Why Kratom Is At The Heart Of A Big Public Health Debate

Summary

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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.

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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).

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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

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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 |

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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.

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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.

Transcript

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[Emily Kwong]

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[Rachel Carlson]

Hey, Emily. So I am here today to talk to you about something becoming more popular. It's called kratom or kratom. People pronounce it both ways, but a lot of the sources I talked to said kratom. So I think that's what we'll stick with for this episode.

[Emily Kwong]

Well, where does kratom come from exactly?

[Rachel Carlson]

Kratom's derived from tree leaves. It's been used for centuries in Southeast Asia, mostly Indonesia, Malaysia and Thailand, for energy and to treat pain. But in the US it's sort of an umbrella term that includes a bunch of different products like teas, pills, extracts, synthetic goods that all vary in strength depending on how they're made. It's kind of like when someone says cannabis products, that could mean whole leaf or extracts from the leaves or synthetic products.

[Emily Kwong]

Okay. So the term kratom could actually mean a bunch of different things.

[Rachel Carlson]

Yeah, I've heard it referred to as a drug, as a supplement, as an ingredient. So I asked the fda, the Food and Drug Administration, and they told me in an email statement it depends on the specific product.

[Memorial Sloan Kettering Cancer Center Announcer]

Okay.

[Emily Kwong]

Complicated.

[Rachel Carlson]

And on top of that, there's one compound in the Kratom plant in particular, that's been in the headlines recently. People call it 7OH, which stands for 7Hydroxymetragynine. Some people also pronounce it mitral gyne. But mostly people just say 7 oh.

[Emily Kwong]

7 oh. Okay, where do people buy 7 oh?

[Rachel Carlson]

You can pretty much buy it anywhere. So it's sold in smoke shops, gas stations, convenience stores. It's possible you've actually seen it advertised on those neon signs that say weed, but instead, it'll say kratom or 7oh in those bright letters.

[FDA Commissioner Marty Makary]

7Oh is not just like an opioid, it is an opioid.

[Rachel Carlson]

That was FDA Commissioner Marty Makary during a press conference in July. And that's when the FDA said they were recommending certain 7oh products be scheduled alongside opioids.

[FDA Commissioner Marty Makary]

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.

[Rachel Carlson]

But not every researcher I talked to was ready to sound those alarm bells. They told me Kratom and 7oh are at the heart of a big public health debate right now. Past estimates for how many people use Kratom every year run anywhere from 2 million to more than 10 million. But there's not that much recent data. And those numbers include people who use kratom or 7oh to wean themselves off opioids like heroin or as a way to manage chronic pain without prescription drugs.

[Emily Kwong]

Oh, okay. I can see why people are so drawn to it because, of course, opioids are known for being really addictive.

[Rachel Carlson]

Yeah. I mean, According to the CDC, 76% of drug overdose deaths in 2023 involved opioids.

[Emily Kwong]

I can imagine having an alternative, a way out of using opioids would be.

[Rachel Carlson]

Really appealing for some people. It is. And some researchers say further restricting access to these products could affect those who've benefited. Others say kratom and 708 products have addictive properties themselves and that they should be better regulated.

[Emily Kwong]

So today on the show, what we do and do not know about Kratom.

[Rachel Carlson]

Why people are drawn to it, what it does to the body, and what happens when the drug market gets ahead of the science.

[Emily Kwong]

You're listening to Short Wave, the science podcast from npr.

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[Emily Kwong]

Okay, Rachel, so you've been looking into a whole suite of products sold under the names Kratom and 7.

[NPR Sponsor Announcer]

Oh.

[Emily Kwong]

What exactly do these products look like?

[Rachel Carlson]

Yeah, naturally, I wanted to know that, too. So when I started reporting on this, I went to go look for some.

[Emily Kwong]

What'd you find?

[Rachel Carlson]

I found so many different permutations of it on shelves. Pills, tablets, gummies, seltzers. Kind of like your average alcoholic seltzer beverage thing. Some companies even make chocolates. And it's available in smoke shops, liquor stores, gas stations, a lot of places.

[Emily Kwong]

But it originally comes from a plant, right?

[Rachel Carlson]

Yeah, it comes from a tree in the coffee family. And traditionally, people brew the leaves like a tea or they'll pick them off and chew them.

[Emily Kwong]

Wait, if it comes from a tree in the coffee family, does that mean it's a stimulant?

[Rachel Carlson]

So it's a little weird because in smaller amounts, Kratom can be a mood booster. I talked to David Epstein. He's a senior investigator at the National Institute on Drug Abuse, or nida. He wasn't speaking on behalf of NIDA when we talked, but he said it can make people feel energized, more focused.

[FDA Commissioner Marty Makary]

And often actually, they do compare that feeling good to what a cup of coffee does.

[Rachel Carlson]

Some people even use it to manage depression, anxiety, ptsd, and adhd. But in larger doses, the they also.

[FDA Commissioner Marty Makary]

Compare it a little bit to what.

[Rachel Carlson]

Opioids feel like, which is what FDA Commissioner Marty Makary was referring to earlier. It can relieve pain, make people feel kind of calm or even euphoric.

[Emily Kwong]

Okay, interesting. And like you said earlier, the term Kratom can refer to a lot of different things, Right. When people are talking about it.

[Rachel Carlson]

Right. The Kratom plant contains different compounds called alkaloids, metragynine and 7 hydroxymetragynine 7OH are two of the major psychoactive ingredients. Mitragynine binds to opioid receptors, but also things like serotonin receptors in the brain and in the Kratom plant and in natural kratom leaf products. 7oh shows up in tiny quantities.

[Emily Kwong]

But what about products that have higher concentrations of 7oH? What does that do to the brain?

[Rachel Carlson]

7Oh does seem to bind more exclusively to opioid receptors in the brain, just like heroin, morphine, or fentanyl, your classic opioids.

[NPR Sponsor Announcer]

Yeah.

[FDA Commissioner Marty Makary]

So I would see 7 hydroxymetragynin more as an opioid than Kratom.

[Rachel Carlson]

That's Oliver Grundmann. He's a professor at University of Florida College of Pharmacy.

[Emily Kwong]

Okay, so he's saying that it's a compound of Kratom that's really worrying people because it's so potent. Yeah.

[Rachel Carlson]

The concern is that there are a lot of new 7oh products popping up, like extracts and pills, that are much stronger than the Kratom products researchers have been studying for the last decade or so.

[Emily Kwong]

Got it. Okay, so seven oh it binds to opioid receptors. Does it make those products more addictive?

[Rachel Carlson]

I asked Ed Boyer that. He's a medical toxicologist at the Ohio State University, and that means his job is dealing with things like poisonings and overdoses in humans. 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.

[Emily Kwong]

Is there any data about this?

[Rachel Carlson]

There's not a lot, but there's some. One study surveyed around 2,000 people who used Kratom in the natural leaf form or concentrates or extracts, and a little over a quarter met criteria for Kratom use disorder. David Epstein told me those symptoms typically include withdrawal, increased tolerance, and cravings, which.

[FDA Commissioner Marty Makary]

Look like mild opioid withdrawal when they try to stop using it and they need to keep using it in order not to have those symptoms.

[Emily Kwong]

Gotcha. But what about seven OH products? Are there reports of, like, addiction concerns?

[Rachel Carlson]

I have seen anecdotal reports on addiction. There are Reddit channels devoted to people quitting kratom and 7oh products. Of course, there are also ones where people say they've benefited. But when it comes to the research, there's even less data on that. Some animal studies and early data suggest 7OH could be more addictive, especially because there are some products that are manufactured specifically to have a stronger impact on the body.

[FDA Commissioner Marty Makary]

When you think about something that is, for example, a nasal spray or something that is a tablet that dissolves under the tongue, then you actually circumvent many of the processes that would potentially prevent 7Hydroxymitragn from getting into the bloodstream and then through the bloodstream into the brain. Whoa.

[Emily Kwong]

Okay. I mean, given that, how are 7 oh formulations affecting people?

[Rachel Carlson]

There have been deaths related to kratom and 7 oh, but the numbers of how many deaths are tricky. A lot of them involve other substances like drugs or medications. And then, of course, there's the fact that kratom and 7oh aren't regulated by the FDA in. In the same way that prescription medications are. And that's created some health scares over the years. The FDA has recalled karatom products for salmonella contamination and for unsafe levels of heavy metals like lead and nickel.

[Emily Kwong]

Oof.

[Rachel Carlson]

And then there's the fact that the products may not be labeled well to begin with.

[NPR Sponsor Announcer]

Yeah.

[Emily Kwong]

Right. So people don't always know, then how much of these different ingredients they are taking.

[Rachel Carlson]

Yeah, you might not. Here's what Albert Garcia Romeo told me. He's an associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine.

[FDA Commissioner Marty Makary]

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. They often just say Kratom. So it would be like picking up a bottle of beer that should have 5% alcohol in it and actually getting a bottle of Everclear that has a very high content of alcohol.

[Emily Kwong]

Oh, that doesn't sound good. Okay, Rachel, at the beginning of our conversation, we talked about how the FDA wants to schedule 7oh products, which would be a big deal. It would regulate them. Do you think this could actually happen?

[Rachel Carlson]

It's really tricky. A similar question came up almost a decade ago. August 2016. The Drug Enforcement Administration, or DEA, wanted to make those two active ingredients in kratom. We talked about metragynine and 7 hydroxymetragynine CO, controlled substances, meaning Kratom would go from being widely available to highly restricted. And there was a huge wave of protest following that announcement. People were sending letters, writing comments, saying.

[Emily Kwong]

Like, don't touch our Kratom. Don't regulate it.

[Rachel Carlson]

Right. And after getting all those comments, the DEA decided not to move forward. Wow. So it's possible 7oh could follow a similar path, but for now, it's up to states. There are some, like Ohio, Florida, Rhode Island, Vermont, Indiana. They have either bans, limitations or age restrictions on either kratom or 7 oh there are also some countries where Kratom products are illegal, including Australia, Sweden, France. And after reporting all this, I feel like we're in ethical and legal limbo. Where are the lines? When you're weighing the risks of a drug against its potential rewards, Ultimately, whether or not 7 oh is scheduled will be up to the DEA. So I'm interested to see where they draw this line and what happens next.

[Emily Kwong]

Rachel Carlson, thank you for diving into this. I learned a lot.

[Rachel Carlson]

Yeah, you're welcome, Emily.

[Emily Kwong]

This episode was produced by Rachel Carlson and Anna Chin. It was edited by Rebecca Ramirez. Ramirez Tyler Jones checked the facts. Jimmy Keeley was the audio engineer. Beth Donovan is our vice president of podcasting. I'm Emily Kwong. Thank you for listening to Short Wave from npr.

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