Kratom: what you need to know

Kratom is easy to find and easy to misunderstand. It’s often packaged as part of the wellness or recovery market, described as a natural option for energy, pain relief, anxiety, or opioid withdrawal, and sold in places that make it feel ordinary: online retailers, smoke shops, convenience stores, and gas stations.

When a product is framed as natural and helpful, it can be easy to overlook the risk. Kratom products come from a plant, but the main compounds in kratom can act on opioid receptors in the brain. At lower doses, people may experience stimulant-like effects; at higher doses, it produces opioid-like effects, including sedation, euphoria, pain relief, tolerance, dependence, withdrawal, and, in some situations, overdose, especially when it is used with other substances. Concentrated 7-OH products, sometimes marketed as kratom or enhanced kratom, raise an even sharper concern because the FDA describes them as potent opioid products.

So much has changed about our knowledge of kratom just from scientific research, but yet so little has changed in the way that people think about it.

           —Suzette Glasner, PhD, Pelago Chief Scientific Officer

Here’s what to know about kratom, 7-OH, withdrawal risk, and treatment options.

What is kratom?

Kratom, or Mitragyna speciosa, is a tropical tree native to Southeast Asia. Its leaves have traditionally been chewed or brewed into tea. In the U.S., kratom is commonly sold as powders, capsules, extracts, tablets, beverages, and gummies. People report using it for pain, fatigue, mental health symptoms, opioid withdrawal symptoms, and cravings. The FDA has not approved kratom for any medical use. 

The FDA also states that kratom isn’t lawfully marketed in the U.S. as a drug product, dietary supplement, or food additive. That distinction matters because products can vary widely in strength, content, purity, labeling, and contamination risk. This means that a person may think they’re buying a simple botanical product while actually taking a concentrated extract, a product with added compounds, or a product with inconsistent dosing. 

Risks of kratom

Kratom-related fatal overdoses, including polysubstance overdoses, have increased from 0.5% of all opioid-related deaths in 2016 to 2% in 2022. The FDA has linked kratom to liver toxicity, seizures, substance use disorder, rare deaths, and neonatal abstinence syndrome after exposure during pregnancy. While people may seek it out for energy, focus, pain relief, relaxation, or relief from opioid withdrawal symptoms, those same effects are part of what makes repeated use risky.

While kratom is sometimes marketed for opioid withdrawal, regular use can lead to tolerance and physical dependence. When use stops, withdrawal can follow and look similar to opioid withdrawal with symptoms including: anxiety, irritability, insomnia, sweating, body aches, nausea, and restlessness. 

There’s no single definitive guideline for treating kratom dependence. Many clinicians manage it with approaches used for opioid dependence, including behavioral interventions and, when clinically appropriate, medications for opioid use disorder such as buprenorphine, methadone, or naltrexone.

 

Kratom vs. 7-OH

Kratom and concentrated 7-OH products are often discussed together, which can create confusion. 7-OH occurs naturally in kratom leaves, although the FDA says it is a minor constituent, less than 2% of the total alkaloid content in natural kratom leaves. Concentrated 7-OH products can contain much higher amounts and are increasingly sold as tablets, gummies, drink mixes, shots, and other retail products.

The FDA is especially concerned about concentrated 7-OH. In 2025, they recommended scheduling certain 7-OH products under the Controlled Substances Act, while making clear that the action targeted concentrated 7-OH products rather than natural kratom leaf. The FDA has also stated that 7-OH is not lawful in dietary supplements, cannot be lawfully added to conventional foods, and is not present in any FDA-approved drug.

Labels to watch for include 7-hydroxymitragynine, 7-OH, 7-OHMG, 7-HMG, 7-Hydroxy, “7,” “enhanced” kratom, “spiked” kratom, and kratom extracts. The FDA’s letter to health care professionals noted that some “spiked” or “enhanced” kratom products may contain 7-OH at levels 500% higher than naturally expected in kratom leaf, and that one study found 7-OH to be 13 times more potent than morphine.

Pelago’s approach to kratom treatment

For employers and health plans, early access matters. Kratom and 7-OH use can be easy to overlook because products may be legal in some places, sold in ordinary retail settings, and marketed as natural wellness products. Pelago helps teams make confidential, stigma-free support available before issues escalate into higher-risk, higher-cost care needs.

To learn more about how your workplace benefits or health plan can support employees and members, including adolescents, contact a Pelago solutions expert today.