An off-the-shelf product may be a bigger danger than it appears.
What is Kratom?
Kratom (mitragynine) is a powder from trees native to Southeast Asia, where the leaves are plucked and chewed to fight fatigue and ease pain.
“At low doses, it has a little bit of a stimulating effect. At higher doses, it's more sedating and helps with pain,” said Hannah Statz DeVries, MD, addiction psychiatrist and Avera Addiction Medical Director.
Much of the kratom you’ll find on the shelves in the United States has been processed and changed significantly from this natural leaf form into high-potency alkaloid products (concentrated extracts or lab-synthesized versions of plant chemicals that have strong effects on the body).
7-OH (7-hydroxymitragynine) is among the most concerning substances because it makes up a very small amount of the raw leaf (less than 0.05% of the dry weight of the raw leaf) and is 1 or 2% of the plant’s total alkaloid content and has an opioid-like effect.
“Recently, several concentrated or semi-synthetic products have entered the market — 7-OH is one of the bigger ones — and they’re being advertised as kratom, but pharmacologically don't resemble traditional kratom much at all,” said DeVries.
How Accessible is Kratom?
Kratom is not federally regulated. Some states have banned the substance, and some have tried to regulate it with the Kratom Consumer Protection Act, which puts age limits and product purity and labeling requirements on it.
In South Dakota, kratom is legal for those 21 or older. Products containing more than 2% 7-OH are banned, and packaging must include clear safety warnings, dosage instructions and alkaloid content. Synthetic concentrates are also prohibited.
In states where kratom is legal, it is sold in multiple forms:
- Powder
- Edibles
- Capsules
- Concentrated extracts
- Liquid shots
What Are the Health Concerns With Using Kratom?
A chief concern about kratom is its addictiveness.
“I see it, I treat it, I have people who can’t stop it,” said DeVries. “Clinically, it can be more challenging to help someone stop kratom, sometimes even more so than traditional opioids. Although there are similarities to opioids, the tolerance and withdrawal can look quite a bit different.”
Because there's no FDA-approved treatment for kratom, addiction care centers can only treat people symptomatically — making them feel comfortable, helping them through withdrawal and getting them off the substance.
Withdrawal can be an especially challenging process, both physically and mentally.
Symptoms of kratom withdrawal include:
- Muscle aches
- Insomnia
- Sweating
- Diarrhea
- Fever
- Appetite changes
- Psychological effects such as restlessness, irritability, anxiety and depression
“Withdrawal typically lasts a few days, but it can really be prolonged with heavy use,” said DeVries. “I've seen it last for weeks for people.”
Death is also a real possibility, especially when kratom is mixed with other substances.
“Over the past 11 years, poison centers have received nearly 15,000 kratom exposure reports, with a record high in 2025,” said DeVries.
Is There a Connection Between Kratom and Other Substances?
Kratom is used both alongside and in place of other substances.
Some individuals report using kratom to self-medicate, starting their day with the substance much like they would a cup of coffee.
Others use kratom in an attempt to stop drinking or stop using meth, cannabis or opioids, believing kratom will help ease withdrawal from those substances. Because of this, kratom use is strongly associated with other substances like cannabis and opioids.
How to Help Your Child Avoid Kratom
DeVries’ recommendation for guardians hoping to steer teenagers away from kratom is open communication. Teenagers are more likely to come to family for support if they feel comfortable being honest.
Parents need to recognize changes in behavior and be willing to take their child to the doctor or to a therapist to talk about kratom use if their child is already using it.
It’s also important for parents to be aware that kratom is being marketed as a natural herbal supplement, leading many teens to perceive kratom as safe.
“Natural doesn't mean safe. Even legal doesn't mean safe. It is addictive,” said DeVries. “Young brains are still forming — they're very susceptible, so we really want to catch this sooner than later if a kid is getting exposed to it.”
DeVries’ clinical approach: listen with the intent to understand someone’s experience and then educate them about why kratom isn’t a safe solution.
“I would never fault someone for trying to feel better by seeking out ways to treat their pain, insomnia, anxiety or depression, but we don't want to be using an off-the-shelf product like kratom to treat mental and physical health,” DeVries said.
