This Week’s Focus: Kratom and Mitragynine-Derived Substances

This week’s NDEWS Weekly Briefing focuses on kratom and the increasing availability of substances derived from its primary alkaloid, mitragynine—including 7-hydroxymitragynine (7-OH) and mitragynine pseudoindoxyl (MP). While kratom leaf has traditionally been used in Southeast Asia and more recently in the US for self-managing pain and opioid withdrawal, reports are pointing to the emergence of semi-synthetic products with elevated potency and unclear safety profiles.

Peer-reviewed studies, regulatory actions, biospatial, and web monitoring surveillance from the NDEWS Early Warning Network highlight growing kratom-related concerns about mislabeled products, novel formulations, and emergency medical encounters. This week’s coverage explores the evolving pharmacology and public health implications of kratom and its derivatives.

Out of 4,233 EMS encounters for kratom/7-OH-related overdoses from January 2023 to April 2025, 1,071 (25.3%) occurred in western states, 1,191 (28.1%) in central states and 1,971 (46.6%) in eastern states. The data shows a statistically significant increase in kratom/7-OH-related EMS encounters across all three regions and nationally overall. This report also covers US counties with the highest rates of EMS encounters for kratom/7-OH-related overdoses (nonfatal or fatal) per 10,000 population and highlights trends in EMS encounters for kratom/7-OH-related overdoses (nonfatal or fatal) in the US by month.

To view the entire Special Report from our Weekly Briefing, click here.

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Why are we reporting on this? Recent research and regulatory actions highlight escalating concerns over high-potency kratom derivatives being sold at gas stations and smoke shops. While traditional kratom leaf has been used for opioid withdrawal and pain management, the emergence of concentrated 7-hydroxymitragynine (7-OH) and mitragynine pseudoindoxyl products represents a significant shift in potency and risk profile.

What is Kratom? Kratom (Mitragyna speciosa) is a tropical tree native to Southeast Asia whose leaves contain over 40 alkaloids, primarily mitragynine. While traditionally used as a mild stimulant and pain reliever, modern extraction techniques have isolated and concentrated specific alkaloids like 7-hydroxymitragynine, which is estimated to be 13-17 times more potent than morphine. These derivatives are now being sold in various forms including tablets, shots, and gummies.

Public Health Impact: Reddit discussants report experiencing significant tolerance development with 7-OH products, leading to rapid dose escalation and financial strain. Users describe withdrawal symptoms from concentrated alkaloid products as more severe than traditional kratom leaf, with some comparing them to pharmaceutical opioid withdrawal. Limited awareness exists about the pharmacological differences between traditional kratom and these novel derivatives, leading to unexpected overdose-like symptoms including respiratory depression concerns.

Previous Reports:
November 15th, 2024
August 16th, 2024
June 21st, 2024

How is it being discussed? Reddit discussion dynamics surrounding kratom and derivatives have increased dramatically since the beginning of 2025. There is a moderate difference which has formed between the number of unique users and number of posts since the beginning of 2025, indicating that online communities are forming into a very active group of core commenters, along with more moderate discussion from others.

Reddit users frequently compare 7-OH effects to prescription opioids like oxycodone and hydrocodone, with many expressing surprise at the potency legally available at smoke shops. Discussants note high prices, ranging from $15-40, for single doses of concentrated products. The convenience of purchasing at gas stations is frequently mentioned as both an accessibility benefit and a concern for impulse use.

Commenters express confusion about dosing, particularly when transitioning between traditional kratom powder (measured in grams) and concentrated alkaloid products (measured in milligrams). Reddit users report using 7-OH products to manage chronic pain, with some noting effectiveness where traditional kratom failed. Some discussants are concerned about rapid tolerance development.

Harm reduction discussions focus heavily on tapering strategies, with users sharing experiences using traditional kratom leaf to step down from concentrated products. Some discussants report using pharmaceutical interventions like gabapentin or clonidine to manage withdrawal symptoms. Some Reddit users mention stockpiling products in anticipation of legal bans.

Drug interactions emerge as a significant concern, particularly mixing 7-OH products with benzodiazepines or alcohol. New users frequently seek basic information about these products, often unaware they differ significantly from traditional kratom leaf in both effects and risks.

Drug Terms: Mitragyna speciosa, kratom, ketum, thang, thom, biak, cratom, 7-hydroxymitragynine, 7ohmz, kratom extract, kratom shot, kratom capsule

Click here to read more about NDEWS Online Monitoring.

A recently published study in Emerging Trends in Drugs, Addictions and Health by Prevete et al. (2025) surveyed 310 adults with experience using classic, novel, and herbal opioids. Kratom was the most frequently reported herbal opioid, used for pain relief, withdrawal management, and mood enhancement. While many cited medical benefits, 45.8% acknowledged kratom’s addictive potential. Physical and psychological adverse events were reported across all opioid classes, highlighting the need for ongoing monitoring and controlled research on kratom’s therapeutic role.
Read the study here.

A recently published short communication in Drug and Alcohol Dependence co-authored by NDEWS affiliates Drs. Grundmann and Smith (2025) examined 304 online products marketed as kratom but containing semi-synthetic 7-hydroxymitragynine (7-OH) and mitragynine pseudoindoxyl (MP). Most (93.1%) were mislabeled as kratom despite containing potent opioid agonists absent from the natural plant. Nearly 73% made claims about its effects (e.g., increased focus, relaxation).
Read the short communication here.

A recent update from Johns Hopkins Medicine highlights the first clinical trial evaluating kratom withdrawal, led by NDEWS affiliate Dr. Kirsten Smith. The study examines pharmacokinetics, behavioral effects, and spontaneous withdrawal among chronic kratom consumers. Smith also co-authored a proposed decision-making algorithm for diagnosing kratom use disorder (KUD), emphasizing product type, severity, and comorbidities. The update warns that synthetic 7-hydroxymitragynine products complicate KUD assessment and may warrant opioid use disorder (OUD) interventions.
Read the update here.

A recently published column in Psychology Today's Addiction Outlook by Dr. Mark Gold, an NDEWS Scientific Advisory Group (SAG) member, reviews current science on kratom’s risks and potential benefits. Drawing on expert input from NDEWS affiliates Drs. McCurdy and Grundmann, as well as colleagues Drs. Singletary and Boyer, the article distinguishes natural kratom leaf—low in 7-hydroxymitragynine (7-OH)—from high-potency commercial products that elevate 7-OH content and escalate overdose risk. While kratom extracts are linked to adverse outcomes, unadulterated kratom tea may serve as a harm reduction bridge. Experts call for regulation, product labeling, and dosing guidelines to prevent misuse and ensure consumer safety.
Read the article here.

A recently published review in Progress in Neuro-Psychopharmacology and Biological Psychiatry by Green et al. (2025), co-authored by NDEWS affiliate Dr. Grundmann, details the complex neuropharmacology of kratom and its alkaloids. The authors summarize evidence from animal models suggesting antidepressant, anxiolytic, and opioid withdrawal-relieving effects, primarily mediated by partial mu-opioid receptor agonism and interactions with adrenergic, serotonergic, and dopaminergic systems. Mitragynine and its metabolite 7-hydroxymitragynine were highlighted for their receptor specificity and lower β-arrestin recruitment.
Read the review here.

A recently published study in Drug Testing and Analysis by Sharma et al. (2025), co-authored by NDEWS affiliates Drs. Sharma, Smith, and McCurdy, analyzed 341 kratom products used by participants in a nationwide ecological momentary assessment study. Nearly all samples were whole-leaf products with consistent alkaloid fingerprints matching Mitragyna speciosa, and none were adulterated with illicit substances. The average mitragynine dose per serving was 31.3 mg (range: 2.0–205.9 mg), with estimated daily intakes of 78.3–134.6 mg. These findings represent the most comprehensive chemical analysis of US. kratom products to date
Read the study here.

 A March 2025 report by WKRC spotlights growing alarm over synthetic 7-hydroxymitragynine (7-OH) products being sold at smoke shops under the guise of kratom extracts. Experts from the Scientific Association for Botanical Education and Research (SABER) and researchers from the McCurdy Lab (Dr. Abhisheak Sharma) warn that these potent mu-opioid receptor agonists—sometimes labeled with phrases like “perks” or “sippers only”—pose high risks for addiction, overdose, and consumer deception. SABER urges regulatory enforcement and stronger penalties for misleading marketing, citing urgent public health and safety concerns.
Read the report here.

The US Food and Drug Administration (FDA) continues to warn against the use of kratom, citing risks including liver toxicity, seizures, neonatal withdrawal, and substance use disorder. No kratom-containing products—whether marketed as drugs, dietary supplements, or food additives—are legally approved for sale in the United States. FDA enforcement actions have targeted unapproved kratom drug products, false health claims, and contaminated imports, with support from the Department of Justice and US Customs and Border Protection.

While FDA continues to evaluate the available safety information about the effects of kratom, the agency encourages health care professionals and consumers to report any adverse reactions to the FDA’s MedWatch program:

1) Complete and submit the report online: MedWatch Voluntary Reporting Form
2) Download and complete the form, then submit it via fax at 1-800-FDA-0178

Read the article here.

You are invited to attend the NDEWS Summit at the College on Problems of Drug Dependence (CPDD) 87th Annual Scientific Meeting on Saturday, June 14th (06/14/2025) from 4:00 pm - 6:00 pm CT in Bayside Ballroom AB, 4th floor. The Summit will be open to all CPDD meeting attendees. 

We hope to see you there!

NDEWS Posters and Presentations at CPDD

In June, the NDEWS team will be traveling to attend the 87th College on Problems of Drug Dependence (CPDD) Annual Meeting in New Orleans, Louisiana. Along with posters, the NDEWS team will be presenting a late-breaking abstract, an oral presentation and two invited symposia. We invite you to join us for these presentations. Please find the presentation information below:

Sunday, June 15
3:30 pm - 4:45 pm CT Late-Breaking Abstract
Anesthetics (“-Caines”) Adulterate the Illicit Fentanyl Supply: A National Drug Early Warning System (NDEWS) Alert
Joseph Palamar, Joshua DeBord, Alex Krotulski, Bruce Goldberger

5:00 pm - 6:30 pm CT Poster Session 1 (Napoleon Ballroom CD, 3rd Floor)
Trends in Nonfatal Fentanyl Poisonings Involving Stimulants in the United States, 2015–2023
Nicole Fitzgerald, Joshua Black, Linda Cottler, Silvia Martins, Joseph Palamar

Monday, June 16
10:45 am - 12:15 pm CT Invited Symposium
Found in Translation: Coordinated Preclinical, Human Laboratory and Epidemiological Approaches to Understanding Polydrug Use
William Stoops, Lori Knackstedt, Linda Cottler, Christa Corley

3:30 pm - 4:30 pm CT Oral Session: Sex Matters: Translational Evaluations of Sex-Specific Factors in Substance Use
Sex Differences in Problematic Substance Use, Mental Health, and Social Determinants of Health among Middle-Aged and Older Adults in the All of Us Research Program
Vijaya Seegulam, Bia Whipp, Liva LaMontagne, Linda Cottler

5:45 pm - 7:15 pm Poster Session 2 (Napoleon Ballroom CD, 3rd Floor)
Natural Language Processing Analysis of 7-Hydroxymitragynine Reddit Discussion
Daniel Van Zant, Kirsten Smith, Oliver Grundmann, Catherine Striley, Elan Barenholtz, Christopher McCurdy, Linda Cottler

Tuesday, June 17
3:45 pm- 4:45 pm CT Oral Presentation at Mini Symposium: Prevalence and Characteristics of Recreational Ketamine Use among Nightclub Attendees and College Students in the New York Tristate Area.
The Current Landscape of Medical and Recreational Ketamine Use
Shahar Almog, Meredith Berry, Joseph Palamar 

5:30 pm - 7:00 pm CT Poster Session 3 (Napoleon Ballroom CD, 3rd Floor)
Reported Use of Recreational and Medical Cannabis, Delta-8, and Delta-10: Findings from NDEWS Sentinel Sites and Hotspots (2022–2023)
Tamara Millay, Vijaya Seegulam, Monica Bhargavi Kodali, Linda Cottler

Wednesday, June 18
2:00 pm - 3:30 pm CT Poster Session 4 (Napoleon Ballroom CD, 3rd Floor)
Alcohol Polysubstance Use among past 30-Day Opioid Users in Northern Florida: A Model for Back Translational Research
Christian Conger, Linda Cottler

Friday, June 20
3:00 pm - 5:00 pm CT Polysubstance Use: From Bench to Communities Session 2 Keynote (LSU Health Sciences Center, 411 S Prieur Street, New Orleans, LA 70112)
The National Drug Early Warning System Networks, Initiatives and Data: How can we help?
Linda Cottler

📅 Dates: June 3, 2025

🕑 Time: 12:00 pm - 1:00 pm ET

📍Location: Online

Learn more here.

📅 Dates: June 2 - 4, 2025

📍 Location: University of Puget Sound, Tacoma, WA

Learn more here.

📅 Date: Thursday, June 12, 2025

🕑 Time: 9:00 am - 3:30 pm PT

📍 Location: Online

Learn more here.

📅 Date: Friday, June 20, 2025

🕑 Time: 3:00 pm - 5:00 pm CT

📍 Location: New Orleans

Learn more here.

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The Weekly Briefing is a newsletter published each week by the National Drug Early Warning System (NDEWS) Coordinating Center, which is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (MPI: Cottler (contact), Co-Is: Goldberger, Nixon, Striley), New York University (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.