Deaths have been associated with kratom use, but in most cases other drugs or contaminants were involved and kratom’s role is unclear. Kratom-alone deaths appear extremely rare (FDA, NIDA, NCCIH, as of October 2026). So the bigger danger in the research is mixing kratom with other drugs and using contaminated products.
Below, you will find what the federal agencies and university researchers report, where the gaps are, and the options for getting help.
Can kratom kill you? What the death data show
As of October 2026, the FDA’s kratom page says that “in rare cases, deaths have been associated with kratom use,” that kratom was usually used in combination with other drugs, and that “the contribution of kratom in the deaths is unclear.” The National Institute on Drug Abuse (NIDA) adds that a very small number of deaths have been linked to kratom products compared to deaths from other drugs, and that nearly all cases involved other drugs or contaminants.
One CDC report covers overdose deaths from July 2016 to December 2017 (CDC MMWR, April 2019):
| Finding | What the CDC reported |
|---|---|
| Overdose deaths entered into the surveillance system | 27,338 |
| Deaths where kratom was found on toxicology | 152 (0.56%) |
| Kratom named as a cause of death by the medical examiner or coroner | 91 (59.9%) of the 152 |
| Deaths where kratom was the only substance found | Seven |
| Fentanyl listed as a cause of death in kratom-positive deaths | 65.1% |
The CDC also says kratom was most often detected with multiple other substances. In the seven kratom-only cases, the CDC notes that the presence of additional substances cannot be ruled out. The counts in different reports differ because they measure different things. NIDA cites a 2019 report of 11 deaths from 2011 to 2017 associated with kratom exposure, two of them linked to kratom alone.
Why 7-OH gets the headlines
Kratom leaves are a mix of compounds. The FDA says 7-hydroxymitragynine (7-OH) is “only a minor constituent that comprises less than 2% of the total alkaloid content in natural kratom leaves.” It also says 7-OH “demonstrates substantially greater mu-opioid receptor potency” than mitragynine and than morphine. That is a receptor finding from laboratory work, not a measure of how a person would feel or how dangerous a dose would be.
Concentrated 7-OH products are where the risk concern is sharpest. As of October 2026, Yale Medicine’s kratom explainer quotes its addiction medicine specialist saying that “some companies are extracting it and making it 10 times more potent.” Her point is that people may be caught off guard and that physical dependence can grow faster. Leaf powder and concentrated 7-OH are not the same product, so check the label for what is actually in it.
“Natural” does not mean safe. The same specialist compares kratom to cannabis: people may assume a plant-derived product is safe, and it is not automatically so.
What kind of substance is kratom, and what do people call it?
Kratom comes from Mitragyna speciosa, a tree native to Southeast Asia. The FDA says there are no prescription or over-the-counter drug products containing kratom or its known alkaloids that are legally on the market in the U.S. As of October 2026, NIDA says kratom “commonly refers to an herbal substance that can produce opioid- and stimulant-like effects.”
Its main compounds, mitragynine and 7-OH, bind to mu-opioid receptors, but NIDA says the effects “only partially compare to those of opioids like heroin or oxycodone.” Yale Medicine calls these compounds atypical opioids, or partial opioid agonists. At low doses people often report stimulant-like effects, and at higher doses sedative-like effects. NIDA says kratom’s effects may depend on the amount taken, the product’s potency, and other factors, so they are hard to predict.
No source here lists slang names. The FDA, NIDA, NCCIH and Yale Medicine pages use “kratom,” Mitragyna speciosa or “7-OH.” Yale’s phrase “gas station drugs” is a loose label for a group of unregulated products, with kratom as one of them. If a seller uses another name, read the label for Mitragyna speciosa or 7-hydroxymitragynine.
What are my options if I am worried about kratom?
Only you and a clinician can weigh these. Prices and coverage vary, so check the cost directly with the clinic, pharmacy or your insurer.
| Option | What it is | What the research and agencies say | Who it may suit | Limits |
|---|---|---|---|---|
| FDA-approved medicines for opioid use disorder | Prescription medicines such as buprenorphine, methadone and naltrexone | Yale Medicine says the same FDA-approved medications used for opioid use disorder “can be effective treatments” for kratom-related opioid use disorder | People who have opioid use disorder, as a clinician decides | Needs a prescriber; cost and coverage vary |
| Kratom compounds in studies | Investigational. NIDA and other NIH institutes support research on potential medicinal uses of kratom and its compounds. | NIDA says “robust clinical trials are still needed” | People who qualify for a research study | Not approved for any use |
| Kratom products | Leaf powder, capsules, tablets, liquid extracts, gummies or tea, sold in shops and online | The FDA says kratom is not lawfully marketed in the U.S. as a drug, dietary supplement or food additive | Not recommended. The FDA warns consumers not to use kratom because of risks including liver toxicity, seizures and substance use disorder. | Effects vary; contaminants have been found; state rules differ |
| Naloxone | A medicine that can reverse opioid effects on breathing | A 2019 case report describes naloxone reversing opioid-type effects from kratom; review articles note its effectiveness for kratom overdose “has not been proven” | Anyone who may be around someone using kratom | Does not replace calling 911 |
| A clinician visit | A conversation about your use, withdrawal symptoms and other medicines | NIDA says there are currently no approved medical therapies for kratom withdrawal or substance use disorder | Anyone who uses kratom regularly or with other drugs | Costs vary by provider |
The 2019 case report in Clinical Practice in Emergency Medicine describes a patient who needed two doses of naloxone before improving, and the authors note that prior to that case there was no documented reversal of this kind from kratom in humans. Naloxone is not a substitute for emergency care.
If you are thinking about a first conversation, a related guide on this site is here: first kratom treatment appointment. For veterans and their families, see va care for kratom concerns.
Is kratom safe to use daily, and what does it do to the brain long term?
Daily use has not been shown to be safe. The NCCIH page, last updated April 2022, says the FDA has not approved kratom as safe and effective for any medical purpose. As of October 2026, NIDA says “long-term health and safety effects are not well understood” and that there is “little evidence to determine how kratom use may affect someone over time.”
On the brain, the FDA says mitragynine also acts on serotonin, dopamine, norepinephrine and kappa opioid receptors. Whether that changes the brain over years is not established. NIDA describes preliminary survey data suggesting that a minority of people who use kratom report kratom-related withdrawal symptoms, and says the extent is still being studied. Some experts are concerned about kratom’s addictive potential, though NIDA notes that researchers have observed the way kratom compounds activate these receptors may reduce the potential for addiction relative to opioids. The FDA says cases of kratom-related substance use disorder have been observed. Yale Medicine’s specialist says regular use for about two weeks can carry a risk of opioid withdrawal and dependence.
Is kava or kratom worse for the liver?
The NCCIH kratom page does not compare kratom with kava, so it cannot tell you which is worse for the liver. What it does say is that “there have been reports that long-term use of large doses of kratom may cause serious liver problems in some people.” NIDA says case reports link regular, long-term, large-amount use with serious liver problems, and the FDA lists liver toxicity among its warnings. If you use either one, ask a clinician to compare them for your liver.
What is the half-life of 7-OH?
NIDA explains that “even though the body converts mitragynine to 7-OH, this occurs slowly enough that it limits mitragynine’s effects on breathing.” For the actual half-life numbers, search PubMed (pubmed.ncbi.nlm.nih.gov) for 7-hydroxymitragynine pharmacokinetics, or ask a pharmacist or clinician to explain what the numbers mean for you.
Is kratom illegal, and is it a felony in my state?
This is general information, not legal advice. Federally, the FDA says kratom is not lawfully marketed as a drug product, a dietary supplement or a food additive in conventional food. That position rests on the Federal Food, Drug, and Cosmetic Act, which treats kratom as a new dietary ingredient because it was not marketed as a dietary ingredient before October 15, 1994, according to the NCCIH page. The DEA has listed kratom as a “drug of concern.” The NCCIH page, last updated April 2022, says kratom and kratom compounds are not listed in the U.S. schedule of controlled substances. That page is dated, and federal scheduling of 7-OH may have changed since, so check the DEA’s current listings and the Federal Register for 7-OH before relying on it. In 2016 the DEA announced an intent to classify mitragynine as Schedule I and then withdrew that notice, according to the 2019 case report.
States are where the real differences are. As of October 2026, Yale Medicine’s news page says seven states, including Connecticut, classify kratom as a Schedule I controlled substance, making it illegal to sell, possess or distribute. Others set age limits of 18 or 21 for purchase, and some have banned it entirely. Whether possession is a felony in your state depends on that state’s statute, so check it or call your state health or law enforcement agency. The FDA says those agencies are “the best resource concerning applicable state laws.”
Will kratom show up on a drug test?
The CDC’s 2019 report says identification of kratom “is method-dependent,” but that remark concerns postmortem toxicology in deaths, not workplace or standard panel tests. Ask your employer, program or testing lab which panel it runs and whether it looks for kratom.
Does kratom change the way you look?
The NCCIH kratom page does not describe changes in appearance from everyday use. The signs that show up in the research are about overdose and liver problems. In a case report summarized by American Addiction Centers, overdose symptoms included constricted pupils and blue or purplish skin. NCCIH lists seizures, high blood pressure and liver problems among the rare but serious effects, so any change that worries you should be checked by a clinician.
Before you decide
- Tell any clinician about kratom and every other drug, alcohol and supplement you use.
- Ask a pharmacist or clinician before combining kratom with prescription medicine.
- Check your state’s controlled substance law or your state health department for current rules.
- Ask your employer or testing lab which panel it runs.
- Keep 911 and naloxone in mind for anyone who is hard to wake.
Where to get help now
If someone is unresponsive, call 911 and give naloxone, as Yale Medicine advises. For poisoning concerns, Yale Medicine lists the Poison Help Line at 800-222-1222 or poisonhelp.org. For help with substance use, the SAMHSA National Helpline is 800-662-4357. Calling early gives a clinician the most options.
By UltimateKratom.com Research Desk
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