Dartmouth Addiction Expert: U.S. Kratom Has Evolved Into Three Waves, and the Third Is Comparable to Potent Opioids

Why it matters

Dr. Stanciu is one of the country's most-cited kratom addiction researchers. His public-facing breakdown of how the U.S. market has evolved — from leaf tea to synthetic 7-OH — is one of the clearest explanations of why traditional kratom safety data doesn't apply to modern products.

The big picture

Kratom's safety profile in traditional Southeast Asian use is often cited to argue against U.S. regulation. But researchers like Dr. Stanciu argue those studies are nearly irrelevant to the modern American market, where products increasingly contain concentrated or synthetic 7-OH. This piece draws a direct line between product evolution and rising harms in states like New Hampshire, and frames regulation — not prohibition — as the appropriate response.

Key findings

• The U.S. kratom market has evolved across three distinct waves: raw leaf (2010–2012), solvent extracts (2014–2018), and synthetic 7-OH products (2019–present)
• Traditional leaf consumption in Southeast Asia resulted in minimal 7-OH exposure; modern U.S. products have been found with 500% more 7-OH than natural leaf content
• Approximately 1 in 4 kratom users meets criteria for kratom use disorder; people with prior substance use disorders are nearly three times more likely to develop it
• Batch-to-batch variability, inaccurate labeling, and contamination with heavy metals or synthetic opioids are documented problems in the unregulated market
• In traditional use, 10–30 leaves per day resulted in negligible 7-OH exposure; in modern extracts, 7-OH can represent the primary active ingredient
• Regulation focused on age limits, product testing, and standardized labeling is proposed as a path to reducing harm without prohibition

What they say

Kratom may hold therapeutic promise when used in controlled, standardized ways. But the products currently sold are unregulated and often unsafe, particularly the concentrated and synthetic 7-OH formulations.

Bottom line

Modern U.S. kratom products often have little in common with the traditional Southeast Asian tea that safety studies have examined — regulators and consumers need to understand the third wave.