia (kratom, 46.6%; co-exposure, 44.6%). Dose dependent sedative effects of kratom were not observed. Coexposure accounted for 39.2% of cases and was associated with higher rates of ICU admission (28.3% vs. 8.6%; p<0.01) and serious medical outcomes (28.3% vs. 7.5%; p<0.01). Conclusion: Kratom exposure is associated with a wide range of symp-toms. Despite the perception that kratom is safe, the probability of more severe symptoms and serious effects should be of concern, particularly when kratom is used with other medications.