Massachusetts Health Department Publishes Full Kratom Guidance After Schedule I Emergency Order

Why it matters

Massachusetts is treating kratom overdose exactly like an opioid overdose, directing residents and providers to use naloxone, which changes how families and first responders will respond to a kratom-related medical emergency.

The big picture

The guidance follows the Commissioner of Public Health's emergency order placing all forms of kratom into Schedule I under Massachusetts law, effective August 28, 2026, and gives local boards of health new enforcement authority against retailers. It sits alongside a growing set of state-level actions, including North Dakota's executive order and Minnesota's age increase, that have moved faster than any pending federal rule.

Key findings

• The order gives local boards of health and municipal officials authority to remove kratom products from retail shelves
• DPH says naloxone should be administered for a kratom overdose exactly as for an opioid overdose
• Synthetic products may contain high concentrations of 7-OH, mitragynine pseudoindoxyl (MP), MGM-15, and MGM-16
• Withdrawal symptoms mirror opioid withdrawal: anxiety, agitation, muscle spasms, hot flashes, and restlessness
• Buprenorphine has been found effective for treating kratom use disorder, per cited case-series research
• The order remains in effect for up to one year after a 14-day notice period

What they say

The department states that "recent state and federal actions will reduce the amount of kratom products, both synthetic and natural," and directs providers and the public to the Massachusetts Substance Use Helpline for treatment and recovery support.

Bottom line

**Massachusetts now instructs residents to treat a kratom overdose exactly like an opioid overdose, including immediate naloxone use, formalizing what clinicians had been doing informally.**