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.
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. |
"The 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."
John Downs, MD, MPH, FACP, FACOEMDirector of Virginia Poison Center, VCU
"Kratom 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."
Hilary TesluckExecutive Director, End Kratom Addiction
"If you're using kratom for therapeutic things, it can lead to dependency and can lead to death. Everybody has different tolerance levels. What may be fine and therapeutic for you might actually be fatal for me."
Mark K. SmithCoroner, Carbon County, PA
