For generations, communities in Southeast Asia have used the leaves of Mitragyna speciosa — kratom — brewed as a drink to relieve pain and steady mood. Its principal alkaloids, mitragynine and the more potent 7‑hydroxymitragynine, act on opioid receptors and produce analgesic effects.
Kratom has since gained a significant presence in the United States, where consumers often use it as an alternative to prescription opioids or as a self-directed aid in managing withdrawal. It is sold in teas, capsules, powders, and concentrated extracts, with purified 7‑OH products increasingly appearing in vape shops, convenience stores, and online markets.
Regulators are now moving toward prohibition. Last July, Food and Drug Administration Commissioner Marty Makary and Health and Human Services Secretary Robert F. Kennedy Jr. announced plans to urge the Drug Enforcement Administration to place 7‑OH in Schedule I — the same legal category as heroin.
Supporters of these efforts argue that kratom — especially high-potency 7‑OH — could fuel the next wave of overdose deaths. But the data tell a different story.
Fatal overdoses in which 7‑OH has been implicated are exceedingly rare, and deaths linked to kratom more broadly are rarer still. In the limited cases where coroners listed kratom or 7‑OH as contributing factors, polysubstance use was the norm. Roughly two-thirds of decedents had fentanyl in their systems. About one-third had heroin present, and just under one-fifth had prescription opioids or cocaine. Around 80% had documented histories of substance misuse, and about 90% were not receiving clinical care for pain.
Each of these deaths is tragic, and any loss of life linked to psychoactive substances deserves careful scrutiny.
Hellbound and Down 