Expert Analysis: Kratom Deaths Were Rising Before Synthetic 7-OH Appeared — Evidence Shows Traditional Kratom Also Carries Opioid Risks

Why it matters

An opioid addiction physician directly challenges the kratom industry's central claim that only synthetic 7-OH products are dangerous. If correct, this analysis has major policy implications: regulators cannot limit enforcement to 7-OH alone, and a much broader range of kratom products may need to be addressed.

The big picture

As the kratom industry lobby has increasingly sought to separate natural leaf kratom from synthetic 7-OH in regulatory debates, medical and public health experts have pushed back. Dr. Andrew Kolodny of Brandeis University draws on CDC data, FDA statements, and published research to argue that the risks of traditional kratom predate and extend beyond the 7-OH controversy — and that claims of kratom as an opioid treatment lack scientific support.

Key findings

• About 1.7 million Americans report using kratom annually, with use rising during the opioid crisis as people sought alternatives to prescription opioids
• Mitragynine in traditional kratom converts in the body to 7-OH — a much stronger opioid — making natural kratom pharmacologically more complex than its plant origin suggests
• Deaths linked to kratom were already rising before concentrated 7-OH products appeared on the market in late 2023, contradicting claims that only synthetic derivatives are dangerous
• States that banned kratom early, such as Vermont, have not seen worse opioid mortality outcomes — undermining claims that kratom access reduces fentanyl deaths
• The FDA has stated explicitly that kratom is not a treatment for opioid addiction and should not be used for that purpose

What they say

"For now, the evidence shows that kratom is an opioid with real risks — not a harmless supplement," wrote Dr. Andrew Kolodny, a Brandeis University physician who studies and treats opioid addiction, in an analysis published in The Conversation and republished in U.S. News.

Bottom line

A leading opioid addiction physician argues that kratom's natural origins do not make it safe — deaths linked to traditional kratom predate the synthetic 7-OH era, and the body's conversion of mitragynine to 7-OH means the risk cannot be isolated to synthetic products alone.