"This opioid extract has not been subject to clinical trials, and furthermore, marketed kratom products are not controlled or standardized for extract potency. Furthermore, it is unclear whether its stimulant effects at low doses could play a contributory role in the death of individuals with cardiac disease, or potentially be sufficient even to cause cardiac arrhythmia without underlying heart disease. Until this drug is regulated and standardized, and access to it controlled, deaths due to its effects will continue."