Joshua Pierce: Though easily available, kratom can have serious consequences

By Joshua Pierce

One of the fastest-growing substances of concern in the United States is kratom. As its use has increased dramatically in recent years, so have concerns among healthcare providers, addiction specialists and public health officials about dependence, overdose risk, youth access and the lack of clear treatment guidelines.

According to the 2023 National Survey on Drug Use and Health, an estimated 1.6 million Americans use kratom products each year, and approximately 5 million people report having used kratom at some point in their lives.

Kratom comes from the leaves of Mitragyna speciosa, a tropical tree native to Southeast Asia, where it has been used for pain relief, mood enhancement, and to ease symptoms of opioid withdrawal. Today, kratom is commonly sold in powders, gummies, capsules and beverages.

The concern lies in its active ingredients. Kratom contains two primary psychoactive compounds – mitragynine and 7-hydroxymitragynine (7-OH) – that bind to the same opioid receptors in the brain targeted by drugs such as morphine. As a result, kratom can produce opioidlike effects, including pain relief, sedation, and dependence.

The rapid growth in use has prompted governments across the country to consider age restrictions, testing requirements and bans. In Washington state, legislation that would have banned kratom and 7-OH failed this year. Locally, however, Spokane, Spokane Valley and Medical Lake have enacted ordinances prohibiting their sale, and a similar proposal has been introduced in Cheney. These actions reflect growing concerns about public health and safety.

Data from the National Poison Data System show that kratom-related exposures increased by approximately 1,200% between 2015 and 2025. Most cases involved men ages 20 to 39, but the fastest growth occurred among adults ages 40 to 59, whose rates nearly matched those of younger adults by 2025. These trends mirror patterns seen in Spokane County’s opioid overdose data.

In Washington, poison center reports indicate that most overdose incidents involved kratom alone. However, when kratom was combined with other substances, the outcomes were often much more severe. Polysubstance use was associated with significantly higher hospitalization rates, more serious medical complications, and nearly 79% of kratom-related deaths.

More recent data from the Centers for Disease Control and Prevention’s State Unintentional Drug Overdose Reporting System identified 86 overdose deaths in Washington associated with the presence of kratom and 7-OH. These findings highlight the need for stronger surveillance, prevention efforts and informed policy discussions.

Another challenge is accessibility. Kratom and 7-OH products are commonly sold in gas stations, convenience stores and smoke shops, often marketed as herbal supplements or wellness products. Yet the U.S. Food and Drug Administration has not approved kratom or 7-OH for any medical use. Kratom cannot legally be marketed as a dietary supplement and cannot lawfully be added to food products.

Despite this, there are often few barriers to purchase. Particularly concerning is the lack of statewide age restrictions in Washington, which can make these products easily accessible to youths.

For individuals who use kratom regularly, dependence is another concern. People who stop using kratom may experience withdrawal symptoms similar to those associated with opioids. Yet there are currently no formal, evidence-based treatment guidelines specifically for kratom dependence.

Some healthcare providers treat kratom use disorder similarly to opioid use disorder, using medications such as buprenorphine, methadone, or naltrexone. However, these approaches rely largely on clinical experience and case reports rather than standardized treatment protocols.

As awareness grows, it is important to remember that many people turn to kratom seeking relief from pain, opioid use, or stress. For those individuals, safer and more effective options may be available. Anyone using kratom or 7-OH for these purposes should consider speaking with a healthcare provider or contacting the Washington Recovery Helpline at 866-789-1511.

It is also important for community members to understand the role of naloxone, also known as Narcan. Because kratom and 7-OH act on opioid receptors and can contribute to respiratory depression, naloxone may help reverse an overdose emergency.

As kratom use becomes more common and these products remain widely accessible, keeping naloxone on hand is increasingly important. Overdoses can happen anywhere and can affect anyone who uses opioids or kratom. To learn more about recognizing an overdose, obtaining naloxone, or responding to an overdose emergency, visit srhd.org/stopoverdose.

Communities are strongest when people have accurate information, access to treatment, and the tools they need to prevent harm. As kratom use continues to rise, Spokane has an opportunity to approach this issue with the same commitment to education, prevention and community safety that has guided our response to other substance-use challenges.

Joshua Pierce is the health promotion manager for the Spokane Regional Health District.