By Nway Linn, Chief Clinical Officer, RADIAS Health
Over the past year, several behavioral health professionals have reached out to me to share that they are seeing more clients reporting kratom use and, increasingly, challenges related to dependence, withdrawal, and adverse health effects. While kratom has often been marketed as a natural or herbal product, growing evidence suggests it is not without risks. While kratom is often marketed as a natural or herbal product, growing evidence suggests it can produce opioid-like effects, dependence, and clinically significant withdrawal symptoms.
Kratom (Mitragyna speciosa) is a tropical tree native to Southeast Asia. Its primary active compounds, mitragynine and 7-hydroxymitragynine, interact with opioid receptors in the brain. Depending on the dose, kratom can produce stimulant-like effects, pain relief, sedation, and mood changes. Many individuals report using kratom to manage chronic pain, anxiety, depression, or symptoms of opioid withdrawal. However, long-term use can result in tolerance, dependence, and withdrawal symptoms like those seen with opioids. (Kratom | National Institute on Drug Abuse; Arhin et al., 2023)
Why Are Providers Seeing More Kratom Use?
One factor is accessibility. Kratom products are widely available through online retailers, convenience stores, vape shops, and gas stations. Unlike FDA-approved medications, kratom products are largely unregulated, resulting in significant variation in potency, purity, and labeling. Recent years have also seen the emergence of concentrated kratom extracts and products containing elevated levels of 7-hydroxymitragynine, raising concerns about increased toxicity and addiction potential. (Increases in Kratom-Related Reports to Poison Centers — National Poison Data System, United States, 2015–2025)
The public health impact appears to be growing. According to the CDC, poison centers received 14,449 kratom-related exposure reports between 2015 and 2025. Annual reports increased from 258 cases in 2015 to 3,434 cases in 2025, representing an increase of approximately 1,200%. The CDC also found increasing rates of hospitalization, serious medical outcomes, and deaths associated with kratom exposures, particularly when kratom was used with other substances. (Towers et al., 2026)
Risk Factors and Clinical Considerations
Several factors may increase the likelihood of problematic kratom use:
- History of opioid use disorder or other substance use disorders.
- Self-treatment of chronic pain.
- Use for anxiety, depression, or opioid withdrawal symptoms.
- High-dose or long-term use.
- Use of concentrated extracts or enhanced kratom products.
- Concurrent use with alcohol, opioids, benzodiazepines, stimulants, or antidepressants.
Withdrawal symptoms commonly reported by individuals stopping kratom include anxiety, irritability, insomnia, headaches, nausea, diarrhea, fatigue, and restlessness. More severe adverse events associated with kratom use have included seizures, hallucinations, respiratory depression, and coma. (Arhin et al., 2023)
Behavioral health providers should consider routinely screening for kratom use during diagnostic assessments, substance use evaluations, and medication reviews. Importantly, many individuals do not perceive kratom as a drug of abuse and may instead describe it as a supplement, herbal product, or natural alternative to prescription opioids. (NIDA; Arhin et al., 2023)
Minnesota’s Legislative Response
Minnesota lawmakers have recently taken steps to address concerns related to kratom products. The 2026 Minnesota Legislature enacted Chapter 63, which establishes additional safeguards related to kratom sales and distribution, including provisions intended to reduce youth access and increase oversight of kratom products. Minnesota strengthened its kratom laws in 2026 by raising the minimum legal age for the purchase and possession of kratom from 18 to 21 years old. Effective August 1, 2026, the law prohibits the sale of kratom and kratom-derived products to individuals under 21 and reflects growing concerns about youth access, increasingly potent kratom products, and rising reports of adverse health effects.
These changes reflect growing concerns regarding consumer safety, product potency, and the increasing availability of kratom among adolescents and young adults. (Chapter 63 – Minnesota Laws 2026) For providers working in Minnesota’s behavioral health and substance use treatment communities, these legislative changes signal increasing recognition of kratom as an emerging public health concern and may lead to greater awareness among consumers, families, and healthcare professionals.
Emerging Treatment Approaches
Currently, there are no established evidence-based standards of care for kratom use disorder. Most treatment recommendations are based on case reports, clinical experience, and adaptation of approaches used for opioid withdrawal and opioid use disorder. (Arhin et al., 2023)
One published case report described a patient with long-term, high-dose kratom dependence who was successfully treated using buprenorphine/naloxone. The medication reduced withdrawal symptoms and supported successful discontinuation of kratom use. Other case reports and clinical discussions have suggested potential benefits from clonidine and symptom-targeted treatment approaches; however, more rigorous research is needed before definitive treatment recommendations can be made. (Arhin et al., 2023)
As kratom-related treatment presentations increase, clinicians should consider consultation with addiction medicine specialists when significant dependence or withdrawal symptoms are identified. Providers familiar with medications for opioid use disorder may be particularly well-positioned to evaluate whether buprenorphine-based treatment is clinically appropriate on an individualized basis. (Arhin et al., 2023)
Conclusion
Kratom occupies a rapidly evolving space within behavioral health and substance use treatment. While some individuals report benefits related to pain management or opioid withdrawal, increasing evidence demonstrates that kratom carries a risk of dependence, withdrawal, hospitalization, and serious health consequences. Growing rates of kratom-related poison center reports, emerging high-potency products, and recent legislative changes in Minnesota highlight the importance of provider awareness. Routine screening, client education, and familiarity with emerging treatment approaches may help behavioral health professionals respond effectively as kratom use becomes more prevalent in our communities. (Towers et al., 2026; Arhin et al., 2023)
References
Arhin, M., Mobley, J., Hamad, H., & Remick, P. (2023). Successful management of kratom use disorder with buprenorphine and naloxone. Cureus, 15(6), e41146. https://doi.org/10.7759/cureus.41146
Minnesota Legislature. (2026). Chapter 63: Regulation of kratom products. Retrieved from Minnesota Session Law Chapter 63.
National Institute on Drug Abuse. (n.d.). Kratom.
Retrieved from NIDA Kratom Resource
Towers, E. B., Thomas, Y. T., Holstege, C. P., & Farah, R. (2026). Increases in kratom-related reports to poison centers: National Poison Data System, United States, 2015-2025. MMWR Morbidity and Mortality Weekly Report, 75(11), 139-145. https://doi.org/10.15585/mmwr.mm7511a1