How state regulations shape kratom exposure and harm with Grant Comstock and Ryan Feldman

In this episode, Dr Tsen Vei Lim talks to Drs Grant Comstock and Ryan Feldman. Grant is an Assistant Professor at the Medical College of Wisconsin and Associate Medical Director of the Wisconsin Poison Center and Ryan is a clinical toxicologist, emergency medicine pharmacist, and Clinical Associate Professor at the Medical College of Wisconsin. The interview covers Grant and Ryan’s article examining the association between state-level kratom regulations and poison center-reported severe medical outcomes and healthcare use in the United States (US).

What is kratom? [01:14]Why people are worried about kratom use in the US [02:58]Grant and Ryan’s research question and focus of the study [05:33]The key findings of the study [10:25]The relationship between kratom regulations and kratom-related hospitalisations [12:16]The implications of the findings for existing kratom regulations [13:04]The data that researchers should collect to improve the data vacuum on kratom [18:03]The takeaway from the study: read the discussion! [19:40]

About Tsen Vei Lim: Tsen Vei is an academic fellow supported by the Society for the Study of Addiction, currently based at the Department of Psychiatry at the University of Cambridge. His research integrates computational modelling, experimental psychology, and neuroimaging to understand the neuropsychological basis of addictive behaviours. He holds a PhD in Psychiatry from the University of Cambridge (UK) and a BSc in Psychology from the University of Bath (UK).

About Grant Comstock: Grant, MD, is an Assistant Professor of Emergency Medicine at the Medical College of Wisconsin and Associate Medical Director of the Wisconsin Poison Center, US. He is board certified in emergency medicine, medical toxicology, and addiction medicine. His academic interests include novel psychoactive substances, harm reduction strategies, and overdose epidemiology. In addition to his clinical work, Dr. Comstock is actively involved in research, medical education, and mentorship within emergency medicine and medical toxicology.

About Ryan Feldman: Ryan, PharmD, DABAT, FAACT, is a clinical toxicologist, emergency medicine pharmacist, and Clinical Associate Professor at the Medical College of Wisconsin. He works with the Wisconsin Poison Center, where he helps manage poisoning and overdose cases, and is Toxicology Section Editor for the American Journal of Emergency Medicine. His work focuses on emerging substances, poison center data, overdose trends, and public health responses to toxic exposures. Ryan has published on substances including kratom, phenibut, tianeptine, cannabinoids, and mushroom toxins. He also hosts The Poison Lab, an educational podcast exploring toxicology, outbreaks, and poisoning science.

Original article: Association between state-level kratom regulations and poison center-reported severe medical outcomes and healthcare use: A United States national analysis https://doi.org/10.1111/add.70416

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Music provided by Jack Shakespeare.

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