Kratom is in the news because two very different products are being sold under similar names. One is the leaf of Mitragyna speciosa, a tree native to Thailand, Malaysia, Indonesia, and neighboring countries. The other is a group of concentrated and semisynthetic products built around 7-hydroxymitragynine, or 7-OH. The leaf has a long history of traditional use. The concentrated products are new, far more opioid-like, and are the focus of recent federal action. They should not be discussed as if they were the same thing.
The leaf, and how it was used
In Southeast Asia, fresh leaves have been chewed, or brewed as tea, for generations. Written accounts go back to at least the nineteenth century. Laborers used small amounts for stamina during physical work. Traditional use also included pain, cough, diarrhea, and low mood. Effects were described as dose-dependent: lower amounts more alerting, higher amounts more calming and pain-relieving. Daily use in some communities was common, and dependence was recognized long before kratom reached Western markets.
The dominant alkaloid in the leaf is mitragynine. In dried leaf, 7-OH is present only in trace amounts, on the order of a few hundredths of a percent by weight, and some of the 7-OH measured in people is formed in the body after mitragynine is metabolized. Mitragynine is a partial agonist at the mu-opioid receptor and also acts on adrenergic and serotonergic systems. That mixed pharmacology is why leaf effects are not identical to those of morphine or oxycodone. It is also why regular use can still produce tolerance, dependence, and withdrawal.
Mental health: use is common, proof of benefit is not
In the United States, surveys repeatedly find that people take kratom on their own for pain, fatigue, anxiety, depressed mood, and to ease opioid withdrawal. Animal studies of mitragynine and related alkaloids show signals in models of pain, anxiety-like behavior, depression-like behavior, and opioid withdrawal. A 2024 multilevel meta-analysis of mostly observational human studies found no clear association between kratom use and internalizing disorders such as depression and anxiety, and only a small association with externalizing problems. The authors did not find evidence that typical use was strongly linked to worse mental health.
That is not the same as evidence that kratom treats a mental health condition. There are no randomized controlled trials showing that kratom is effective for depression, anxiety, or opioid use disorder. There is no FDA-approved kratom product for any use. Systematic reviews still call the therapeutic case inconclusive. Self-treatment can also mask an untreated depressive, anxiety, or substance-use disorder, and stopping suddenly can produce withdrawal that feels like a relapse of those symptoms.
Extracts and 7-OH are a different exposure
Products sold as 7-OH tablets, shots, gummies, and “enhanced kratom” are not traditional leaf. Manufacturers isolate mitragynine and chemically oxidize it to 7-OH, then formulate doses the leaf does not deliver. 7-OH binds the mu-opioid receptor more strongly than mitragynine. The FDA has described concentrated 7-OH as an opioid that can be more potent than morphine, and has said these products are not lawful dietary supplements, not lawful food ingredients, and not approved drugs. Some are mislabeled as kratom.
Related manufactured compounds, including mitragynine pseudoindoxyl, MGM-15, and MGM-16, were placed in Schedule I by a temporary DEA order effective August 26, 2026. FDA and HHS have separately recommended scheduling 7-OH above a set threshold. Those actions have been aimed at concentrated and synthetic products, not at botanical leaf.
Why the warnings increased
U.S. poison centers recorded 14,449 kratom-related exposure reports from 2015 through 2025. Reports rose from 258 in 2015 to 3,434 in 2025. CDC linked that surge to wider sale of high-potency products, especially those enriched with 7-OH. In July 2025 the FDA sent warning letters to companies marketing concentrated 7-OH and recommended scheduling. In December 2025, federal officials seized about 73,000 units of 7-OH foods and supplements, valued at about $1 million, from three Missouri firms. Most serious poison-center cases involve other substances as well. In CDC data, about 79 percent of kratom-associated deaths also involved another substance, often an opioid. Polysubstance use makes it hard to assign every death to kratom alone. It does not make the products safe.
Harms that are documented
Regular use of leaf can cause dependence. Withdrawal can include muscle aches, irritability, insomnia, runny nose, gastrointestinal upset, and strong cravings. Concentrated 7-OH appears to produce faster tolerance and a withdrawal syndrome closer to other opioids. Case reports describe cholestatic liver injury, seizures, and altered mental status. Many of those cases also involve other drugs, so cause is not always clear, but the signal is enough to take seriously. Risk rises with alcohol, benzodiazepines, opioids, and other sedatives. Product content is inconsistent, and some items sold as leaf are adulterated with extract. Pregnancy exposure has been linked to neonatal withdrawal. Kratom alkaloids can also interact with medications metabolized by liver enzymes.
What this means in practice
Kratom leaf is a traditional plant preparation with partial opioid activity and a real dependence risk. Concentrated 7-OH products are a newer, more potent opioid exposure and are the products driving current enforcement. Neither is an evidence-based treatment for depression, anxiety, or opioid use disorder. People using either product who want to stop, or who are treating mood or anxiety symptoms with them, should tell their clinician. Withdrawal can be managed, and established treatments for depression, anxiety, and opioid use disorder have a much stronger evidence base.
This article is education, not medical advice, and it is not an endorsement of kratom or 7-OH.
References
- Yang Y, Müller CP, Singh D. Kratom (*Mitragyna speciosa*) use and mental health: a systematic review and multilevel meta-analysis. *Eur Addict Res*. 2024;30(4):252-274.
- Grundmann O, et al. The neuropharmacology of kratom, a novel psychoactive natural product. *Prog Neuropsychopharmacol Biol Psychiatry*. 2025;136:111215.
- Smith KE, et al. A review of kratom product evolution and its associated health outcomes. 2025.
- FDA. FDA takes steps to restrict 7-OH opioid products threatening American consumers. July 29, 2025.
- FDA. Warning letters to firms marketing products containing 7-hydroxymitragynine. July 15, 2025.
- FDA. FDA seizes 7-OH opioids to protect American consumers. December 2, 2025.
- HHS. HHS, FDA commend DEA action against dangerous enhanced 7-OH products. July 1, 2026.
- CDC. Increases in kratom-related reports to poison centers — National Poison Data System, United States, 2015–2025. *MMWR*. 2026;75(11).
- WHO Expert Committee on Drug Dependence. Kratom critical review outcome, 2021.
- Swogger MT, Walsh Z. Kratom use and mental health: a systematic review. *Drug Alcohol Depend*. 2018;183:134-140.
- Smith KE, Lawson T. Prevalence and motivations for kratom use in a sample of
substance users enrolled in a residential treatment program. Related U.S. survey literature summarized in NIDA and FDA consumer materials, 2022–2025.