Kratom’s rise sparks health concerns amid weak regulations

The kratom plant, a Southeast Asian evergreen whose leaves have been chewed or brewed into tea for generations, has emerged as a growing public health issue in the U.S. Despite its widespread availability—from smoke shops to convenience stores—most Americans remain unfamiliar with it. A survey by the Annenberg Public Policy Center found that about two-thirds (66%) of Americans have never heard of kratom, and even those who had struggled to differentiate between natural leaf products and newer synthetic derivatives.

Kratom’s active compounds, including 7-hydroxymitragynine (7-OH), mitragynine pseudoindoxyl (MGPI), and dihydro-7-hydroxy mitragynine (MGM-15), now appear under brand names such as Dozo Perks, Roxy, and UltraOhmz Pseudo Supreme. These products are frequently marketed as dietary supplements, but their potency has increased significantly in recent years. Federal oversight remains unresolved, leaving a fragmented regulatory system.

The plant contains dozens of alkaloids, with mitragynine being the most prevalent. It functions as a partial agonist on mu-opioid receptors, producing effects ranging from mild stimulation at low doses to pain relief and opioid withdrawal support at higher doses. Unlike full agonists such as fentanyl or oxycodone, mitragynine triggers a weaker receptor response, but its potential for dependence and withdrawal remains a subject of debate.

She consumes 70–75 milligrams of mitragynine every six hours, a dosage that does not induce euphoria but enables her to perform daily activities she previously could not. Unlike her past dependence on opioids such as OxyContin, she has not experienced severe withdrawal symptoms upon discontinuing kratom. However, research indicates that up to 38% of users may develop disorders from prolonged use.

Synthetic 7-OH: A Stronger, Riskier Opioid-Like Threat

Before synthetic products gained prominence, concerns centered on extracts and tinctures, which concentrate mitragynine far beyond natural levels. Attention soon shifted to 7-OH, an alkaloid absent in fresh kratom leaves but now artificially concentrated in tablets, gummies, and drink mixes. Unlike mitragynine, 7-OH acts as a direct opioid receptor agonist, raising concerns about addiction and the severity of withdrawal.

Katherine Hill, an epidemiologist at Yale, notes that while natural kratom poses risks, 7-OH products are far more potent. Users report sedative effects at doses as low as 12–14 milligrams, though tablets now contain 25, 50, or even 100 milligrams. Twinkle VanFleet, who lives with complex regional pain syndrome, initially found relief in small 7-OH doses but now advocates for stricter limits. She states, “In my perfect world, there would be 3, 5, and 10 milligram tablets, period.”

The rise of synthetic compounds has drawn regulatory scrutiny. The DEA initially proposed banning MGPI, another mitragynine metabolite, but after lobbying from the American Kratom Association, the agency revised its approach. Instead of an outright ban, the DEA now proposes restricting both 7-OH and MGPI based on their ratio to mitragynine in products. The concern stems from trace amounts of MGPI potentially occurring naturally in kratom, though their safety remains unverified.

How Synthetics Lured a Recovering Addict Back

Greg Kiesow had been sober from alcohol for nearly 20 years and retired for three days when he went into a smoke shop that was promoting 7-OH products. The shopkeeper had heard it was some sort of natural energ

As synthetic products spread, so do the risks. The National Poison Data Center reports a 1,200% increase in kratom-related exposures over the past decade, from 258 cases in 2015 to 3,434 in 2025. While most fatalities involve other substances, Florida alone recorded 580 kratom-linked overdoses over nearly a decade. The challenge lies in mislabeling: many products do not disclose their actual contents, and toxicology tests often cannot distinguish between natural and synthetic compounds.

Regulatory Battles Divide Users and Critics

Regulatory debates remain divisive. Mac Haddow of the American Kratom Association argues for clear distinctions. Others, like Danelle Kawasaki, a member of the Fort Peck tribe, reject natural kratom entirely after her struggles. For Kawasaki, “the risks outweigh the remedy that people are searching for.”

Mislabeling persists across all kratom products. A 2023 investigation by the Tampa Bay Times revealed that many brands advertised lower concentrations of 7-OH or mitragynine than were actually present. In some cases, products contained entirely undeclared compounds, including synthetic opioids like tramadol. The National Poison Data Center’s data further illustrates this issue: while kratom-related exposures surged 1,200% from 2015 to 2025, toxicology screens often fail to differentiate between natural and synthetic forms, leaving gaps in overdose monitoring.