Kratom is a leafy plant belonging to the coffee plant family, named Mitragyna Speciosa, native to Southeast Asia. Tea, tonics, capsules or pressed tables have been consumed for a long time in certain countries in Asia and have been available in the US as supplements with psychoactive properties.
The leaves contain multiple substances with activity on human serotonin, dopamine, adrenergic and opioid receptors. Depending on the dose ingested, activity on these receptors can produce stimulant-like effects or opioid-like effects. Mitragynine and 7-hydroxymitragynine (7-OH) are those components of the Kratom leaves that bind to the opioid mu-receptors, just like classical opioids (such as morphine) do.
In fact, 7-OH mitragynine demonstrates substantially greater mu-opioid receptor potency, estimated to be 13 times stronger than morphine. While the leaves contain relatively small amounts of 7-OH, synthetically produced concentrates of 7-OH have now penetrated the market in the US, and are widely available in smoke shops, vape stores, gas stations, convenience stores, and through various online retailers.
According to the National Survey on Drug Use and Health, a large survey run by the National Institute of Health every few years, almost 2% of the adult population has used Kratom at some point in their lives, more so amongst people who use other substances as well.
The users of Kratom reported using it as self-help for anxiety, depression, or for more complex symptoms such as those associated with PTSD or ADHD, and also for pain relief. Those who have an opioid use disorder reported using Kratom as self-help to prevent or treat withdrawal symptoms resulting from interrupting the main opioid.
Self-treatment of mental health symptoms is highly prevalent among individuals with substance use disorders, with almost a quarter of people reporting self-medication for mood and anxiety disorders with alcohol or drugs. This behavior represents a critical pathway to developing comorbid substance use disorders and significantly impacts treatment outcomes. The attraction to self-help also signifies the poor access to effective care for mental health symptoms, which can lead to development and persistence of substance use disorder. With the rise in Kratom and especially 7-OH more potent products, there is a new candidate to unregulated and potentially toxic use motivated by the need for self-help often in the context of lack of access to proper care.
Case reports documented associations between kratom use and psychiatric adverse reactions, thought to be derived from Kratom’s specific psychoactive properties, some even severe psychiatric symptoms such as psychosis, mania, aggression, hostility, especially in people with pre-existing psychiatric illness. The withdrawal symptoms produced by Kratom products themselves, while generally milder than opioids for most users, can be highly uncomfortable for some, making abstinence difficult. A small number of users may develop a substance use disorder with kratom, using kratom for longer than intended, continuing to use kratom despite adverse consequences (either physically or in their personal life), and showing signs of psychological or physical dependence.
While Kratom use can be of concern as an unregulated substance, the increasing availability of concentrated synthetic 7-OH products rises even more serious concerns, as this is a widely available uncontrolled opioid with variable potency and content that has the potential of creating dependency and all the severe physical and psychiatric symptoms associated with opioids.
A 2025 National Institute on Drug Abuse study found that 7-OH resulted in respiratory depression at a magnitude three times more severe than morphine. Seizures, liver toxicity, and deaths have been reported, often in the context of mixing it with other substances of abuse. Testing for 7-OH is also not widely available or performed, so the presence of 7-OH might be underreported amongst those presenting for care with acute symptoms.
The Food and Drug Administration has not approved Kratom for any medical use and it has issued warnings that that the newer 7-OH synthetic products which are now easily accessible, may “fuel a new opioid crisis.” The Drug Enforcement Agency has declared Kratom as a Drug and Chemical of Concern. Increased federal scrutiny has not resulted yet in an effective ban, but state and city-local laws have banned the sale of 7-OH altogether or subjected it to various restrictions. In New Hampshire, a senate bill was introduced, the “New Hampshire Kratom Act” which would introduce a number of restrictions on the dangerous “gas station” availability of this opioid. Large, properly conducted studies on the effectiveness and safety of Kratom are necessary to further elucidate any potential use for treatment, but unregulated use has large potential for harm. Wide access to concomitant, evidence-based treatment of co-occurring disorders, is a fundamental element of population health and of the individual health.
Delia Cimpean Hendrick MD, Psychiatrist
WestBridge’s Medical Director
WestBridge provides evidence-based treatment for adults and their families experiencing mental illness with or without substance use. Contact for inquiries and questions. For more information about our programs, please visit https://www.westbridge.org/programs/. .