Is Kava Safe? Liver Myths, Studies, and What Regulators Say

We are not going to tell you kava is safe. No bar should tell you that about anything it serves, and the honest version of the answer is more useful anyway.

Here is what happened in 2002, what regulators say now, and the one variable that most writing about kava safety skips: what was actually in the cup. That last part is where the real difference lies, and it is the reason we can tell you precisely where ours comes from.

Is Kava a Drug?

Kava is a psychoactive plant beverage. It is made from the root of Piper methysticum, a pepper family plant, and it affects how people feel, which is the sense in which the word drug fits.

What it is not is alcohol, and it is not a federally controlled substance in the United States. There is no ethanol in it, nothing in it is fermented or distilled, and NCCIH describes kava as native to the South Pacific and a member of the pepper family, used in Pacific Islander beverages for thousands of years for ceremonial and medicinal purposes.

So the answer depends on which definition you brought. Psychoactive, yes. A controlled drug, no. For what the plant actually is and how the drink is made, start with What Is Kava?.

Where the Liver Story Came From

Almost every worry about kava traces back to a cluster of liver injury cases in Europe and the United States around the turn of the century, and the facts of it are narrower than the reputation.

The US Food and Drug Administration issued a consumer advisory on March 25, 2002, stating that kava-containing dietary supplements may be associated with severe liver injury. At that point it was working from five case reports, four European and one American, and it noted more than 25 reports of adverse events in other countries. One US report involved a previously healthy young woman who required a liver transplant.

Later that year the CDC published a fuller accounting. Its November 29, 2002 report, “Hepatic Toxicity Possibly Associated with Kava-Containing Products, United States, Germany, and Switzerland, 1999 to 2002,” described 11 patients who used kava products, developed liver failure and went on to liver transplantation. Two were in the United States. Eight of the European cases were in Germany and Switzerland, six and two respectively. The report noted that several countries, including Germany, Switzerland, Canada, Australia and France, had restricted the sale of kava products.

Those are real cases with real outcomes and we will not minimize them. What is also true is that nobody established a single clean mechanism.

The 2002 German Ban, and What Happened After

Germany withdrew kava’s clinical use as an anxiolytic in 2002 over hepatotoxicity concerns, and a court later overturned that decision.

The German regulator, the Federal Institute for Drugs and Medical Devices, pulled the marketing authorizations for kava-containing medicinal products in 2002. A 2020 review in the journal Nutrients records both halves of the story in a line: Germany banned kava’s clinical anxiolytic use in 2002, and the ban was lifted in 2014 after a court ruling.

The regulator appealed that ruling, and we could not confirm the final disposition from a primary source, so we are not going to assert one. What matters for a reader is the shape of it: a ban was imposed on the evidence available in 2002, it was challenged, and a court found against the regulator on the merits. That is a materially different story from a ban that still stands, and it is the part most coverage of kava safety never caught up with.

Noble and Tudei: The Variable Most Coverage Skips

The single most useful question about kava safety is not whether kava is safe. It is which kava, from which part of the plant, prepared how.

Kava is not one uniform product. Vanuatu permits only cultivars classified as noble kava for export. The Nutrients review reports that noble cultivars contain roughly one quarter the amount of flavokavains A and B found in two-day, or tudei, cultivars, and that the two groups differ in their kavalactone makeup, with two-day cultivars associated with more overpowering or prolonged effects. The same review suggests flavokavains may need to be included in quality control for kava products, and that the standard practice of summing the six major kavalactones is not sufficient on its own.

Which part of the plant matters too. Kava is prepared from roots and rhizomes, and sometimes stem peelings, which the review notes carry higher alkaloid content that may contribute to cytotoxicity.

And the preparation method is its own variable. The 2016 technical report from the UN Food and Agriculture Organization and the World Health Organization reviewed traditional and recreational beverage consumption and noted that kava has been consumed for more than two thousand years with little documented evidence of adverse health effects, while drawing a clear line around newer practices such as organic solvent extraction and non-noble varieties, which it said lack sufficient history and documentation of effects on human health. Hawaii’s Department of Health, relying on that report in 2024, summarized its finding as a low-level health risk for the traditional beverage.

Put those together and the useful question becomes answerable. Lower-cost supply chains in this category are sometimes cut with material that is not lateral root, and a drinker usually has no way to tell by looking.

Which is why we will tell you ours. Our kava comes from Vanuatu, lateral root and chips, prepared fresh in house every day, and a Kavatender can tell you which strain is in your shell and where the crop came from. If you are choosing where to drink kava, make sure the bar serves kava from Vanuatu. That is the safest supply, and it is a standard you can hold any bar to, including this one.

What Regulators Say Now

The current regulatory position is not that kava is harmless and not that it is dangerous. It is that specific risks exist, some of them rare and serious, and that certain combinations and conditions are the real flags.

NCCIH, on its kava page last updated in April 2025, states that various kava products have been linked to rare cases of liver injury, some of which have been serious or even fatal. It notes that genetic differences among people might influence susceptibility to liver toxicity, and that other possibilities include consuming kava together with alcohol. It lists digestive upset, headache and dizziness among side effects, and says kava may have special risks during pregnancy or breastfeeding. Its clearest instruction is that kava should not be used together with other substances that have sedative effects, such as benzodiazepines or alcohol.

On the trial evidence, the 2003 Cochrane review of kava extract reported adverse events in the included trials as mild, transient and infrequent, and described kava as relatively safe for short-term use of one to 24 weeks while asking for the long-term safety studies that still have not been done.

So the practical list is short. Talk to a doctor before drinking kava if you take prescription medication, especially anything sedating, or if you have any liver condition. Do not combine it with alcohol, which is one reason there is none in our bars. Kava is 18 and up at every Kavasutra and we do not serve it to anyone who is pregnant. Long-term heavy use is associated with a skin condition called kava dermopathy, which has its own post. The dependence question has its own post as well, at Is Kava Addictive?.

If you have read all of that and you still want to try it, your first visit covers how to order.

Sources: NIH Office of Dietary Supplements, Kava, on the FDA advisory of March 25, 2002 · CDC MMWR, Hepatic Toxicity Possibly Associated with Kava-Containing Products, November 29, 2002 · NCCIH, Kava · Kava as a Clinical Nutrient: Promises and Challenges, Nutrients, 2020 · Hawaii Department of Health, GRAS determination for awa, citing the FAO and WHO 2016 report · Pittler and Ernst, Kava extract versus placebo for treating anxiety, Cochrane Database of Systematic Reviews, 2003

Frequently asked questions

These statements have not been evaluated by the Food and Drug Administration. Nothing on this page is medical advice. Kava is served to adults 18 and up and not to anyone who is pregnant.