Kratom regulations considered as ex-users, doctors warn of addiction risks

When Kristen Sweeney Avila first started drinking small bottles containing ground kratom leaf in 2020 to give her an energy boost, she saw them as a healthy alternative to alcohol, to which she had been addicted for a decade.

The Melville woman kept upping her consumption until she was spending $100 a day on kratom products at gas stations, convenience stores and smoke shops. She finally kicked her addiction in April, she said, but not before draining her bank account and enduring severe withdrawal symptoms during several unsuccessful attempts at quitting.

Sweeney Avila, 37, feels duped into taking a product that promised to lift her mood and help her focus.

"You definitely feel you’re taking something natural, that you’re doing something safe," she said.

Kratom products are sold at stores across Long Island, sometimes on counters next to cash registers and 5-hour Energy drinks. While Suffolk has since 2016 limited kratom sales to those 21 and over, in Nassau and most of New York, anyone, including children, can legally buy kratom products, including a concentrated and synthesized byproduct of the leaf called 7-OH that doctors and federal officials say is more potent than morphine.

The Food and Drug Administration on July 29 recommended that all sales of 7-OH, which it called an opioid, be banned, but that kratom leaf products remain legal.

The 7-OH products are based on a substance that makes up about 1% of the kratom leaf, which grows on trees primarily in Southeast Asia. But they are highly concentrated, synthesized versions of natural 7-OH, or 7-hydroxymitragynine, giving them their potency, experts say. Yet packaging touts 7-OH, which in tablet form is either swallowed or chewed, as "a plant-based botanical extract."

Ground kratom leaf is sold in powders to make teas, and in capsules, as well as in liquids or other versions that sometimes are more heavily concentrated.

Medical and addiction experts are also concerned about these types of kratom products, because of their potential for dependence, subsequent withdrawal symptoms and other physical and mental health problems. Long Island doctors and social workers say their patients started using kratom for alertness and focus, pain relief, opioid withdrawal or just to get high, and didn’t realize they could get hooked.

The State Legislature in June unanimously passed bills to restrict kratom sales to people 21 and over and to require warning labels on kratom products. Gov. Kathy Hochul will review the legislation, spokeswoman Nicolette Simmonds said in an email.

Store: Most buying 7-OH

Research indicates that kratom could relieve some types of pain and may help in opioid withdrawal, said Christopher McCurdy, a professor of medicinal chemistry at the University of Florida and a leading expert on kratom. He co-authored a study released in January that found that nearly half of kratom consumers have chronic pain, and most said kratom helped them.

But, McCurdy said, kratom also can create physical dependence and health problems, and more research is urgently needed.

"We don’t really understand where the line between potential benefit and potential harm actually is," McCurdy said.

What is clear is that 7-OH is so powerful that it "has all the attributes of a traditional opioid," he said.

McCurdy said 7-OH has been on the market for less than two years, but vendors are telling him that it now dominates kratom sales.

At 141 Woodbury Smoke Shop in Woodbury, liquids previously were the most popular kratom products, but for the past six months, "most of the people are buying this one," cashier Mohammed Wasim said, pointing to a box of 7-OH tablets. The store is in Nassau but only sells kratom products to people 21 and older, he said.

Sen. Steven Rhoads (R-Bellmore) is alarmed by how easy it is for kids to buy 7-OH and other kratom products and co-sponsored the bill to bar kratom sales to people under 21. He doesn’t support a total ban yet, in part because of research showing potential benefits of kratom.

Rhoads also co-sponsored the bill requiring warnings of potential side effects, including nausea, agitation, breathing difficulties, hallucinations, liver damage and death. The bill also bars language stating or implying that the product is "natural."

'Functions just like an opioid'

At low doses, kratom can give people more energy and acts as a stimulant. In higher doses its effects can be similar to opioids, and it is more like a sedative.

Kratom can potentially impair driving, but because it is not specifically named in New York law, "even an obviously impaired driver who admitted to taking Kratom would escape drugged driving charges,"  Nassau County District Attorney Anne T. Donnell y said in a statement. She supports legislation to penalize anyone who drives while impaired by drugs, including ones like kratom not explicitly mentioned in the law.

McCurdy said until there’s more research, he doesn’t recommend kratom consumption, but, he said, "liquid products, the concentrates or the extracts are much more at risk of being harmful or having more abuse potential than the leaf."

Some deaths have been tied to kratom overdoses. In New York, kratom was listed as a cause of death in 100 of more than 10,000 overdoses in 2023-24, according to federal State Unintentional Drug Overdose Reporting System data, state Health Department spokeswoman Cadence Acquaviva said in an email. But in nearly all of those cases, other substances, such as fentanyl and other synthetic opioids, also were listed as causes of death, she said. That mirrors a Centers for Disease Control and Prevention report that found in a review of medical examiner reports in 2016-17 that more than 90% of people who died of overdoses in which kratom was listed as a cause of death also had fentanyl, heroin or other potentially dangerous drugs in their systems.

That study was conducted before the rise of 7-OH, which has more potential to cause death or serious harm, said Joseph Palamar, a professor of population health at New York University and an expert on drug use prevalence.

"It functions just like an opioid," Palamar said. "You can overdose and it could be addictive. It is more potent than morphine, and morphine is very addictive."

The FDA’s July 29 recommendation that 7-OH be termed a Schedule 1 drug — meaning it has a high potential for abuse with no currently accepted medical use — was sent to the Drug Enforcement Administration, which is soliciting public comments as it decides whether to ban the substance.

FDA Commissioner Dr. Marty Makary said in announcing the recommendation that the agency is not saying other forms of kratom are safe, but "we have to prioritize what we work on, so we are going after the killer first, which is the synthetic concentrated kratom."

The Holistic Alternative Recovery Trust, which includes 7-OH manufacturers as members, said in a statement that 7-OH does "not present a significant or unreasonable risk of illness or injury under the conditions of use recommended or suggested in labeling, or under ordinary conditions of use." The organization, which says it promotes "access to safe, plant-based alternatives to opioids and other pharmaceuticals," is in favor of restricting 7-OH to those 21 and over.

The American Kratom Association supports the FDA’s action, with Mac Haddow, senior fellow on public policy for the group, calling 7-OH "a designer opiate."

The association, which gets most of its funding from kratom-related companies, backs regulations of all kratom products, including lab testing for purity, age limits and warning labels, Haddow said. But attempts to fully ban its sale — Louisiana became the seventh state to do so in June — are misguided, he said.

"Kratom is so wildly popular today because people are finding that it helps them and improves their quality of life," Haddow said. Kratom is now a roughly $2-billion-a-year industry in the United States, he said.

Haddow said some people with a propensity for addiction can become dependent on kratom, "but most people have no problem. You can walk away from kratom use, and you might have for a week to 10 days a headache, runny nose, upset stomach, then you're done with it."

But drug counselors and doctors have seen many people get addicted to kratom and have difficulty quitting.

Some people use kratom to get off opioids, only to find they get addicted to kratom, said Elizabeth Accetta, director of addiction and support services for YES Community Counseling Center in Massapequa. They hear it can have similar effects as opioids but leave users better able to function, she said.

Opioid users trying to kick their addiction sometimes say they prefer kratom to FDA-approved Suboxone, because they perceive it as more natural, said Dr. Jarid Pachter, a Stony Brook Medicine specialist in family and addiction medicine. But some later had to take Suboxone to stop using kratom, he said.

"The vast majority of people are really just trying to feel better or be healthier, and they are really vulnerable to what an advertisement says, or what somebody else told them, or what they see on social media," Pachter said. "They're falling into something they know very little about."

Most people who buy kratom from New Paradise Convenience in Huntington Station say they take it to relieve pain, including back and after-surgery pain, said store manager Surendra Pradhan. But Pachter said someone looking for pain relief should consult a doctor, not go shopping at a smoke shop or gas station.

'Falling into a spiral'

Sweeney Avila first started drinking kratom tea she bought in growlers from non-alcoholic bars. Then she saw highly concentrated liquid "shots" at gas stations and smoke shops and started taking those.

"Once I realized it was everywhere, that was when things got really out of control," she said.

She switched to Feel Free — a popular brand of 2-ounce bottles with kratom and kava, which comes from a South Pacific shrub — because it was cheaper than the shots. But her consumption of kratom only increased, and she started experiencing nausea, irritability and stomach pains with the higher amounts, she said.

A Reddit group called Quittingfeelfree has more than 5,300 members reporting physical, mental health and financial problems from using the substance.

Botanic Tonics, the maker of Feel Free, said in a statement that it makes clear on its bottles the maximum amount of liquid that should be consumed in a day, voluntarily added a "21+" label, and warns that people with histories of substance abuse shouldn’t use it.

Sweeney Avila said several attempts to quit Feel Free led to profuse sweating, restless legs, insomnia, anxiety, depression and other symptoms. She finally quit in April, with the help of her husband and therapist.

She said there should be much stronger regulations for kratom, including warnings about potential side effects and addiction.

"I just want to avoid people not knowing what they're getting themselves into and falling into a spiral like I did," Sweeney Avila said.