[The Journal] This Opioid Alternative Is Fueling an Addiction Crisis

Kratom is a plant native to Southeast Asia whose leaves contain compounds that act on the brain’s opioid receptors. In low doses it functions as a stimulant; in higher doses it produces sedative and pain-relieving effects similar to opioids. For years it has been sold legally in the United States as a dietary supplement, available in powder, capsule, and drink form at gas stations, smoke shops, and online retailers. Proponents argue it offers a natural, accessible alternative to prescription painkillers and has helped many people wean themselves off harder drugs.

The supplement industry has aggressively marketed kratom to a broad audience — veterans dealing with chronic pain, workers seeking an energy boost, and individuals struggling with opioid use disorder. Vendors emphasize its herbal origins and over-the-counter availability to position it outside the sphere of conventional drug regulation. Estimated sales run into the hundreds of millions of dollars annually, making kratom a significant niche market

within the broader wellness economy.

Despite its popularity, kratom occupies a legal gray zone. Because it is classified as a dietary supplement rather than a drug, it is not subject to the same pre-market approval

process required of pharmaceuticals. The FDA has not approved it for any medical use, yet it remains widely available, a situation that critics say leaves consumers without adequate safety guarantees.

Public health officials and medical researchers have increasingly linked kratom to a rising wave of addiction and fatal overdoses. Because its active compounds bind to the same receptors targeted by opioids such as morphine and fentanyl, regular use can produce physical dependence, withdrawal symptoms, and cravings. Poison control centers across the country have reported a sharp increase in calls related to kratom exposure, and the substance has been detected in a growing number of toxicology

reports filed in overdose deaths.

Part of what makes kratom particularly dangerous, experts say, is consumer confusion about its potency and risk profile. Many users begin taking it believing it to be a benign herbal remedy and escalate their intake without recognizing the signs of dependence. The lack of standardized dosing — products vary widely in their concentration of active alkaloids — means that users can inadvertently consume far more than intended. This variability is compounded by the fact that kratom is frequently cut with

other substances or synthetic opioids in some unregulated products.

The financial dimension of the crisis is also significant. Treatment for kratom addiction places new fiscal pressure

on already strained state healthcare systems, and the societal costs — lost productivity, emergency room visits, and law enforcement expenditures — are difficult to quantify but unmistakably large.

The question of how — or whether — to regulate kratom has triggered contentious debates at both the federal and state levels. The Drug Enforcement Administration once moved to classify kratom as a Schedule I controlled substance, a designation reserved for drugs with high abuse potential and no accepted medical use, but withdrew the proposal after a fierce backlash from consumer advocacy groups and some lawmakers. Since then, regulatory momentum has shifted to the states, with some enacting outright bans and others establishing age restrictions or labeling requirements. The patchwork of state laws has created an uneven landscape that industry groups argue is commercially unworkable and that public health advocates say is dangerously inadequate.

At the federal level, the FDA has used its authority to seize shipments of kratom products it deems adulterated or misbranded, yet it lacks the statutory authority

to remove it from the market entirely without going through a lengthy rulemaking process. The kratom industry, meanwhile, has organized a well-funded lobbying operation to resist stricter oversight, framing regulation as government overreach that would strip millions of Americans of a legal wellness product.

The debate ultimately reflects a broader tension between consumer freedom and public safety — a tension that has defined regulatory fights over substances from tobacco to hemp-derived products. Whether kratom ends up more tightly regulated, banned outright, or eventually approved through a formal medical review process will depend heavily on the accumulation of clinical evidence and the political will of legislators at both the state and federal level. For now, millions of Americans continue to use the supplement in a regulatory environment that satisfies almost no one.