BrieAnne Gray: ‘Natural’ doesn’t mean safe: Why kratom needs regulation

By BrieAnne Gray

In my practice as an OB-GYN nurse practitioner in Spokane, I care for women at some of the most vulnerable and transformative moments of their lives. Increasingly, I am seeing something that should concern all of us: pregnant patients and young women using kratom and high-potency 7-hydroxymitragynine (7-OH) products purchased at gas stations, smoke shops and online, often with little understanding of what they are taking.

These products are widely available, largely unregulated, and frequently marketed as “natural” alternatives for pain relief, anxiety or energy. But “natural” does not mean safe, especially during pregnancy. Kratom’s active compounds act on opioid receptors in the brain. I have had difficult conversations with patients who did not realize that what they were taking could have opioid-like effects or pose risks to their developing baby.

That is why I support the efforts underway in the Washington Legislature to regulate kratom and 7-OH products. Lawmakers are considering proposals that would ban sales to individuals under 21, establish product standards and labeling requirements, and impose a meaningful tax on sales for adults. These are reasonable, measured steps.

First, we must protect young people. The adolescent brain is still developing, and substances that act on opioid receptors can interfere with that development. We already restrict alcohol, cannabis and tobacco for this reason. Kratom and concentrated 7-OH products should be treated no differently. A clear, enforceable ban for those under 21 would send an important message: these are adult products with real physiological effects.

Second, we need meaningful regulation. Product potency currently varies widely. Some extracts contain highly concentrated levels of 7-OH, which is significantly more potent than traditional kratom leaf. Without labeling standards, consumers have no reliable way to know what they are ingesting. That is unacceptable, particularly when pregnant women or young adults may be using these products to self-treat pain, depression or opioid withdrawal.

Taxing kratom and high-potency 7-OH products is responsible policy. If these products are going to remain legal for adults, they should not be treated like ordinary dietary supplements. A meaningful excise tax recognizes that they have real pharmacological effects and ensures the state has the resources to regulate them effectively.

Revenue from these sales can fund youth prevention efforts, support enforcement to keep products out of the hands of minors, and provide oversight to ensure labeling and safety standards are upheld. Regulation without funding is simply an unfunded mandate. A dedicated tax structure makes enforcement sustainable and credible.

Washington is also facing a significant budget shortfall. Allowing a rapidly expanding market with opioidlike properties to operate without contributing revenue is short-sighted. If adults choose to purchase these products, a portion of that revenue should help support the broader public good, including the health systems that address substance-related harms.

As a health care provider, I am not calling for alarmism. I am calling for balance and responsibility. Adults can make informed choices, but only when products are clearly labeled, sold responsibly and regulated appropriately. And our children deserve stronger protections than the current free-for-all marketplace provides.

We have learned hard lessons from past public health crises. Waiting too long to regulate emerging substances carries real costs, measured not just in dollars, but in long-term health consequences. Sensible guardrails now can prevent deeper harm later.

Banning sales to those under 21, establishing clear product standards, and implementing a meaningful tax on adult sales are prudent, common-sense steps. They protect young people, provide transparency for consumers, and ensure that if these products are sold in our communities, they contribute to the health and stability of our state.

Our patients, and our children, deserve nothing less.

BrieAnne Gray, ARNP, is an OB-GYN nurse practitioner in Spokane and a mother committed to protecting the health of women and children.