ASTHO Policy Primer: State Health Officers Navigate Patchwork of Kratom Regulations as Federal Action Stalls

Why it matters

State health officers are on the front lines of the kratom and synthetic 7-OH crisis, yet federal regulation remains absent. ASTHO's policy primer helps health departments understand the current legal landscape and what tools states have used to act.

The big picture

In the absence of FDA or DEA scheduling action, more than 30 states introduced kratom-related legislation in 2024–2025, with some passing full bans and others enacting consumer protection laws. This has created a fragmented patchwork that complicates enforcement, cross-border commerce, and consumer safety.

Key findings

• Six states and Washington D.C. classify kratom alkaloids as controlled substances; 18 additional states have partial regulations including age restrictions
• Approximately 1.6 million Americans used kratom products in 2023 according to SAMHSA data
• In July 2025, FDA recommended that DEA classify synthetic 7-OH as a controlled substance under the Controlled Substances Act
• Over 30 states introduced kratom legislation in 2024–2025; seven states advanced contradictory bills simultaneously
• Rhode Island enacted one of the most comprehensive frameworks, with licensing, age-21 sales restrictions, and a 15% excise tax

What they say

"The conflicting nature of the proposed legislation showcases the controversies involving kratom and differing perspectives of its use and safety," wrote ASTHO policy analyst Heather Tomlinson.

Bottom line

With FDA action stalled and DEA yet to schedule synthetic 7-OH, states are operating in a regulatory vacuum—passing widely varying laws that leave consumers and health officials without consistent federal guidance.