Across gas stations, smoke shops and the internet, consumers can easily buy kratom—a herbal substance that some users claim is an antidote to opioid dependence and a lifeline for alleviating mental and physical pain. In 2021 alone, roughly 1.7 million Americans used kratom, although the F.D.A. has not approved it for any medical use.
There is limited information on kratom — a 2022 review of its health effects characterized the research in the United States as “still in its infancy.” But federal health authorities have persistently highlighted the potential harms: The Food and Drug Administration urges consumers not to use it “because of the risk of serious adverse events,” and the Drug Enforcement Administration has labeled kratom a “drug and chemical of concern.” Recently, a string of lawsuits have alleged that kratom consumption may have contributed to the deaths of several people.
Despite those warnings, kratom largely remains legal and accessible across the United States. It’s up to consumers to weigh the allure of what some consider a more “natural” alternative to opioids against the stark warnings from health officials.
“When you take something that is essentially a drug, and you essentially don’t study that drug, and you don’t advertise anything except, ‘Oh it’s a plant product, therefore it’s safe,’ you create all sorts of problems,” said Dr. Rif El-Mallakh, the director of the Mood Disorders Research Program at the University of Louisville School of Medicine.
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