Understanding Kratom: Effects, Risks, and Regulations

In this post I discuss Kratom, a psychoactive herbal substance, gaining attention for its potential use in managing opioid withdrawal, pain, and anxiety. Despite its popularity, it is not FDA-approved, with growing scrutiny due to concerns over safety and increased regulation at state levels.

This information is current as of the date of original publication or update. It may have changed by the time you read this. I invite you to fact-check what you read here.

This information is not intended for diagnosis or treatment. Before making health decisions, discuss with your physician or other qualified healthcare provider to decide what is right for you.

What is Kratom?

Before I read the following article, I knew little about kratom, other than it is a psychoactive drug that is popular with young people. I was thinking along the lines of the substances used in vaping.

But this article made me pause and realize I needed to learn more.

According to NIDA, the National Institute on Drug Abuse, an agency of the NIH, National Institutes of Health,

“Kratom” commonly refers to an herbal substance that can produce opioid- and stimulant-like effects. Kratom and kratom-based products are currently legal and accessible in many areas of the world.

While there are no uses for kratom approved by the U.S. Food and Drug Administration, people report using kratom to manage drug withdrawal symptoms and cravings (especially related to opioid use), pain, fatigue, and mental health problems.

 NIDA supports and conducts research to evaluate potential medicinal uses for kratom and related chemical compounds.

NIDA also supports research towards better understanding the health and safety effects of kratom use. Rare but serious effects have been reported in people who use kratom, including psychiatric, cardiovascular, gastrointestinal and respiratory problems.

 Compared to deaths from other drugs, few deaths have been linked to kratom products and nearly all cases involved other drugs or contaminants.

More info from NIDA at this link

Kratom (Mitragyna speciosa) Mitragynine. Drugs and Narcotics

Kratom (Mitragyna speciosa) is a tree in the coffee family, found in Thailand and neighboring countries. Traditionally, in Southeast Asia, people have chewed its leaves or made them into a tea that is used to fight fatigue and improve work productivity

Kratom faces increasing scrutiny from states and the feds

by Amanda Hernández, Oklahoma Voice
August 11, 2025

For years, state lawmakers have taken the lead on regulating kratom — the controversial herbal supplement used for pain relief, anxiety and opioid withdrawal symptoms. Some states have banned it entirely. Others have passed laws requiring age limits, labeling, and lab testing.

At least half of the states and the District of Columbia have enacted some form of regulation on kratom or its components — building a patchwork of policies around a product largely unaddressed by the federal government.

But that may soon change. The U.S. Food and Drug Administration is pushing to ban 7-hydroxymitragynine, or 7-OH — a powerful compound found in small amounts in kratom and sometimes concentrated or synthesized in products sold online, at smoke shops, or behind gas station counters.

Federal health officials announced last month that the compound poses serious public health risks and should be classified as a Schedule I controlled substance, alongside heroin and LSD.

The move marks a significant shift in how federal regulators are approaching kratom, which they attempted to ban in 2016. It has sparked debate about how the change could impact the growing 7-OH industry and its consumers.

This year, at least seven states have considered bills to tighten kratom regulations, including proposals for bans, age restrictions, and labeling requirements.

Kratom and 7-OH differences

Kratom, which originates from the leaves of a tree native to Southeast Asia, can have a wide range of mental and bodily effects, according to federal officials, addiction medicine specialists, and kratom researchers. Reports of fatal kratom overdoses have surfaced in recent years, though kratom is often taken in combination with other substances.

Kratom and 7-OH are distinct products with separate markets, but they are closely connected. 7-OH is a semi-synthetic compound derived from kratom and only emerged on the market in late 2023, while kratom itself has been available for decades.

Leading kratom researchers say more research is needed to fully understand the long-term effects of using both substances.

“There’s much we don’t know, unfortunately, on all sides,” said Christopher R. McCurdy, a professor of medicinal chemistry at the University of Florida. McCurdy is a pharmacist and has studied kratom for more than 20 years.

Research suggests kratom may help with opioid withdrawal and doesn’t seem to cause severe withdrawal on its own. Smaller amounts seem to act as a stimulant, while larger doses may have sedative, opioidlike effects.

Very little is known about the risks of long-term use in humans, according to McCurdy.

As for 7-OH, it shows potential for treating pain, but hasn’t been studied in humans, and may carry a high risk of addiction. Researchers don’t yet understand how much is safe to take or how often it should be used, McCurdy told Stateline.

While some leading kratom experts agree that kratom and 7-OH should be regulated, they caution that placing 7-OH under a strict Schedule I classification would make it much harder to study — and argue it should instead be classified as Schedule II as are other opioids.

A federal survey from 2023 estimated that about 1.6 million Americans age 12 and older used kratom in the year before the study. The American Kratom Association, an industry lobbying group, estimated in 2021 that between 11 million and 16 million Americans safely consume kratom products each year.

Since gaining popularity in recent years, 7-OH is in a larger number of products. Some researchers and addiction medicine specialists say many consumers, especially those new to kratom, sometimes don’t understand the difference between products.

“It’s a pure opioid that’s available without a prescription, so it’s akin to having morphine or oxycodone for sale at a smoke shop or a gas station,” McCurdy said. “This is a public health crisis waiting to happen.”

Photo by Laryssa Suaid on Pexels.com

FDA targets 7-OH, not kratom

In late July, the U.S. Department of Health and Human Services recommended that the federal Drug Enforcement Administration place 7-OH in Schedule I, citing a high potential for abuse. The classification would not apply to kratom leaves or powders with naturally occurring 7-OH.

“We’re not targeting the kratom leaf or ground-up kratom,” FDA Commissioner Marty Makary said at a news conference. “We are targeting a concentrated synthetic byproduct that is an opioid.”

Makary acknowledged that there isn’t enough research or data to fully understand how widespread 7-OH’s use or impact may be. Still, he said the Trump administration wants to be “aggressive and proactive” in addressing the issue before it grows into a larger public health problem.

The Trump administration wants to be aggressive and proactive before the issue grows into a larger public health problem.

FDA head Marty Makary

While only small amounts of 7-OH occur naturally in the kratom plant, federal officials have raised concerns about U.S. products containing synthetic or concentrated forms of the compound because it’s more potent than morphine and primarily responsible for kratom’s opioidlike effects

the chemical formula for kratom products; credit NIDA

What will the DEA do with 7-OH?

The FDA’s recommendation to schedule 7-OH will now go to the DEA, which oversees the final steps of the process — including issuing a formal proposal and opening a public comment period.

If finalized, the rule could affect both companies selling enhanced kratom products and consumers in states where those products are currently legal.

The DEA backed off scheduling kratom compounds in 2016 after widespread public opposition.

Kirsten Smith, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University who is studying kratom’s effects in humans, said she was surprised by the FDA’s push to schedule 7-OH.

“We don’t really have a public health signal of a lot of adverse events for either kratom or for 7-OH at this time,” she told Stateline. “I was, frankly, always surprised that kratom was pushed toward scheduling at an earlier time point. … I don’t know that we have data to support scheduling even now.”

Pushback from advocacy groups

Still, some advocacy groups, including the Holistic Alternative Recovery Trust, argue the push to schedule 7-OH is driven more by corporate interests than public health, suggesting the kratom industry is trying to sideline competition from 7-OH products.

“We think that this is just happening because of the legacy kratom manufacturers losing market share and wanting to gin up a crisis with this,” said Jeff Smith, the national policy director for the group, who said he has used 7-OH for sleep and pain management.

While his organization supports regulation and safe consumption, members worry the federal government’s move could drive people to riskier substances or push the market underground.

“It’s made a profound difference in my life,” Smith said. “We think it would be tragic to cut it off based on such a paucity of data when there’s so much potential for this product to help people.”

Public health concerns 

Federal health officials say a key concern is the growing use of kratom and 7-OH products among teens and young adults.

Some officials and addiction medicine specialists have pointed out that these products often come in flavors and packaging designed to appeal to younger buyers, with few controls over where or how they’re sold. In some states without clear regulations, kratom and 7-OH products are available at gas stations or online, sometimes without any age verification.

“Whenever you go into a gas station and even though it’s behind the glass, it’s of eye level, and it has all of these bright colors — it has all of these things that really attract the visual of a kiddo,” said

Socorro Green, a prevention specialist with Youth180, a nonprofit focused on youth substance use prevention in Dallas.

Green added that kratom and 7-OH products may be even more accessible to young people in rural communities, where gas stations and convenience stores are often among the few available retailers.

Some researchers and experts say that certain products may not clearly or accurately disclose their 7-OH content and are sometimes marketed or mistaken for traditional kratom.

Some cities, counties and states have responded by banning kratom or raising the minimum purchase age to 18 or 21. But in many areas, enforcement remains inconsistent, and some addiction specialists say clearer federal and state guidance is needed — especially as more people are using kratom and 7-OH to manage pain, anxiety or withdrawal symptoms on their own.

“There needs to be some kind of oversight, including some way of maybe helping to ensure that people know what they’re getting,” said Terrence Walton, the executive director and chief executive officer of NAADAC, the Association for Addiction Professionals.

State regulations

At least seven states have considered or enacted legislation this year related to kratom — ranging from age restrictions and labeling requirements to outright bans.

In New York, lawmakers passed two bills: one requiring warning labels and prohibiting kratom products from being labeled as “all natural,” and another raising the minimum purchase age to 21. Neither has been sent to the governor.

In Colorado, a new measure, which was signed into law in May, prohibits kratom from being sold in forms that resemble candy or appeal to children, increases labeling requirements, limits concentrations of 7-OH, and bans the manufacture and distribution of synthetic or semi-synthetic kratom.

In Mississippi, a new law that took effect in July raised the minimum purchase age for kratom to 21. It also bans synthetic kratom extracts and products with high concentrations of 7-OH.

Lawmakers in Montana and Texas introduced similar legislation this year, but neither proposal advanced.

Louisiana is the latest state to enact a kratom ban.

Rhode Island became the first state to reverse its ban. The new law establishes a regulatory framework for the manufacturing, sale, and distribution of kratom products, set to take effect in April 2026.

As of this year, Washington, D.C., Alabama, Arkansas, Indiana, Louisiana, Vermont, and Wisconsin have banned kratom. At least half of U.S. states now regulate kratom or its components in some way.

Oklahoma Voice is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Oklahoma Voice maintains editorial independence. Contact Editor Janelle Stecklein for questions: info@oklahomavoice.com.

 

This story is republished under Creative Commons license CC BY-NC-ND 4.0.

Learn more about kratom products marketed as herbal supplements from the National Institutes of Health (NIH) National Center for Complementary and Integrative Health (NCCIH).

How will you respond to this information?

  1. Who do you need to share this information with?
  2. What more do you need to know about kratom?
  3. How do you feel generally about psychoactive drugs?
  4. What should our local governments do about kratom, if anything?

Images in this Post

The images of kratom are from the NIH website and in the public domain. The cover image was generated by AI on WordPress.

Exploring the HEART of Health

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Here is a related post for you to review

“Full Recovery” from addiction to recovery-book review

This post reviews Brian McAlister’s “Full Recovery” . It outlines a personal action plan for overcoming addiction through self-discovery and empowerment. Using personal anecdotes and principles from s successful figures, he emphasizes a moral foundation based on n a Higher Power. The book serves as a guide for transformation, encouraging positive life changes.

Making Our States Healthy with Doctor Patient Partnerships

In this post I share an opinion from an Oklahoma physician on the recent visit of HHS Secretary Robert Kennedy Jr. to promote the “Make Oklahoma Healthy Again” initiative, which includes controversial policy changes. Dr. Sharon D’Souza critiques the program’s focus on distractions rather than scientific health measures. I also point out the lack of patient involvement.

This information is current as of the date of original publication or update. It may have changed by the time you read this. I invite you to fact-check what you read here.

This information is not intended for diagnosis or treatment. Before making health decisions, discuss with your physician or other qualified healthcare provider to decide what is right for you.

On June 30, 2025 I published a post about HHS Secretary Robert Kennedy, Jr.’s visit to Oklahoma. He met with Governor Kevin Stitt at the state capitol to discuss their plan to “Make Oklahoma Healthy Again”, modeled after his national plan to Make America Healthy Again (MAHA).

Their plan included eliminating the state health department’s recommendation for fluoride in drinking water to prevent cavities and prohibiting recipients from using SNAP (food stamps) benefits to buy soda beverages.

Although no physicians had been invited to attend, many still showed up and presented their recommendations to help Oklahomans achieve better health.

After all, wouldn’t you think the doctors who take care of Oklahomans would know best what they need?

Oklahoma physicians at the state capitol holding a press conference,
photo from the state medical association Facebook page

In this post, I share an opinion piece from Dr. Sharon D’Souza, originally published on the website Oklahoma Voice and shared here by permission. I have edited the article minimally for length and readability.

Dr. Sharon D’Souza is a board-certified diagnostic radiologist in Tulsa, Oklahoma. She is president of the Oklahoma State Radiological Society, Vice President of the Tulsa County Medical Society, and a member of the Oklahoma State Medical Association Board of Trustees. She also earned an MPH in Public Health.

You probably don’t live in Oklahoma, but as you read the article, substitute the name of your state or territory for “Oklahoma”, since where you live likely faces the same or similar issues.

Gov. Stitt and RFK Jr. pledge to ‘Make Oklahoma Healthy Again.’ Their policies signal the opposite.

by Dr. Sharon D’Souza, Oklahoma Voice
July 30, 2025

Imagine this: a TV drama where a patient is being pushed through an emergency room by people in scrubs. Lights are blinking, alarms are sounding. Rounding the corner, the camera zooms in on an operating theatre ready to receive its patient.

a hospital emergency entrance
from LIGHTSTOCK.COM, affiliate

Except, the person waiting to spring into action isn’t a trained physician; it’s a politician in a suit with an unqualified idea to make the patient healthier. If this seems inconceivable, consider the events of June 26.

Gov. Kevin Stitt, center, pens his name during a ceremonial signing of an executive order to “Make Oklahoma Healthy Again,” as Robert F. Kennedy Jr., right, the nation’s secretary of health, and other supporters look on Thursday, June 26, 2025. (Photo by Janelle Stecklein/Oklahoma Voice)

Gov. Kevin Stitt welcomed U.S. Secretary of Health and Human Services Robert F. Kennedy Jr. to the Oklahoma Capitol for the “Make Oklahoma Healthy Again” rally. It served as a dramatic photo op, but behind the cameras, the policies promoted were anything but healthy.

As one of the unhealthiest states in the nation, Oklahoma cannot afford anti-science distractions that move us further from real solutions.

As a physician dedicated to practicing evidence-based medicine and advocating for patients, I wanted to see the assembly in person. I was joined by dozens of my colleagues, who canceled vital appointments so they could be on hand to advocate for the medical perspective that seemed to be ignored.

Physicians-Advocates for Solutions and Results

While Stitt and RFK Jr. rallied against fluoride in drinking water — a safe, proven public health measure — our coalition came prepared with something of value: a list of practical, data-backed solutions capable of improving the health of Oklahomans. Our coalition is not interested in political gains; we’re focused on actionable solutions and real results designed to strengthen the health care system.

Our list includes

  • prioritizing investments in health care infrastructure and education by properly funding Oklahoma hospitals, both rural and urban,
  • increasing educational opportunities for doctors and dentists, and
  • growing incentives for them to practice in Oklahoma’s underserved communities.

You simply can’t make a state healthier by undercutting its essential health care workforce, facilities, and resources.

Preventive Health Care Funding Cuts

Evidence-based preventive health care is also critical. Routine wellness visits, dental cleanings, immunizations, and continued fluoridation of public water are cost-effective, scientifically-proven tools for improving health and reducing healthcare costs.

The recent DOGE-OK cuts took funding out of Oklahoma’s hands and sent it elsewhere, weakening our resources to care for our own citizens. DOGE-OK slashed $15 million in “wasteful” immunization funding while we battle new cases of measles and tuberculosis, coupled with the lowest immunization rates in years.

(Note: In the United States, tuberculosis vaccination is not recommended routinely.)

We support putting Oklahoma tax dollars back in Oklahoma by restoring the funding cuts to health care.

Insurance Hurdles and Cuts

Our current health care process is burdened by a cumbersome insurance review process, leading to delays and denial of care recommended by a doctor or dentist. These practices intend to save corporations money, but patients pay the price with their wallets, health, and in some instances, their lives.

Legislation that promotes prior authorization reform and provides legal protection for those negatively affected by claims delayed or denied in bad faith would help.

Medicaid is critical to Oklahoma’s health care system, serving as the foundation of care for more than 900,000 Oklahomans, including low-income veterans, pregnant women, children, and people with disabilities. Cuts to Medicaid aren’t the answer and will simply shift the burden elsewhere, putting further strains on hospitals, physicians, and taxpayers.

How to Make Oklahomans Healthy

The problems we face, such as declining immunization rates and high occurrences of preventable diseases, will not be fixed by scapegoating fluoride. This is simply a distraction from the actual work that needs to be done.

While we can find common ground on issues like promoting exercise and proper nutrition, we must make these things affordable and accessible to everyone by investing in public health and food programs, rather than cutting those essential lifelines.

Oklahoma doesn’t need slogans borrowed from Washington. We need policies rooted in science, not conspiracy. If we’re serious about making Oklahomans healthy, we have to stop performing for the cameras and start listening to the experts.

Oklahoma Voice is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Oklahoma Voice maintains editorial independence. Contact Editor Janelle Stecklein for questions: info@oklahomavoice.com.

What patients can do to make their communities healthy

I agree with Dr. D’Souza that health recommendations and public policy should start with health and medical science. Many government and private agencies and organizations release evidence-based medical practice guidelines.

I also think our communities should support what residents believe is vital for their families’ health. What is important to you? What will help you achieve and maintain health?

I suggest you start by answering these questions and discussing them with your primary care physician.

What does health mean to me?

What do I need to be physically, mentally, and emotionally well?

What do I need and want from my community to help me create a healthy lifestyle?

Knowing the answer to these questions will help you evaluate the public policy and public health decisions created by your local, state, and federal governments. Ideally, health decisions should be based on science, need, and patient preference, not political ideology.

Exercise your right to express your opinions to your elected and appointed officials and never miss the opportunity to vote.

Photo by cottonbro on Pexels.com

KFF Health News

KFF Health News is a national newsroom that produces in-depth journalism about health issues.

KFF is an endowed nonprofit organization providing information on health issues to the nation. KFF Health News reports on how the health care system — hospitals, doctors, nurses, insurers, governments, consumers — works.

In addition to its website, its stories are published by news organizations nation wide. The site also features daily summaries of major health care news.

Here is a link to a recent KFF report about Secretary Kennedy, HHS, and the $6.3 trillion global wellness industry.

Vested Interests. Influence Muscle. At RFK Jr.’s HHS, It’s Not Pharma. It’s Wellness.

Images in this Post

The graphics in this post were created by the Oklahoma State Medical Association for public use.

Cover Image

The cover image of this post was created by JetPackAI available with WordPress.

Exploring the HEART of Health

I’d love for you to follow this blog. I share information and inspiration to help you turn health challenges into health opportunities.

Add your name to the subscribe box to be notified of new posts by email. Click the link to read the post and browse other content. It’s that simple. No spam.

I enjoy seeing who is new to Watercress Words. When you subscribe, I will visit your blog or website. Thanks and see you next time.

Use this search box for related posts on this blog or other topics of interest to you.

Dr. Aletha