Kratom is becoming an increasingly important public health concern across the United States, yet many people may not recognize it as an opioid or understand the risks associated with its use. In “Kratom Is an Opioid,” published in the Journal of Clinical Psychopharmacology, Andrew Kolodny and Christopher Holstege examine the science behind kratom’s effects and explain why its classification matters for prevention, treatment, public education, and policy.

Kratom is derived from a tree native to Southeast Asia and is commonly sold in the United States as powders, capsules, and liquid extracts, often in gas stations and convenience stores. Because it is frequently marketed as a natural product that can help with pain, energy, mood, or opioid withdrawal, consumers may assume it is safe or nonaddictive. However, the article highlights a concerning increase in kratom-related harm. Between 2015 and 2025, reports to US poison centers increased by approximately 1,200%, reaching a record 3,434 reports in 2025. Approximately one-quarter of these exposures involving kratom alone resulted in hospitalization. Kratom was also detected in thousands of overdose deaths between 2020 and 2024, although many of those deaths involved other substances.

The authors’ primary argument is that kratom should be recognized as an opioid based on how it affects the brain and body. The primary active compound in kratom is mitragynine, which activates the same opioid receptors affected by drugs such as morphine. The body also converts mitragynine into 7-hydroxymitragynine, a more potent opioid compound. Research cited in the article shows that kratom can produce typical opioid effects, including euphoria, physical dependence, tolerance, and withdrawal. Although kratom is often described as a stimulant at low doses and an opioid-like substance at higher doses, the authors explain that some traditional opioids can also produce stimulating effects. These characteristics do not make kratom a separate class of drug.

These findings highlight the importance of addressing misinformation and increasing awareness in our communities. People may use kratom without realizing that it can lead to dependence or that combining it with other substances may increase the risk of serious harm. Kratom products also vary considerably in potency, particularly concentrated extracts and products enriched with 7-hydroxymitragynine. Community education should therefore go beyond simply describing kratom as an herbal supplement and provide clear, evidence-based information about its effects, potential risks, and signs of problematic use.

The article also has implications for prevention, treatment, and community partnerships. Healthcare providers should consider kratom when assessing substance use, withdrawal symptoms, and unexplained adverse effects. The authors recommend approaching kratom use disorder using established approaches for opioid use disorder. Medications such as buprenorphine have shown promise in reported cases, although more research is needed to establish standardized treatment guidelines.

Kratom use during pregnancy is another concern because prenatal exposure can cause opioid withdrawal in newborns. Stronger communication among healthcare providers, treatment programs, prevention professionals, and public health agencies can help ensure that kratom-related harms are recognized and addressed.

Finally, the authors raise concerns about policies that focus only on highly concentrated 7-hydroxymitragynine products while leaving other kratom products widely available. Although concentrated products may pose particularly serious risks, traditional kratom products can also cause opioid effects, dependence, and other harms. The authors argue that prevention and policy efforts should account for the full range of kratom products rather than treating only one category as a concern.

Kratom deserves a place in local substance use prevention strategies, community education efforts, and conversations about emerging drug trends. Coalitions can help by sharing accurate information, engaging schools and healthcare partners, educating families and community leaders, and monitoring local patterns of use and harm. The goal is not to create unnecessary alarm, but to make sure people have the information they need to make informed decisions. As communities continue responding to the opioid crisis, recognizing kratom’s risks is another opportunity to apply what we have learned and prevent avoidable harm.

Kolodny, A., & Holstege, C. P. (2026). Kratom is an opioid. Journal of Clinical Psychopharmacology. https://doi.org/10.1097/JCP.0000000000002272