Kratom: A Legal Drug That's Dangerously Addictive

Marianne Chai, MD, a psychiatrist in New York City, first encountered the kratom drug a few years ago when a teenage boy came to her office for addiction treatment. “He had been drinking it as a tea to help with anxiety and ultimately ended up in the school’s student health center in acute opioid withdrawal,” she says.

Kratom is a substance derived from the leaves of a plant native to Southeast Asia. At low doses, it produces stimulant effects comparable to medications commonly used to treat ADHD. At higher doses, the substance functions as an opioid. However, kratom doesn’t require a prescription, and unlike “street” opioids such as heroin, it is currently legal in many states and can be purchased at smoke shops, gas stations, convenience stores and the internet . Kratom is sold in powder form and can be taken in capsules or made into a tea. Some states even have “bars” devoted to it.

Since it’s made from a plant, there’s a misperception that kratom is safe. In fact, it’s addictive. And newer, synthetic forms of kratom are increasingly powerful.

As of 2026, 10 states have passed laws making kratom illegal, and a number of other states regulate its use with age limits, labeling requirements, and limits on the concentration of certain compounds.

“High school and college students are surrounded by kratom these days — in smoke shops and on the internet, says Mike Milham, MD, PhD, a child and adolescent psychiatrist at the Child Mind Institute. “For students especially, you can imagine the allure of the stimulant effects, but once you start experiencing the euphoria of the opioid aspect, you’re at risk for addiction.”

Students say kratom helps them study and counters anxiety. “Initially it helps you with your all-nighters, and it helps you with your stress,” says Dr. Milham. “But then you’re stuck.”

Despite a lack of high-quality evidence or approval by the Food and Drug Administration (FDA), Kratom is also being used for pain relief and help reduce opioid withdrawal symptoms.

Two substances found in kratom leaves — mitragynine and 7-α-hydroxymitragynine — interact with opioid receptors in the brain, producing the pleasurable, pain-reducing effects of opioids, especially when users consume large amounts of the plant. Natural kratom contains overwhelmingly more mitragynine than 7-hydroxymitragynine, but the latter, present in only trace amounts, is more potent.

Since kratom is not regulated by the FDA, there’s no way to know how potent any given amount is, or if a batch contains other substances as well. In April 2019, the FDA released results of a laboratory analysis that found significant levels of lead and nickel in 30 kratom products — enough to potentially cause heavy metal poisoning.

In recent years products have been manufactured to contain much higher concentrations of the compound 7-hydroxymitragynine —referred to as 7-OH — than the tiny amount present in kratom leaves. As a result, these synthetic products have much stronger opioid-like effects.

According to the FDA, “Some kratom leaf products marketed as ‘spiked’ or ‘enhanced’ may contain 7-OH at a level 500% higher than would be naturally expected in kratom leaf.”

In July 2026, the Drug Enforcement Administration announced its intention to issue a temporary scheduling order placing 7-OH above a certain threshold in Schedule I for two years. Schedule I is the most restrictive category for regulated substances — for those deemed to have no accepted medical use and a high potential for abuse — making it illegal for commercial sale even with a prescription.

The order does not apply to products including kratom leaves containing only naturally occurring trace levels of 7-OH, despite the fact that these, too, are addictive if consumed regularly in large amounts.

David Seitz, MD, the medical director of Ascendant, a New York based rehab program, reports seeing an increase in cases of kratom addiction. “I think the major challenge is a perceptual one,” he notes. Young people using think it’s harmless because it’s touted as natural. “They don’t consider it a drug until they get into trouble with it.”

One father reports that his son started using the kratom drug in boarding school, where he was introduced to it in his dorm and was told it was a tea. He started using it for social anxiety, but then he got addicted. “We noticed that he seemed angrier and had an explosive temper,” his dad said. “He realized he had a problem and stopped, but had some relapses before stopping completely. It was a scary thing.”

Kratom addiction is also particularly challenging to treat. There are a lot of substances in the kratom drug, Dr. Seitz explains, “some of which haven’t even been properly identified.” Among those other substances, he says, seems to be something that acts like a benzodiazepine, an anti-anxiety medication.

When you treat a patient withdrawing from kratom with medications used for opioid addiction, like Methadone or Suboxone, they deal with the opioid effect but not with the effects other substances in the plant. Patients withdrawing from kratom may become so anxious they give up on treatment. “It appears that just treating the opioid effect is often not enough,” Dr. Seitz says. “If you just use the Suboxone, the person is likely to leave treatment.”

Dr. Seitz, who is also a diplomate of the American Society of Addiction Medicine, notes that few physicians realize how complicated kratom is. He reports hearing from other doctors and medical students who are frustrated with their kratom patients. “They’re seeing the patient and they’re like, ‘I’m giving opioids and you can’t be having the symptoms you’re having because I’m giving you this.’ And it just doesn’t work that way. There’s another effect in there.”

 Another way in which kratom appeals to some users is thatit does not show up on standard drug tests. Testing can be done by certain labs, but this is expensive, and, at the moment, kratom is not something most people think to test for.

Dr. Milham’s takeaway for parents: “Educate yourself, and don’t be fooled if your child dismisses your concerns, saying it’s just a tea, it’s legal and sold in stores.”

It’s important that parents have a conversation with teenage children about kratom, to let them know what the dangers are, whether or not they are aware that a child is using the drug. Dr. Chai notes that parents are very often unaware of the extent of their child’s substance use.  “Parents don’t realize until their kid has progressed much further along to the point of having consequences,” she says. “Parents are often the last to know what their child is really doing.”

If you suspect your child might be developing a kratom addiction, here are some of the symptoms to be on the lookout for, according to Dr. Chai:

• Runny nose
• Muscle aches
• Joint and bone pain and spastic, jerky movements
• Mood swings
• Depression
• Anxiety
• Irritability
• Tremors, chills, sweating, pin-point pupils, gooseflesh (typical of opioid withdrawal)

If your teen or young adult child is using kratom, the conversation should be not only about why they should stop using it, but what it’s doing for them, and how they might find healthier alternatives. “You need to be able to figure out,” as Dr. Seitz puts it, “if your kid is using it, why is your kid using it?”

If eliminating kratom proves to be difficult, or if your child is struggling with withdrawal symptoms, then an evaluation by an addiction professional is in order.

Dr. Seitz notes that it’s important to have open communication with kids about drug use, to keep it from being driven underground. “It can become sort of a cat-and-mouse game, where what parents are concerned about is catching their kid. And then it doesn’t serve any function.”