For generations, communities in Southeast Asia have used the leaves of Mitragyna speciosa — kratom — brewed as a drink to relieve pain and steady mood. Its principal alkaloids, mitragynine and the more potent 7-hydroxymitragynine, act on opioid receptors and produce analgesic effects.
Kratom has since gained a significant presence in the United States, where consumers often use it as an alternative to prescription opioids or as a self-directed aid in managing withdrawal. It is sold in teas, capsules, powders, and concentrated extracts, with purified 7-OH products increasingly appearing in vape shops, convenience stores, and online markets.
Regulators are now moving toward prohibition. Last July, Food and Drug Administration Commissioner Marty Makary and Health and Human Services Secretary Robert F. Kennedy Jr. announced plans to urge the Drug Enforcement Administration to place 7-OH in Schedule I — the same legal category as heroin.
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Supporters of these efforts argue that kratom — especially high-potency 7-OH — could fuel the next wave of overdose deaths. But the data tell a different story.
Fatal overdoses in which 7-OH has been implicated are exceedingly rare, and deaths linked to kratom more broadly are rarer still. In the limited cases where coroners listed kratom or 7-OH as contributing factors, polysubstance use was the norm. Roughly two-thirds of decedents had fentanyl in their systems. About one-third had heroin present, and just under one-fifth had prescription opioids or cocaine. Around 80% had documented histories of substance misuse, and about 90% were not receiving clinical care for pain.
Each of these deaths is tragic, and any loss of life linked to psychoactive substances deserves careful scrutiny.
Despite this evidentiary backdrop, lawmakers in several states — including Colorado, Tennessee, and New Jersey — have advanced prohibition bills named after individuals said to have died from 7-OH overdoses, while in Michigan, sponsors have invoked similar cases in arguing for restrictions. These eponymous measures invoke sympathy while implying a simple causal narrative: 7-OH alone caused the death.
Autopsy and medical examiner findings underscore the complexity of causal attribution.
In multiple cases, toxicology reports revealed polysubstance exposure alongside 7-OH — sometimes including fentanyl, heroin, cocaine, or prescription opioids. In the Tennessee case, the decedent, Matthew Davenport, was residing in a sober living facility for alcohol dependence and had diphenhydramine (Benadryl) and two psychiatric medications in his system in addition to 7-OH — substances that can increase respiratory risk in combination with opioid-like compounds. Tennessee’s Matthew Davenport’s Law “establishes criminal penalties for the possession, manufacture, delivery, and sale of Kratom.”
Last May, Colorado Gov. Jared Polis (D-CO) signed the Daniel Bregger Act, which bans the sale or marketing of kratom products to people under 21 and prohibits products that exceed specific 7-OH limits, appeal to children, are intended for vaping or are combustible, or contain more than 2% 7-OH. In addition to kratom, Bregger was found on autopsy to have Benadryl, trazodone (an antidepressant and sleep aid), and cannabinoids in his blood.
In New Jersey, CJ’s Law, named after Christopher James “CJ” Holowach, would totally prohibit all forms of kratom. The autopsy report showed he had a combination of Adderall (amphetamines), kratom, tranquilizers, cannabinoids, and fentanyl.
Although Michigan’s House Bill 4969 — which aims to ban 7-OH — is not named after overdose victim Dakota Herrera, aged 27, bill sponsors often reference his story. Toxicology studies found Herrera to have valproic acid and carbamazepine — anticonvulsants that cause respiratory depression when taken with opioids — along with cannabinoids and kratom in his bloodstream.
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Policymakers confronting a fentanyl-driven overdose crisis understandably feel pressure to act, and emotionally charged cases can illuminate real risks. But they should resist the temptation to legislate by anecdote when broader population-level evidence points in a more complicated direction — especially when prohibition could deny some consumers a substance they believe helps them manage pain, withdrawal, or psychological distress.
Moving 7-OH into Schedule I would not eliminate demand; it would displace it, shifting sales from regulated retail settings into illicit markets where potency is unverified, adulteration is common, and risks are far greater. Such a step could also provide transnational criminal organizations with yet another product to layer onto a portfolio already dominated by fentanyl and its analogues. In striving to prevent harm, lawmakers risk repeating a familiar policy pattern — one that inadvertently amplifies danger while removing a lower-risk alternative from the legal marketplace.
Dr. Jeffrey A. Singer practices general surgery in Phoenix, Arizona, and is a senior fellow at the Cato Institute. His recent book is Your Body, Your Health Care.