Episode Overview

Episode: Why Kratom Is At The Heart Of A Big Public Health Debate
Podcast: Short Wave (NPR)
Date: December 29, 2025
Hosts: Emily Kwong and Rachel Carlson

This episode explores the growing popularity and controversy surrounding kratom in the United States. With kratom products proliferating and recent FDA moves to regulate some of their components, hosts Emily Kwong and producer Rachel Carlson break down what kratom is, why people use it, the science behind its effects, public health concerns, and the debate over its safety and legality.

Key Discussion Points & Insights

1. What is Kratom?

• Origins and Traditional Use
  • Kratom is derived from tree leaves in Southeast Asia (Indonesia, Malaysia, Thailand); traditionally used for energy and pain relief.
  • In the US, "kratom" now refers to a wide range of products: teas, pills, extracts, and synthetics, varying in strength and purity.
  • "[...] a bunch of different products like teas, pills, extracts, synthetic goods that all vary in strength depending on how they’re made." (Rachel Carlson, 01:47)
• Confusion Over Terminology
  • The term "kratom" means different things depending on the context/product.
  • The FDA told Rachel it "depends on the specific product." (Rachel Carlson, 02:19)

2. Rise of 7-Hydroxymitragynine ("7OH")

• What is 7OH?
  • A compound in the kratom plant, much more potent than most kratom alkaloids.
  • Available in common retail settings (smoke shops, gas stations, convenience stores) and often marketed under flashy signage.
  • "7Oh is not just like an opioid, it is an opioid." (FDA Commissioner Marty Makary, 03:09)
• Potency and FDA Concerns
  • The FDA seeks to schedule 7OH products alongside opioids, citing studies showing 7OH is "13 times more potent than morphine." (FDA Commissioner Marty Makary, 03:26)
• Wider Debate Among Experts
  • Some see heavy regulation as necessary; others warn this could restrict those using kratom to manage pain or avoid stronger opioids.

3. Why Do People Use Kratom?

• Opioid Alternative
  • Many US users turn to kratom to self-manage opioid dependence, wean off heroin, or treat chronic pain without prescriptions.
  • "Those numbers include people who use kratom or 7OH to wean themselves off opioids like heroin or as a way to manage chronic pain.” (Rachel Carlson, 03:37)
• Stimulant/Mood Booster
  • In small doses, kratom can act as a mild stimulant—comparable to caffeine.
  • "It can make people feel energized, more focused." (David Epstein, cited by Rachel Carlson, 07:18)
• Other Uses
  • Some use for mood disorders: depression, anxiety, PTSD, ADHD.

4. How Kratom Works

• Active Compounds
  • Primary psychoactive ingredients are mitragynine and 7-hydroxymitragynine (7OH).
  • Mitragynine acts on opioid and serotonin receptors; 7OH is more opioid-specific.
  • "[7OH] does seem to bind more exclusively to opioid receptors in the brain, just like heroin, morphine, or fentanyl, your classic opioids." (Rachel Carlson, 08:23)

5. Addiction and Health Concerns

• Addiction Potential
  • Both kratom and 7OH can be addictive; the risk level compared to standard opioids is not fully known.
  • "Can you get addicted to Kratom? Yes. Can you get addicted to 7-hydroxy mitragynine? Yes. Is the propensity towards addiction greater for kratom than other opioids? I don’t know." (Ed Boyer, 09:18)
  • ~25% of surveyed users met criteria for Kratom Use Disorder; symptoms include withdrawal, tolerance, and cravings.
• Withdrawal Symptoms
  • Resemble mild opioid withdrawal: "they need to keep using it in order not to have those symptoms." (David Epstein, 09:52)
• Anecdotal Reports & Forums
  • Reddit and online communities support both quitting and benefiting from use; data on 7OH addiction still sparse.
• Potency and Methods of Use
  • Extract products (such as nasal sprays, dissolvable tablets) may bypass natural barriers, increasing potency and addiction risk.
  • "[...] circumvent many of the processes that would potentially prevent 7-hydroxymitragynine from getting into the bloodstream and then through the bloodstream into the brain." (FDA Commissioner Marty Makary, 10:29)

6. Regulation, Safety, and Labeling

• Product Safety Risks
  • Deaths involving kratom/7OH often occur alongside other drugs, and precise figures are unclear.
  • Lack of FDA regulation has led to contamination incidents (salmonella, heavy metals).
  • "There’s the fact that kratom and 7OH aren’t regulated by the FDA in the same way that prescription medications are. And that’s created some health scares over the years." (Rachel Carlson, 11:03)
• Labeling Issues
  • Many products contain unknown or inaccurately labeled levels of active compounds.
  • "Even some of these products [...] have high levels of 7OH [but] are not labeled as such. They often just say Kratom. So it would be like picking up a bottle of beer [...] and actually getting a bottle of Everclear." (Albert Garcia Romeo, 11:49)
• Current Legal Status
  • FDA is considering scheduling 7OH; previously, the DEA tried (2016) but backed off after strong public pushback.
  • Regulation varies state to state; some states ban or restrict kratom or 7OH, and it is banned in several countries (Australia, Sweden, France).

Notable Quotes & Memorable Moments

• 03:09: “7Oh is not just like an opioid, it is an opioid.”
  — FDA Commissioner Marty Makary
• 03:26: “Our focus is not on Kratom. Our focus is on 7 oh, which, according to the Journal of Medical Chemistry, is 13 times more potent than morphine.”
  — FDA Commissioner Marty Makary
• 07:22: “They do compare that feeling good to what a cup of coffee does.”
  — David Epstein (as cited by Rachel Carlson)
• 09:18: “Can you get addicted to Kratom? Yes. Can you get addicted to 7 hydroxy mitrogynine? Yes. Is the propensity towards addiction greater for Kratom than other opioids? I don't know.”
  — Ed Boyer
• 11:49: “The real problem, too, is that even some of these products that are extracts that have high levels of 7OH are not labeled as such. […] It would be like picking up a bottle of beer that should have 5% alcohol in it and actually getting a bottle of Everclear.”
  — Albert Garcia Romeo

Timestamps for Key Segments

| Timestamp | Segment | |-----------|---------------------------------------------------------------| | 01:29 | Rachel Carlson introduces kratom and its growing popularity | | 02:34 | Explanation of 7-hydroxymitragynine (7OH) and its significance| | 03:09 | FDA's stance and comment on 7OH as an opioid | | 04:06 | Public health debate: why people use kratom | | 06:23 | Rachel describes variety of kratom products on the market | | 07:05 | Discussion of kratom’s stimulant effects in small doses | | 08:18 | How mitragynine and 7OH act in the brain | | 09:00 | Addiction potential of kratom and 7OH | | 10:29 | Potency, new products, and pathways into the bloodstream | | 11:01 | Reports of health effects and regulatory gaps | | 11:35 | Labeling issues and product inconsistency | | 12:20 | History and obstacles in attempts to regulate kratom/7OH | | 12:52 | State-by-state and global differences in kratom legality |

Tone & Style

The conversation is science-forward but approachable, grounding complex scientific and regulatory details in everyday analogies and real-world implications. The tone is curious, balanced, and at moments urgent—highlighting both the promising aspects and real dangers of kratom’s popularity.

Summary for New Listeners

This episode serves as a concise primer on why kratom, especially its potent 7OH variant, is currently at the center of U.S. public health debate. The science is both promising and concerning: kratom may help people reduce or avoid opioid use, but newer, less-regulated products might present their own risks, including addiction, contamination, and overdose. Unclear legal status, inconsistent product labeling, and the patchwork of state and federal regulation create uncertainty for users, health officials, and lawmakers alike — and the future of kratom’s legal status remains undecided.