Health Affairs: The Kratom Industry Is Repeating the Opioid Playbook — Experts Urge Federal Action Now

Why it matters

A policy analysis in Health Affairs, one of the nation's leading health policy journals, draws a direct parallel between the kratom industry's current lobbying and marketing behavior and the early opioid crisis, calling for immediate federal regulatory action before harms escalate to the same scale.

The big picture

Nearly two million Americans used kratom in 2024, and poison control center reports of kratom-related exposures have increased more than 1,000% over the past decade. The authors — public health researchers — argue that the combination of inadequate regulation, aggressive industry lobbying, natural-product marketing, and easy youth access parallels the conditions that enabled the opioid crisis. The piece specifically calls for federal bans on high-potency synthetic and semi-synthetic kratom derivatives including 7-OH, and argues the FDA's 2025 scheduling recommendation for 7-OH has not been implemented quickly enough.

Key findings

• Nearly 2 million Americans used kratom in 2024; kratom-related poison control reports increased by more than 1,200% from 2015 to 2025
• More than one-third of 7-OH-related poison control cases in the first half of 2025 involved severe outcomes including seizures, respiratory depression, and loss of consciousness
• Many kratom products sold in the U.S. contain concentrated or synthetic alkaloids, particularly 7-OH, that "far exceed" the potency of naturally occurring kratom leaf
• The FDA recommended scheduling certain 7-OH products in 2025, but the DEA has not yet initiated its review process
• Authors call for federal bans on high-potency synthetic derivatives, pharmaceutical-grade safety and efficacy testing for medically marketed kratom, youth access restrictions modeled on alcohol and cannabis regulations, and expanded public and clinician education
• The piece draws explicit parallels to how delayed federal responses to opioids and intoxicating hemp-derived THC products allowed harms to become entrenched

What they say

"With kratom, the warning signs are already here: rapid market growth, increasing poison center calls, addiction, overdose, potent new derivatives, weak oversight, and an industry eager to frame regulation as unnecessary." — Oster, Richter, and Kaufman, Health Affairs

Bottom line

Health Affairs researchers argue the U.S. is repeating the opioid crisis pattern with kratom and urge immediate federal action to ban high-potency 7-OH derivatives before harms become irreversible.