Is kratom safe? Rising health concerns explained

Kratom and products containing 7-hydroxymitragynine (7-OH) have become increasingly common in smoke shops and gas stations, often promoted as safe, natural alternatives for pain relief, mood enhancement, or help with opioid withdrawal.

However, the U.S. Food and Drug Administration (FDA) is urging consumers to avoid these products due to serious concerns about addiction, overdose, and other health risks.

“One of the biggest misconceptions is believing that ‘natural’ automatically means safe,” said John Downs, M.D., M.P.H., director of the Virginia Poison Center at VCU Health. “Kratom and 7-OH are not harmless herbal supplements. They act on the same brain receptors as opioids, and users can experience the same dangerous effects associated with opioid use.”

Kratom products are commonly sold as powders, gummies, teas, or energy shots. While they are not federally regulated or approved by the FDA, state laws vary. In Virginia, kratom cannot be sold to anyone under 21. Several states—including Alabama, Arkansas, Indiana, Rhode Island, Vermont, Wisconsin, and Louisiana—have moved to ban kratom altogether.

What Is Kratom and Why Do People Use It?

Kratom is derived from the leaves of the Mitragyna speciosa tree, native to Southeast Asia. In small amounts, users report stimulant-like effects such as increased energy. At higher doses, kratom can produce opioid-like effects and is often used for pain relief, anxiety, or self-treatment of opioid withdrawal.

Although legal in the United States, kratom is not approved for any medical use by the FDA. In some other countries, it is either regulated or restricted to medical use only.

What’s the Difference Between Kratom and 7-OH?

Kratom typically refers to the raw or processed plant material, which contains mitragynine, the primary psychoactive compound, along with small amounts of 7-hydroxymitragynine (7-OH).

Products marketed specifically as 7-OH are highly concentrated versions of this compound. These products are significantly more potent and more closely mimic the effects of opioids such as morphine or heroin. Because of the increased risk of overdose and dependence, the FDA has issued specific warnings about 7-OH products.

Health Risks of Kratom and 7-OH

Reported side effects include:

• Nausea

• Confusion

• Agitation

• Shallow or slowed breathing

• Seizures

• Severe sedation or coma, similar to an opioid overdose

With repeated or long-term use, individuals may develop dependence and withdrawal symptoms, further increasing health risks.

Is Kratom the “Next Wave” of the Opioid Epidemic?

While kratom has been available in the U.S. for more than a decade, health officials are still studying whether it will contribute to a new phase of the opioid epidemic. So far, it has not reached the same scale of overdose deaths as drugs like fentanyl, but concerns remain.

One major shift is how openly these products are marketed and sold, often without clear warnings. Easy access in vape shops and convenience stores raises concerns about exposure among teens and young adults.

When to Seek Medical Help

Call 911 immediately if someone experiences confusion, extreme sedation, slowed breathing, or seizures after using kratom or 7-OH. Naloxone may help reverse some effects if available.

For questions about exposure or side effects, contact the Virginia Poison Center at 1-800-222-1222. Trained nurses and physicians are available 24/7.

What Does Recovery Look Like?

Recovery depends on how long and how heavily a person has used these substances. Those with long-term use may require treatments similar to those used for opioid use disorder, under medical supervision.

How to Avoid These Risky Products

Experts recommend avoiding products labeled “extra strength,” “extract,” “enhanced,” “ultra,” or “7-OH.” Products that make bold claims about pain relief or energy boosts are unlikely to be FDA-approved or safe.

Mixing kratom or 7-OH with alcohol or other drugs greatly increases the risk of dangerous side effects, including slowed breathing and loss of consciousness.