Beware of All Kratom-Related Products

In 2018 and 2019 we alerted our readers to the emerging risk of kratom (mitragynine) products,[1],[2] which are derived from the leaves of a tropical tree native to Malaysia, Thailand and other Southeast Asian countries.[3] Historically, farmers and laborers seeking relief from the effects of physical work in these countries chewed on fresh kratom leaves or brewed them into teas.

Regular use of kratom products (which are often available online in the United States in crushed dry leaf, powder, resin extract, capsule or tablet formulations)[4] is associated with serious adverse effects. These adverse effects include dependence (needing to use increasingly higher doses), addiction, physical withdrawal reactions (such as diarrhea, frequent yawning, lethargy, irritability, muscle or joint pain, and runny nose) and psychological withdrawal symptoms (including aggression, delusion, hallucination, nervousness, sadness, restlessness and tension), as well as liver injury and seizures.[5]

By 2024 an estimated 5 million Americans aged 12 or older reported using kratom at least once during their lifetime, according to data from the Substance Abuse and Mental Health Services Administration’s national survey on drug use and health.[6]

Since approximately 2024, synthetic derivatives of kratom — mainly 7-hydroxymitragynine, commonly known as 7-OH — have been available in candy-like formulations (including gummies and pills that can be chewed or placed under the tongue) at U.S. retail stores and online.[7] These products have much higher potency than leaf kratom products.

Kratom reports to poison centers

Kratom-related reports to U.S. poison centers have hit record levels, according to a March 2026 analysis in Morbidity and Mortality Weekly Report published by the Centers for Disease Control and Prevention.[8] Approximately 14,450 kratom-related reports were documented in the last 11 years. Of those, 3,434 reports were received in 2025, about a 1,200% increase from 258 reports in 2015. The collected information did not include details regarding whether kratom use involved leaf or synthetic kratom products.

Most reports involved males and young adults aged 20 to 39 years. However, by 2025 reports involving adults aged 40 to 59 years increased substantially, reaching rates close to those for young adults.

Overall, 62% of the reports pertained to individuals who reported consuming kratom by itself. The remaining reports pertained to those who combined it with certain drugs or other psychoactive substances, including alcohol, antidepressants, benzodiazepines (such as alprazolam [XANAX and generics] and diazepam [VALIUM and generics]), opioids, cannabis or cannabinoids.

Reported hospitalizations due to kratom exposure alone rose from 43 in 2015 to 538 in 2025. For kratom exposure in combination with drugs or other substances, hospitalizations rose from 40 in 2015 to 549 in 2025.

There were 233 kratom-related deaths during the study period. Of those, 79% involved consumption of other drugs or substances as well.

U.S. attempts to regulate kratom

The Drug Enforcement Administration (DEA) has considered kratom a “drug and chemical of concern.”[9] In August 2016 the agency endeavored to temporarily classify kratom and its 7-OH derivative as Schedule I controlled substances — a classification for substances with no valid medical uses but a high potential for abuse — for two years.[10] This classification could have criminalized the sale and use of these products. Two months later, however, the agency withdrew its decision due to pressure from kratom supporters,[11] spearheaded by the American Kratom Association. In contrast, several countries (including Australia, France, Malaysia, Sweden and the United Kingdom) have banned kratom, and others (including Finland and Portugal) have classified it as a controlled substance.[12]

The Food and Drug Administration (FDA) has not approved kratom for any therapeutic uses, and FDA scientists showed that multiple kratom compounds bind strongly to opioid receptors. In 2017 the agency issued a public health advisory highlighting kratom risks and noted taking steps to prevent its importation.

In July 2025 the FDA issued seven warning letters to companies that were illegally marketing 7-OH products.[13] In an opinion article in the New York Post, Dr. Martin Makary, then the FDA commissioner, stated that the agency is not targeting plant-leaf kratom, claiming that it contains “trace amounts of 7-OH and has been consumed for centuries.”[14] In June 2026 the New York Times reported that the Trump administration is likely to take a permissive stance on plant-based kratom.[15]

Although Makary was correct that the potency of 7-OH products greatly increases their risks, he and the Trump administration miss the mark on the risks of plant-leaf kratom. Many sources agree that the traditional Southeast Asian uses of kratom — which have been limited to chewing the fresh, bitter-tasting leaves or boiling them in water — do not form 7-OH in measurable amounts.[16] In contrast, contemporary preparations — which come from processed dry kratom leaves — produce high 7-OH levels during drying and processing.

A March 2026 letter from a group of senators led by Sens. Pete Ricketts and Richard Blumenthal urged the FDA to recommend that the DEA schedule the whole kratom leaf, not just 7-OH products.[17] The letter highlighted that young Americans have reported increasing addiction to various kratom products, consuming as many as a dozen a day and experiencing severe withdrawal symptoms when they try to quit.

On July 1, 2026, the DEA issued two notices of intent to temporarily place products that contain more than a specified amount of 7-OH, as well as those containing three related substances (known as mitragynine pseudoindoxyl, MGM-15 and MGM-16), into Schedule I of the Controlled Substances Act.[18]

Some U.S. cities, counties and states have either banned kratom or raised the minimum legal age for its purchase to 18 or 21 years. An April 2026 study in Addiction showed that states with some local restrictions on kratom use had similarly high rates of exposure, health care utilization or severe outcomes as states with no local restrictions.[19] In contrast, states that have banned kratom had lower rates of the above outcomes.

Therefore, federal action to ban all kratom-related products is urgently warranted to ensure public protection from what could become a new, preventable opioid crisis. Scheduling only 7-OH above a certain threshold and other synthetic substances would leave many other potentially addictive kratom products on shelves, incorrectly implying that they are safe.

What You Can Do

Do not use kratom, 7-OH or related products. When buying candy and dietary supplements, carefully review their listed content to ensure that they do not include these risky products.

If you are struggling with addiction, anxiety, depression or pain, seek medical care from a licensed clinician, and never self-medicate with kratom-related or other unapproved products.

If you suspect that someone has consumed a kratom-related product or other opioids and is not responsive or is unable to breathe, call 911 immediately. You should also give the person naloxone (KLOXXADO, NARCAN, REXTOVY, RIVIVE and generics), if available, to reverse the slowed or stopped breathing effects of kratom. If you have questions or concerns related to kratom exposure or use, call the Poison Help line (800-222-1222).
 

References

[1] News brief: Federal researchers link kratom to 91 unintentional overdose deaths. Worst Pills, Best Pills News. October 2019. https://www.worstpills.org/newsletters/view/1293. Accessed July 6, 2026.

[2] FDA issues a public health advisory regarding the dangerous plant kratom. Worst Pills, Best Pills News. April 2018. https://www.worstpills.org/newsletters/view/1191. Accessed July 6, 2026.

[3] Drug Enforcement Administration. Kratom (mitragyna speciosa korth) – (street names: thang, kakuam, thom, ketum, biak). October 2025. www.deadiversion.usdoj.gov/drug_chem_info/kratom.pdf. Accessed July 6, 2026.

[4] Food and Drug Administration. FDA report. 7-hydroxymitragynine (7-OH): An assessment of the scientific data and toxicological concerns around an emerging opioid threat. 2025. https://www.fda.gov/media/187899/download?attachment. Accessed July 6, 2026.

[5] Singh D, Narayanan S, Vicknasingam B. Traditional and non-traditional uses of mitragynine (kratom): A survey of the literature. Brain Res Bull. 2016;126(Pt 1):41-46.

[6] Substance Abuse and Mental Health Services Administration. Results from the national survey on drug use and health, 2023 and 2024. 2025. https://www.samhsa.gov/data/sites/default/files/reports/rpt56484/NSDUHDetailedTabs2024/NSDUHDetailedTabs2024/2024-nsduh-detailed-tables-sect8pe.htm. Accessed July 6, 2026.

[7] Alsbrook S, Pro G, Koturbash I. From kratom to 7-hydroxymitragynine: evolution of a natural remedy into a public-health threat. Pharm Biol. 2025;63(1):896-911.

[8] Towers EB, Thomas YT, Holstege CP, et al. Increases in Kratom-related reports to poison centers — national poison data system, United States, 2015–2025.  Morb Mortal Wkly Rep. 2025;75(11):139-145.

[9] Drug Enforcement Administration. Drugs of abuse. 2017. https://www.dea.gov/sites/default/files/pr/multimedia-library/publications/drug_of_abuse.pdf. Accessed July 7, 2026.

[10] A Proposed rule by the Drug Enforcement Administration. Schedules of controlled substances: Temporary placement of mitragynine and 7-hydroxymitragynine into schedule I. Federal Register. August 31, 2016. https://www.federalregister.gov/documents/2016/08/31/2016-20803/schedules-of-controlled-substances-temporary-placement-of-mitragynine-and-7-hydroxymitragynine-into. Accessed July 7, 2026.

[11] A Proposed rule by the Drug Enforcement Administration. Withdrawal of notice of intent to temporarily place mitragynine and 7-hydroxymitragynine into schedule I. Federal Register. October 13, 2016. https://www.federalregister.gov/documents/2016/10/13/2016-24659/withdrawal-of-notice-of-intent-to-temporarily-place-mitragynine-and-7-hydroxymitragynine-into. Accessed July 7, 2026.

[12] World Population Review. Kratom legality by country 2026. https://worldpopulationreview.com/country-rankings/kratom-legality-by-country. Accessed July 7, 2026.

[13] Food and Drug Administration. FDA issues warning letters to firms marketing products containing 7-hydroxymitragynine. July 15, 2025. https://www.fda.gov/news-events/press-announcements/fda-issues-warning-letters-firms-marketing-products-containing-7-hydroxymitragynine. Accessed July 7, 2026.

[14] Makary M. Beware: Synthetic kratom — 7-OH — is powering a new opioid crisis. July 29, 2025. https://nypost.com/2025/07/29/opinion/beware-synthetic-kratom-7-oh-powers-a-new-opioid-crisis/. Accessed July 7, 2026.

[15] Vogel KP, Jewett C. How an addictive gas station drug found allies in Trump’s cabinet. NYT. June 15, 2026. https://www.nytimes.com/2026/06/15/us/politics/kratom-trump-administration.html?eafs_enabled=false. Accessed July 7, 2026.

[16] Alsbrook S, Pro G, Koturbash I. From kratom to 7-hydroxymitragynine: evolution of a natural remedy into a public-health threat. Pharm Biol. 2025;63(1):896-911.

[17] Rickets P, Blumenthal R, Shaheen J, et al. Letter to the Food and Drug Administration urging consideration to schedule the whole kratom leaf kratom. March 18, 2026. https://www.ricketts.senate.gov/news/press-releases/ricketts-letter-calls-on-fda-to-address-kratom-scheduling-loophole/. Accessed July 7, 2026.

[18] Drug Enforcement Administration. DEA to temporarily schedule 7-OH and related substances to protect public safety. July 1, 2026. https://www.dea.gov/press-releases/2026/07/01/dea-temporarily-schedule-7-oh-and-related-substances-protect-public. Accessed July 13, 2026.

[19] Comstock G, Gulotta AP, Rein LE, et al. Association between state-level kratom regulations and poison center-reported severe medical outcomes and healthcare use: A United States national analysis. Addiction. doi:10.1111/add.70416. Published online ahead of print April 21, 2026.