Kratom: What Is It and Is It Safe?

It’s packaged in pills, powders, liquids, and, rarely, in its original form as a plant leaf. Kratom—a substance derived from the Mitragyna speciosa plant, which grows in Southeast Asia—is gaining popularity and raising alarm, popping up on shelves in convenience stores and bodegas in the United States along with other substances known as “gas station drugs.”

In small amounts, kratom acts as a stimulant, and is often marketed as an energy booster or a tool for managing anxiety. In higher doses, however, it has the opposite effect, acting as a sedative with opioid properties. Sometimes it is advertised as a painkiller. This dose-dependent shift—from a pick-me-up to a heavy sedative—can lead to unpredictable effects, says Melissa Weimer, DO, a Yale Medicine addiction medicine specialist.

“Like any substance you use, it can have negative effects if you’re using it too much, in large quantities, or for too long,” Dr. Weimer says. “And if you use it regularly enough, say consistently for two weeks, then you're going to be at risk for opioid withdrawal and dependence because of its opioid properties.”

Kratom comes from Mitragyna speciosa, a tree found in Thailand, Malaysia, and Indonesia. The leaves of the tree have been used for medicinal and recreational purposes in those regions for centuries, most commonly by field laborers.

Because it is not derived from the opium poppy, kratom is not a traditional opioid. But its primary alkaloids, mitragynine and 7-hydroxymitragynine (7-OH), are known as atypical opioids, or partial opioid agonists, because they bind to the brain’s receptors, albeit in a different way than morphine or oxycodone.

They don’t fully activate the biological pathways that can lead to respiratory failure, which is the primary cause of fatal opioid overdoses, but that doesn’t mean kratom is safe. “It’s like cannabis in that people might mistakenly think it is safe because derived from a plant,” Dr. Weimer says.

However, there is less risk of unintentional overdose with kratom compared to traditional opioids. “But kratom can still lead to physical opioid dependence and opioid addiction,” she adds.

Kratom also interacts with the brain's serotonin system, which plays a role in mood regulation, adding another layer of complexity to its effects.

In the U.S., kratom is often sold as a fine powder made from dried and pulverized Mitragyna speciosa plant leaves. But it is also widely available in capsules, compressed tablets, highly concentrated liquid extracts, and gummy candies.

It is sold in gas stations, smoke shops, and online. Regulation varies by state. Seven states—including Connecticut—have classified kratom as a Schedule I controlled substance, making it illegal to sell, possess, or distribute. Other states have age restrictions (18 or 21 to purchase), and some have banned it entirely. Some states have no restrictions at all.

Kratom is not regulated by the U.S. Food and Drug Administration (FDA), and there are no federal standards governing its contents, potency, or labeling.

“People think, ‘Well, this must be safe if I can buy it at a gas station,’” Dr. Weimer says, noting there are concerns that, with easy access, more adolescents are using kratom.

It can be. People can become physically dependent on kratom for its opioid-like, sedative effects—sometimes without expecting it.

“I’ve heard many accounts of people who said they were surprised this would happen from a legal substance with no warnings on it,” Dr. Weimer says. “Many, many patients have told me that they started off just using it a little bit and it grew over time to the point that they were using it every hour of the day.”

According to the Journal of Addiction Medicine, from 2021 to 2023, 0.7% of adults in the U.S. used kratom in the past year, a rate that has remained steady. Kratom usage is most common among men ages 26 to 49.

In a recent study led by Katherine Hill, MPH, of Yale School of Public Health, researchers found that one-quarter of individuals who use kratom met the criteria for addiction, or opioid use disorder, with the vast majority reporting increased opioid tolerance and physical withdrawal symptoms. The risk of developing opioid use disorder is nearly three times higher for people who already have a history of another substance use disorder.

Dr. Weimer says she is most concerned about concentrated kratom products known as 7-OH (7-hydroxymitragynine).

“It’s a more potent compound that occurs naturally in the plant, but only in very small amounts,” she explains. “Some companies are extracting it and making it 10 times more potent, which produces a greater opioid, sedative effect. Some individuals might not understand how 7-OH is different from nonconcentrated kratom and are caught off guard; then physical dependency grows faster and the risk of addiction increases.”

In fact, kratom-related reports to U.S. poison control centers increased approximately 1,200%—from 258 to 3,434 cases—between 2015 and 2025, according to the Centers for Disease Control and Prevention (CDC), with a notable surge in 2025.

There has been discussion at the federal level about banning kratom, largely because of how concentrated compounds like 7-OH have such profound opioid effects. However, there has also been strong pushback from individuals who use kratom, advocacy groups, manufacturers of kratom, and some lawmakers, who argue that the natural kratom leaf is a safer option for the treatment of pain or opioid withdrawal.

From the harm reduction standpoint —an approach that focuses on reducing the dangers of substance use rather than eliminating use entirely—Dr. Weimer acknowledges that kratom is less potent and less immediately dangerous than illicitly manufactured fentanyl.

But she draws a firm line when it comes to younger users. “There is no safe use of kratom in teens. It shouldn’t be in a bodega and it shouldn’t be sold to anyone under 21, at least. Additionally, if you are an adult and you use it, you should be fully aware of the potential risks,” she says.

Some people turn to kratom to manage opioid withdrawal symptoms, but Dr. Weimer is direct: it is not a recommended or proven treatment.

“There are evidence-based treatments that are highly effective for opioid use disorder, including buprenorphine, methadone, and naltrexone. Utilizing a non-evidence based strategy like kratom could place your life at risk,” she says.

For people who develop opioid use disorder related to kratom, the same FDA-approved medications used for opioid use disorder—including buprenorphine—can be effective treatments.

Kratom is only one of the so-called “gas station drugs,” the loose term for products that are often unregulated, sold in stores, and may carry health risks. They include:

• Bromazolam and flubromazolam, also known as “designer” benzodiazepines, a class of sedative drugs
• Nitazenes, a class of ultra-potent synthetic opioids—including isotonitazene—linked to overdose deaths
• Tianeptine, an atypical antidepressant with opioid-like effects and often called “gas station heroin”
• Phenibut, a sedative supplement that acts on the brain's GABA system, which helps regulate anxiety and calm

Connecticut banned all of these substances along with kratom in 2026. Some other states have done the same. Others have taken a patchwork approach, with several banning some of the drugs, but not all of them.

If you believe someone is experiencing an adverse event from kratom or a 7-OH product, contact the Poison Help Line at 800-222-1222 or visit poisonhelp.org. If someone is unresponsive, call 911 and administer naloxone.

For help with substance use, call the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline at 800-662-4357. Treatment for problems related to kratom is available—and effective.