Author: Megan Brooks
Medscape Medical News
Interest in kratom has surged in the United States, with estimates of up to 16 million users and $2 billion in annual sales. While some believe kratom may ease opioid withdrawal, experts caution that products containing its potent metabolite, 7-hydroxymitragynine (7-OH), may themselves be addictive and harmful.
Kratom is derived from the Southeast Asian tree Mitragyna speciosa. Its main alkaloid, mitragynine, has mild stimulant and mood-boosting effects at low doses, but 7-OH, often found in concentrated extracts, is 30–40 times more potent at opioid receptors. These products, sometimes mislabeled as “kratom extract,” have been linked to euphoria, respiratory depression, and withdrawal syndromes. Independent tests in several states have found dangerously high 7-OH purity levels, far beyond what naturally occurs in the plant.
The FDA and DEA continue to warn against kratom use. Although not federally scheduled, kratom remains on the DEA’s “Drugs of Concern” list, with a patchwork of state bans and regulations. Reports include substance use disorder, liver toxicity, seizures, and even neonatal abstinence syndrome in newborns exposed prenatally.
Clinicians are urged to directly ask patients about kratom use, as it is readily available in gas stations, vape shops, and online. Testing for mitragynine is feasible, but reliable testing for 7-OH is limited. Experts note that patients often self-medicate withdrawal symptoms with kratom, mistaking relief for therapeutic benefit.
Currently, no medications specifically treat kratom misuse. Clinicians may classify kratom-related problems under stimulant use disorder (low doses) or opioid use disorder (high doses). Buprenorphine-based therapies are often used for dependence, alongside counseling and treatment of co-occurring psychiatric or medical conditions. Experts stress the urgent need for more published case reports and clinical guidance.
What You Should Know
• Kratom use is increasing in the U.S., with highly potent 7-OH products driving safety concerns.
• 7-OH is far more addictive and dangerous than mitragynine, with opioid-like withdrawal and toxicity risks.
• Regulatory oversight is inconsistent, leaving consumers vulnerable to mislabeled or unsafe products.
• Clinicians should ask about kratom use and consider OUD treatments such as buprenorphine when needed.
Practice Implication
Physicians should be vigilant in screening for kratom and 7-OH use, especially in patients with pain, psychiatric conditions, or suspected substance use disorders. Until more research is available, treatment should mirror existing strategies for opioid or stimulant use disorder, with careful monitoring and supportive therapy.
References
Brooks M. May 16, 2025.
Thank you JAMA Network Open for allowing us to use this article.