Most people haven’t heard of kratom. What is it, and who’s using it?

Over the last few years, the kratom plant and supplements made from it have garnered increasing attention from public health leaders. This broad category of products, which largely skirts any regulation, has seen major surges in potency, while becoming omnipresent on smoke shop and gas station shelves. Health officials have warned that concentrated compounds like 7-hydroxymitragynine (7-OH) are an emerging public health threat, and federal policies to limit their availability are pending. In the meantime, multiple states and smaller localities have issued emergency bans on 7-OH, and in some cases, on all kratom products. Despite the messaging and rising use, few Americans are familiar with kratom or the newer derivative products. They’re made with compounds that have scientific names like 7-OH, mitragynine pseudoindoxyl (MGPI) and dihydro-7-hydroxy mitragynine (MGM-15) but are often sold on shelves with names like Dozo Perks, Roxy, and UltraOhmz Pseudo Supreme. New survey data from the Annenberg Public Policy Center show about two-thirds (66%) of Americans have never heard of kratom. Among those who had at least some familiarity, few understood the difference between its natural leaf form and more synthetic products. That confusion carries over to the associated risks. In the survey of nearly 2,000 people, 66% were unsure if kratom products posed a serious public safety hazard. And most people didn’t understand health secretary Robert F. Kennedy Jr.’s stance on regulation — a question that’s become complicated by repeated reports of kratom industry lobbying influence on the DEA’s proposed action. STAT spoke with researchers and people who use or have used kratom and 7-OH to get a full picture of what these products are, along with their potential risks and benefits. What is kratom? To an untrained eye, a kratom leaf might resemble a bay leaf. It grows on evergreen trees indigenous to Southeast Asian countries, including Thailand, Malaysia, and Indonesia. For centuries, people there have chewed the leaf or brewed it into tea for its stimulant-like effects. Kratom (pronounce it with a hard or soft “a,” your choice) contains dozens of alkaloids, but mitragynine is the most abundant and the best understood. It acts as a partial agonist that binds to mu-opioid receptors in the nervous system. (Partial agonists produce less of a response from the receptor than full agonists, such as fentanyl or oxycodone.) The first kratom products to arrive in the U.S. were made by drying and grinding up those leaves to create a matcha-like powder often used as a tea or swallowed in a capsule. In low quantities, it acts as a mild stimulant that can appear similar to coffee. In higher doses, people have used kratom to stave off chronic pain and even to help ease withdrawal from opioids. (There are no evidence-based dose recommendations, and there’s a lot of variation in both product potency and personal preference.) “We call it swamp water, so that should give you a good visual,” said Madalyn Sklar, who uses kratom to ease chronic pain caused by degenerative disc disease, and hosts two podcasts on kratom. The first time Sklar drank the bitter tea made from kratom powder, she added orange juice as a sweetener, but still “it was so gross that I almost puked.” She’s taken it nearly every day since 2019, and says the results are better than when she was on meds like OxyContin and gabapentin. She takes two teaspoons of powder — which works out to about 70-75 milligrams of mitragynine — every six hours. For her, there’s no high or euphoria. But she can do simple tasks that she couldn’t before, such as walk her dog and bend down to pick up its poop. Sklar hasn’t experienced withdrawal symptoms when she’s occasionally stopped taking kratom and returned to more traditional pain medication. Research is limited, but has found that up to around 38% of kratom users may develop use disorders. In studies, withdrawal from kratom has appeared mild on a scale that measures clinical opioid withdrawal, with symptoms like anxiety, fatigue, gastrointestinal issues, and restlessness. Before semi-synthetic products came onto the scene, most public health concern around kratom was directed at extracts and tinctures, recalled Sklar. Many of these products still tout mitragynine as the active ingredient, but in much more concentrated volumes than the whole leaf powder — think 100 to 300 milligrams of mitragynine in a bottle of liquid the size of a 5-hour Energy. (There are currently no federal proposals that aim to regulate concentrated mitragynine products.) “But people got really interested in the other alkaloids over time,” said Katherine Hill, an epidemiologist at the Yale School of Public Health who has studied kratom. “And specifically they got interested in 7-hydroxymitrogynine.” What is 7-OH? The alkaloid 7-OH does not appear in the fresh kratom leaf that people in Southeast Asia chew, according to Hill. It shows up in the dried leaf powder products, in small amounts. It’s also a metabolite, meaning that when the body absorbs mitragynine, some of it turns it into 7-OH. Once inside the body, 7-OH, like mitragynine, is a partial agonist to the mu-opioid receptor. The products made with 7-OH — including tablets, gummies, shots, and drink powders — are semi-synthetic; they contain artificially concentrated amounts of the compound. When the products first started popping up, they were often sold in tablets containing 12-14 milligrams, users said. Those can offer sedative effects and pain relief. But now, tablets containing 25, 50, and even 100 milligrams of 7-OH are available. “The first time I heard of 7-OH, it was very negative,” said Twinkle VanFleet, who co-hosts a kratom podcast with Sklar. While natural kratom products carry a risk of dependence and what’s thought to be mild withdrawal at low doses, there’s growing concern that concentrated 7-OH products are even more addictive, and that withdrawal can be as bad as coming off a traditional opioid. Hill is working on a study of 7-OH users that will look at both tolerance and withdrawal. But for now, the risks are mainly documented in case reports, series, and other anecdotal accounts. VanFleet suffers from intense pain from an injury that led to complex regional pain syndrome, and she has a deep mistrust of the medical system. Kratom didn’t ease her symptoms, so she eventually tried 7-OH, and found comfort in what she calls “nibbles” of smaller tablets. She currently takes around 12 milligrams per day and worries about a ban by the Drug Enforcement Administration. Still, she shares concerns about the availability of higher-dose products. “I do see both sides of a lot of this,” VanFleet said. “In my perfect world, there would be 3, 5, and 10 milligram tablets, period. If even that.” 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 energy supplement, like coffee, and gave Kiesow a free sample of tablets. “I took it home, and I took it. And 10 to 15 minutes later, it wasn’t coffee. It was a very powerful opioid,” Kiesow said. Kiesow said he quickly developed an addiction. After 10 months, which he described as an extremely isolated period spent sitting on his back porch watching the birds at his bird feeder, he began to taper himself off the products. A few weeks later, he formed Kratom Anonymous, which has 15 virtual meetings per week for people looking to quit. What about MGPI? As 7-OH gained popularity, newer synthetic products have continued to crop up, including some with concentrated levels of mitragynine pseudoindoxyl (MGPI), another metabolite of mitragynine. Over the summer, the DEA proposed a ban of MGPI at any quantity. But an updated proposal in October, pushed by a lobbyist for the American Kratom Association, would allow small amounts of the compound to show up in products. Instead of an outright ban, the DEA now proposes limiting both MGPI and 7-OH based on the ratio of those compounds to mitragynine in any given product. The reason for the change, according to the DEA, is that trace amounts of MGPI could appear in natural kratom. But the safety of small amounts is unclear. Test results presented in recent wrongful death lawsuits suggest that a natural kratom powder product, used by somebody who died after taking it, was likely contaminated with MGPI. Kratom, 7-OH, and MGPI: What are the risks? As more people use kratom and other associated products, there’s a growing recognition of the potential risk for addiction. Over 10 years, the National Poison Data Center found a 1,200% increase in kratom-related exposure reports — from 258 in 2015 to 3,434 in 2025. That includes all types of products. Clinicians who run addiction treatment centers say, over the last year, they’ve seen a rise in patients seeking help to get off 7-OH in particular. But data on the most serious risks — overdose and death — are murky. The poison center data showed 233 deaths over the decade, most of which involved other substances like opioids, benzodiazepines, stimulants, and alcohol. (Researchers believe kratom can exacerbate the danger of a drug like fentanyl, and even more common medications like certain antidepressants.) A 2023 investigation by the Tampa Bay Times found that, over nearly 10 years, more than 580 people in Florida alone died from overdoses that involved kratom products. Because both 7-OH and MGPI are metabolites of mitragynine, it can be difficult to draw conclusions about a given death, even with toxicology data. Complicating the matter even further: When tested, many kratom products — natural and synthetic — are found to have different concentration levels than the labels advertise, and some have been found to contain compounds that were not on the label at all. Sklar and VanFleet are both proponents of regulations, not bans, on all types of kratom-related products. Others who advocate for natural kratom are working hard to distance themselves from the more synthetic products. “Any who unwittingly support every concentrated 7-OH product are not defending the natural kratom plant. It may be helping to destroy it,” Mac Haddow, the American Kratom Association’s lobbyist, said in a recent video. “The solution is not to defend everything. The solution is to draw a clear, bright line.” But others said they’ve suffered from taking natural kratom products, too. Danelle Kawasaki first tried kratom at a dry bar in her Montana town. It came at room temperature, and was advertised as a natural, herbal tea. The concoction eased her anxiety, making her feel both calm and energetic, able to speak with anyone she wanted. At first it was a weekly treat, then a few times a week. After a few months, she was having two drinks per day. She’d wake up with a jolt of anxiety, which she attributes to the tea not being in her system overnight. Without more, she’d be sick, crawling to the bathroom to puke. It frustrates Kawasaki when people try to tell her that 7-OH, not natural kratom, is the problem. “This argument comes up all the time and it drives me nuts,” she said. “I know what was going on — it was the actual kratom tea powder. It wasn’t a concentrated form.” At one point, she was drinking nearly 140 ounces of the tea per day. When she finally stopped, cold turkey, the withdrawal was its own dayslong nightmare. Now, she advocates that the Fort Peck tribe, of which she’s a member, ban kratom on the reservation. For Kawasaki, “the risks outweigh the remedy that people are searching for.” STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.