Is kratom safe? Rising health concerns explained
Director of the Virginia Poison Center at VCU Health warns consumers about the hidden health risks associated with kratom and 7-OH products.
November 14, 2025
Kratom and 7-OH products are often sold as powders, candies, teas and energy shots. Federal officials are warning consumers about these unsafe products. (U.S. Food and Drug Administration)
By Mia Stephens
Kratom and 7-hydroxymitragynine (7-OH) products are all the buzz in smoke shops and gas stations, marketed as safe alternatives for pain relief and opioid withdrawal, and supposedly can lift your mood.
But the U.S. Food and Drug Administration (FDA) is warning consumers to stay away from these products because of the risk of addiction and overdose.
“The biggest misconception is that “natural means safe,” said John Downs, M.D., M.P.H., director of the Virginia Poison Center at VCU Health. “Kratom and 7-OH are not harmless herbal supplements — they act on the same receptors as opioids. People using these substances can have the same detrimental effects seen with opioids.”
Often sold as powders, candies, teas or energy shots, kratom products are not banned or regulated federally in the U.S. In Virginia, kratom is illegal to sell to those under the age of 21. Many other states, such as Alabama, Arkansas, Indiana, Rhode Island, Vermont, Wisconsin, and Louisiana, have taken steps to ban it.
Downs spoke with VCU Health News about the risky side effects of kratom and 7-OH and tips to steer clear from these unsafe products.
What is kratom and why is it used?
Kratom comes from the leaves of the mitragyna speciosa, a tree found in parts of southeast Asia. The herb in small amounts is used for energy, pain relief, anxiety, and self-treating opioid withdrawal or opioid use disorder.
In the U.S., the substance is legal, but not FDA-approved for medical use. In other countries, it is legal or used strictly for medical purposes.
Are there any differences between kratom and 7-OH? Why is this important to know?
Yes, there are several differences between kratom and 7-OH.
Kratom often refers to the herbal supplement. The traditional kratom leaf contains mitragynine, a compound that has psychoactive properties that may relieve pain and opioid-withdrawal symptoms, as well as trace amounts of the compound 7-OH, a more potent opioid-like chemical. While approved for medical purposes in other countries, it is not approved as a medical treatment in the U.S.
Items sold under the name 7-OH are concentrated versions of the 7-hydroxymitragynine chemical, derived from the kratom plant, but more strongly mimicking the effects of opioids, like heroin and morphine. The FDA is specifically warning consumers about 7-OH because of the risk of overdose and dependence.
What are the health risks associated with kratom?
Common side effects of using kratom include:
- Nausea
- Confusion
- Agitation
- Shallow breathing
- Seizures
- Becoming sedated or comatose, similar to an opioid overdose
Users may also experience an increase in dependency and withdrawal symptoms with chronic, repeated use.
Federal officials say kratom is part of the “next wave of the opioid epidemic.” How has the opioid epidemic changed when it comes to these products?
There is no clear answer if the use of kratom-related products will truly represent a new phase in the evolving opioid epidemic. Kratom has been around for more than a decade in various forms, and the risks still exist. Health care professionals are still learning how to manage cases of toxicity and dependence. However, we still haven’t seen the same magnitude of overdose cases as with other opioids like fentanyl.
Another notable shift is the marketing and availability of these products. They’re out in the open in vape shops and convenience stores for purchase without any clear explanations of the potential downsides or consequences related to use – potentially making it easier to get into the hands of teens and young adults.
When should someone seek medical help?
If you see someone showing signs of confusion, extreme sedation, slowed breathing or seizures after using kratom or 7-OH, immediately call 911. Naloxone may reverse some of these effects and can be administered if available.
For questions about possible exposure or side effects, call the Virginia Poison Center at 1-800-222-1222 for assistance. We have nurses and doctors on standby around the clock to help.
What does recovery look like?
Recovery from kratom or 7-OH depends on how much and how long someone has used these products. People who have used these products for an extended amount of time may receive similar treatments used for opioid use disorder.
How can people avoid these popular but risky products?
In general, I recommend avoiding products labeled “extra strength,” “extract,” “enhance,” "Ultra” or “7-OH.”
We don’t know enough about these products yet, but early reports indicate that these products are harmful. If a label makes bold claims such as pain relief or energy boost – it’s very unlikely to be FDA-approved and safe. Other things to avoid are mixing them with other drugs or alcohol. This may cause difficulty breathing and sedation.
If you have any questions or concerns, please call the poison center.
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