The industry calls it an herb. The science calls it an opioid.
Here is what decades of research, FDA data, and CDC surveillance actually show, in plain language.
It binds to the same receptors as morphine.
Kratom's primary compound, mitragynine, acts on opioid receptors in the brain. When the body metabolizes mitragynine, it produces 7-hydroxymitragynine, a compound the FDA has found produces respiratory depression at more than three times the potency of morphine.
This is not a fringe finding. It is the pharmacological basis for why kratom causes the same dependence, withdrawal, and overdose risk associated with opioids. Calling it a "natural supplement" does not change what it does inside the human body.
FDA adverse event reports show kratom-associated drug dependence at 14.5 times the expected rate, drug abuse at 13.7 times the expected rate, and withdrawal syndromes at 10 times the expected rate compared to other reported drugs.
People get addicted following the directions on the label.
The kratom industry frames addiction as user error, a result of misuse or abuse. The evidence does not support that claim.
Dependence has been documented in people using kratom as directed. Withdrawal symptoms mirror opioid withdrawal: severe muscle pain, insomnia, nausea, anxiety, and uncontrollable agitation. Onset typically occurs within 12 to 48 hours of last use and can persist for weeks. Clinical data meets DSM-5 criteria for substance use disorder.
The American Psychiatric Association, Mayo Clinic, and addiction clinicians across the country have flagged kratom's addictive potential. The industry's own self-regulatory program is built around the acknowledged reality that adverse events occur.
202
People have died. The industry says those deaths don't count.
The CDC's State Unintentional Drug Overdose Reporting System documents 255 deaths with kratom detected in postmortem toxicology between 2019 and 2024. Of those, 202 list kratom as a cause of death. The rate has increased every year.
The kratom industry's standard response is that most deaths involve multiple substances. That is sometimes true, and it is the same argument Purdue Pharma made about OxyContin. Coroners have documented single-substance kratom fatalities. Medical examiners have found lethal concentrations of kratom alkaloids with no other drugs present.
The Tampa Bay Times investigation documented over 580 kratom-related deaths in Florida alone. Michigan documented 330 kratom-involved deaths from 2020 to 2024. These are not outliers. They are a pattern.
It is sold as food. That is the loophole.
Kratom is marketed as a dietary supplement or food product. That classification allows it to bypass FDA pre-market review, pharmacy oversight, and purchase controls we require for any opioid-class substance.
The FDA has issued multiple warnings. It has not approved kratom for any use. The DEA lists it as a drug of concern. And yet it remains available at checkout counters in convenience stores, sold next to energy drinks, with no age verification required in most states.
This is a regulatory failure with documented human costs.
Their talking points don't survive scrutiny.
| What the industry claims | What the evidence shows |
|---|---|
| "Kratom is a natural supplement, not a drug." | Kratom's active compounds act on opioid receptors. The FDA classifies it as an unapproved drug, not a supplement. |
| "Deaths involve other substances, not kratom alone." | The CDC documents 202 deaths listing kratom as a cause of death. Coroners have confirmed single-substance fatalities. |
| "Addiction only happens through misuse." | Dependence is documented in people using kratom as directed. FDA adverse event data shows dependence at 14.5 times the expected rate. |
| "7-OH products are the problem, not natural kratom." | 7-hydroxymitragynine is produced in the body when anyone consumes natural kratom. The liver makes it. The distinction the industry draws does not exist in human physiology. |
| "The kratom industry supports consumer protection." | The AKA's own terms of use state that nothing on their website should be used to make health decisions. They disclaim the safety claims they make to lawmakers. |
15 Addiction Expert Voices
– Dr. John Downs, MD, MPH, FACP, FACOEMThe biggest misconception is that 'natural means safe.' Kratom and 7-OH are not harmless herbal supplements…People using these substances can have the same detrimental effects seen with opioids.
Director of Virginia Poison Center, VCU
– Hilary TesluckKratom addiction is real, and so is the pain and suffering that goes with it. Tens of thousands of people, and all their families, are facing a crisis that never should have happened. This industry chose to side-step safeguards to maximize a profit, and now attempts to blame the users. It was preventable then, and it is preventable now.
The good news is that we are no longer suffering in isolation. We’ve organized, and our collective voice will be heard.
Executive Director of End Kratom Addiction
– Mark K. Smith…if you’re using it (kratom) for therapeutic things, it can lead to dependency and can lead to death. Everybody has different tolerance levels. Studies have shown that. So, what may be fine and therapeutic for you might actually be fatal for me.
Coroner of Carbon County, PA
– Alta DeRoo, MD, MBA, DFASAM, FACOGDon't start kratom. It's like starting down a road of addiction with an opioid. It may seem like some herbal supplement, but there's much more underlying sinister effects with it.
Chief Medical Officer, Hazelden Betty Ford
– Dr. Faried Banimahd, MDThe claim that kratom has no potential abuse and can do no harm is ludicrous. Until we truly understand how kratom interacts with other medications, promoting it as a safe herbal supplement puts lives at risk.
Board-Certified Addiction Physician, Coleman Clinic, Richmond, VA
– Dr. Kate Gibson, DNP, APRN, PMHNP, CPRSMore than half of the patients presented to me for detox do so because of kratom derivatives. It is distressing to watch these readily available substances—marketed as herbal dietary supplements—cause such profound harm in our community.
Addiction Medicine Nurse Practitioner, Richmond, VA
– Dr. Michael Sucher, MD, DFASAMCalling something plant-based doesn't make it safe. Cocaine comes from a plant. Opium is a plant. Natural doesn't mean it's safe or non-addictive. The patients we see with kratom addiction are exactly like those that we see with fentanyl or heroin or other opioid addictions.
Executive Medical Director at Meadows Behavioral Healthcare
– Dr. Joshua Smith, MDThis is now becoming a real crisis because our building is full of people addicted to this. They just thought this was a safe or organic product that they picked up from wherever they buy their cigarettes.
Family & Addiction Medicine, Henry Ford Health System
– Dr. Ronald MejzakTraditional kratom preparations have been associated for years with tolerance, withdrawal, and compulsive use, demonstrating inherent addictive potential. Kratom marketed as 'safe' or 'non-addictive' is contributing to a growing population struggling with dependence and withdrawal.
Director of Addiction Services and Medical Staff President at Virginia Beach Psychiatric Center
– Dr. Eliza Hutchinson, MD, FASAMWe are seeing patients walking into my clinic who’ve used it for about two weeks, and are absolutely addicted, meaning their body is physiologically dependent. They’re spending hours and hours of their day trying to acquire the product.
University of Michigan, Family and Addiction Medicine Physician
– Dr. Andrew KolodnyYears ago, most of my patients' addiction stories began with an opioid prescription. Today, most all start with kratom—it’s fueling a rise in opioid use disorder itself.
Kratom’s principal active compound is an opioid that activates the same brain receptors as heroin and prescription painkillers. Like other opioids, kratom is highly addictive: Repeated use leads to tolerance, dependence and the need for progressively higher doses. As the FDA put it, kratom ‘isn’t just a plant—it’s an opioid.’ [Read Dr. Kolodny's Oped in Washington Post July 14, 2026]
Opioid Research Director at Brandeis University and Addiction Psychiatrist
– Dr. Chris HolstegeWe want the public to be aware that these products contain chemicals of varying concentrations such as mitragynine and 7-hydroxymitragynine that have complex pharmacological actions and can cause drug interactions and adverse consequences in humans.
Chief of Medical Toxicology at University of Virginia, and Blue Ridge Poison Control Director
– Jill CichowiczI work alongside hundreds of addiction treatment professionals in Virginia, who all attest to a growing crisis tied to kratom addiction. Many clinicians report that kratom withdrawal and recovery can be as severe as heroin or worse. HB360’s straightforward measure to move kratom products behind the counter will prompt consumers to pause, ask questions, and understand this substance is not harmless, helping prevent addiction and save lives.
Founder & CEO of 2 End the Stigma
– Dr. Sean Esteban McCabe, PhDPolicy changes regarding kratom and 7-OH products are needed in all states if we are serious about protecting our children. Five million people is more than the entire population of the six smallest states in the U.S. combined: Wyoming, Vermont, Alaska, South Dakota, North Dakota and Delaware.
University of Michigan, Department of Health Behavior and Clinical Sciences
– Michael TillemKratom presents like an opioid when using it. It's addictive and deadly. I see the effects everyday. People come in all strung out on it, and the damage it leaves behind in their bodies is devastating.
Journey House Addiction Recovery, Richmond, VA