Kratom

A tree in the coffee family

Kratom comes from the leaves of Mitragyna speciosa, a tropical tree native to Southeast Asia — botanically a cousin of the coffee plant. Farmers and laborers in Thailand and Malaysia have chewed the leaf or brewed it as tea for centuries: small amounts for energy through a workday, larger amounts for pain and rest at the end of one. In the United States it arrives as powder, capsules, and extracts, and federal survey data suggest roughly two million Americans use it in a given year — with pain the most commonly reported reason.

How it works in the body

The leaf’s main active compound is mitragynine, which makes up about one to two percent of dried leaf. Mitragynine is a partial agonist at mu-opioid receptors — the same receptors morphine and oxycodone act on — which is why researchers call kratom an “atypical opioid” even though the plant is unrelated to the opium poppy. It also touches adrenergic and serotonin systems, which fits what users describe: stimulant-like effects at low amounts, opioid-like effects at higher ones.

In laboratory studies, mitragynine activates opioid receptors in a biased way that recruits less of the signaling associated with respiratory depression, and animal studies have found less breathing suppression than with classic opioids. That pharmacology is genuinely interesting — it is part of why NIH-funded labs study kratom compounds as leads for safer analgesics. But “less in animal studies” is not “safe in humans,” and no controlled human data yet establish that margin.

What the evidence shows — and doesn’t

Surveys of tens of thousands of users consistently report relief from pain, and some people with chronic pain report substituting kratom for prescription opioids. Controlled evidence is far thinner. The best-known human trial, a randomized, placebo-controlled, double-blind study published in 2020, found that a kratom decoction roughly doubled pain tolerance in an ice-water test — a real, measurable analgesic signal. But it enrolled 26 long-term users, measured experimental pain rather than a pain condition, and lasted one afternoon.

That is the entire top shelf of the evidence: no large randomized trial has ever tested kratom in people with chronic pain. So the honest summary is not “kratom doesn’t work” — it is that nobody has yet measured how well it works, at what cost, compared to treatments that have been through that process. NIDA is funding the studies that could close that gap.

The risks, honestly

Because mitragynine works through opioid receptors, regular use can produce physical dependence, and stopping can bring an opioid-like withdrawal: muscle aches, irritability, insomnia, runny nose, low mood. Reported harms also include nausea and constipation, rare but documented liver injury, and seizures — mostly with heavy use or combinations. Calls to U.S. poison centers about kratom have risen sharply. Deaths involving kratom are rare relative to the number of users and almost always involve other drugs — but that is itself the warning: kratom is processed by the same liver enzymes as many common medications, and mixing it with opioids, benzodiazepines, or alcohol is where the danger concentrates.

The other risk is the product itself. Because kratom is sold as a botanical outside FDA oversight, the powder in one package can differ from the next — in alkaloid content, in purity, and occasionally in contamination. A 2018 multistate Salmonella outbreak was traced to kratom products, and testing has found heavy metals in some. None of this is unique to kratom; it is what an unregulated supply chain looks like.

If you or someone you love is struggling with kratom, opioid, or other substance use, the SAMHSA National Helpline is free, confidential, and open 24/7 at 1-800-662-HELP (4357).

7-OH: when the leaf becomes a pill

The leaf also contains a trace alkaloid called 7-hydroxymitragynine (7-OH) — present below 0.05% in the plant, but many times more potent than mitragynine at opioid receptors. Around 2023, manufacturers began selling tablets, gummies, and drink shots of concentrated or synthetic 7-OH at gas stations and smoke shops. The FDA’s assessment was blunt: these products are not kratom in any traditional sense — they are potent, untested opioid products wearing the leaf’s name.

In July 2026 the DEA filed notice of intent to temporarily place 7-OH above that natural threshold — along with three related synthetic compounds — into Schedule I. The first half of that action has now landed: on August 26, 2026, a temporary order took effect placing the three synthetics — mitragynine pseudoindoxyl, MGM-15, and MGM-16 — in Schedule I. The order for 7-OH itself is still pending, with public comment on the proposed threshold open through September 10, 2026 — and natural leaf kratom remains federally unscheduled throughout. However the rest resolves, the direction is clear: regulators are drawing a line between the traditional leaf and the isolated compound.

Where the law stands

Leaf kratom is not a federally controlled substance — the DEA proposed scheduling it in 2016 and withdrew the proposal after significant public and congressional pushback, an unusual reversal. It is also not FDA-approved for any medical use, and the agency has warned against using it for pain, mood, or opioid withdrawal. States have gone different ways: a half-dozen ban it outright, while a growing number regulate it through Kratom Consumer Protection Acts that set age limits, labeling rules, and purity standards. What is legal, and in what form, depends on where you live.

Talking with your physician

If you use kratom or are weighing it, the single most useful step is to tell your physician — before surgery, before a new prescription, and at routine visits. Not because you will be lectured, but because it changes real decisions: anesthesia planning, drug-interaction checks, and how withdrawal or dependence would be recognized and treated if they arise. Pain medicine’s regulated pipeline is working on the same target kratom points at — opioid-receptor relief with less harm — and you can follow those candidates in the pain treatment pipeline. This page describes; it does not prescribe. The decision belongs in an open conversation with your care team.