Sarah Kawasaki first heard about kratom around five years ago. It wasn’t through her work — she’s an addiction medicine specialist at Penn State, and the medical director of their associated opioid treatment program — but through her personal life.
“People would say, ‘Hey, what do you know about kratom?,’” she told the Capital-Star. “And I’d be like, ‘What?’”
So Kawasaki began looking into it. Kratom, she found, is an herbal supplement with opioid-like effects. In low doses, it can act as a stimulant, and in higher doses it produces a more sedative-like effect. Along with being a recreational drug, many users have reported using it to manage chronic pain or opioid withdrawal symptoms.
As her interest grew, she began to notice advertisements at smoke shops and other stores around her neighborhood. Then there were a couple of patients who acknowledged using it.
Fast forward to the present and Kawasaki has 10 to 20 patients in central Pennsylvania she is treating exclusively for kratom use, most of whom (around 80%) had previously sought treatment for opioid addiction and managed to kick the habit.
“Some people know that it can cause dependence and harm, and are intentionally using it that way,” she said. “But some people don’t. Then they get started on it and don’t realize they’re dependent until they stop.”
Kawasaki’s story is an increasingly common one in the world of addiction treatment. What, in America at least, was a little known substance, has become a growing source of concern for addiction specialists, ER doctors, and public health professionals — especially as potent extracts and synthetic kratom products become more widely available.
Increasingly, treatment centers are advertising their ability to treat kratom addiction. And as its popularity has grown, kratom has caught the attention of journalists, lawmakers, drug policy researchers, regulators, law enforcement and parents concerned about what their children may be exposed to.
In Pennsylvania, kratom and more potent, related products remain legal. There are multiple bills moving through the statehouse that would ban or regulate them. But researchers warn there’s still a lot they don’t know.
“Is it orders of magnitude less dangerous than fentanyl? Probably,” Kawasaki said. “But we don’t really know the definitive answer to that. We don’t really have a grasp on how many people are using it, or how they’re using it.”
“That should be alarming to anyone,” she added. “I don’t want people to put something in their body that they really don’t know what it is, or what it’s doing, or what’s even in the bottle, and trusting that more than they would an actual FDA-approved, quality-controlled medication.”
What is kratom?
The plant kratom is made from is native to southeast Asia, where it’s been ingested for hundreds of years for medicinal, cultural, ritualistic and recreational reasons.
More recently, in America, kratom’s availability has boomed. Kratom and related products can be bought at gas stations, smoke shops and corner stores. That includes powdered forms of the leaf itself, highly potent extracts with stronger psychoactive effects, and lab-made synthetic products derived from its intoxicating compounds.
At the state and federal level, kratom and related products are hardly regulated.
Estimates for how many people in America have used kratom range from over one million to more than 20 million. But use is likely at an all-time high, and growing.
A recent study from the University of Michigan found that more than half of reported users have struggled with substance use disorder. Roughly a quarter reported having major depression, and around 38% experience psychological distress.
“It takes up a very complex space in the substance use landscape,” says Laura Nettuno, a researcher at the think tank RAND Corporation’s drug policy research center. “On one hand, for some people, it’s harm reduction because it helps manage opioid cravings and symptoms of withdrawal. But on the other hand, it’s creating its own issue.”
Nettuno points to the proliferation of kratom extract products, which are made from the kratom leaf, but have larger amounts of its intoxicating compounds, and more potent synthetic products. In particular, there’s 7-hydroxymitraynine, or 7-OH.
Mmitragynine is the primary psychoactive ingredient in kratom leaf, and 7-OH is found in trace amounts as well. But lab-made products with higher 7-OH concentrations are far more potent and addictive. Those have become more widely advertised and available in stores and online. And because there is so little regulation, it’s not always clear which kratom products contain higher amounts of the compound.
While kratom-related overdose rates are much lower than other opioids, there’s little research available on its negative health effects. Kratom products can also contain a host of adulterants that are unreported. And its half-life is much shorter than opioids like fentanyl, meaning regular users can go into withdrawal in a matter of three to six hours after taking it.
According to the Pennsylvania Department of Health, there have been 17 overdose deaths where kratom was a contributing factor in the state this year. That includes overdoses where kratom was found in a victim’s system along with other substances. There were 33 in 2025, but data is preliminary.
The number of Pennsylvania Poison Control Center cases related to kratom has also grown in the last two years. Last year, there were 114, including 25 involving 7-OH. This year, through June 30, there have already been 106, including 41 involving 7-OH.
“More potent synthetic products are coming out of these labs, and they’re tweaking them faster than regulation can keep up with,” Nettuno said. “And they’re also putting them on the market faster than our surveillance systems can keep up with. “It’s very much an open question whether kratom and kratom-related products are really harm reductive or not, because we just don’t know anything.”
That makes deciding how to regulate kratom uniquely difficult.
“Any researcher who is doing their job well should tell you we really have no idea,” Nettuno said. “We don’t have good data systems to track use-prevalence over time, and certainly not at granular, geographic levels, like in the state of Pennsylvania.”
“It’s clearly a public health concern,” she added.
What’s less clear, Nettuno says, is how to regulate it.
“The regulation is evolving very quickly,” she said. “Products and producers are responding to that very, very quickly, and we don’t know what that means in terms of what products are going to be on the market six months from now that don’t currently exist today.”
Bills, bills, bills
In the last few years, Pennsylvania lawmakers have introduced a number of bills seeking to regulate kratom, though none have advanced to the governor’s desk.
Those with the most momentum would allow the sale of natural kratom leaf products to adults over 21, but would ban synthetic kratom products and some highly-potent extracts.
Rep. James Prokopiak (D-Bucks) is a co-sponsor on multiple bills.
“They really have the same end goal, which is providing regulation of both natural and synthetic kratom,” he said. “[They’re about] putting real guidelines on it, greater transparency in what the actual product is, and providing safeguards against children getting ahold of them.”
Both bills Prokopiak is co-sponsoring would ban synthetic kratom products, create labelling and standards, and bar the sale of natural products to people under 21.
“From what we’ve heard, the synthetic [product] is really the one that can be made much more potent than a naturally occurring kratom,” he said. “We’re trying to balance sort of the health and safety of people, and also the ability of individuals to do what they want. But we want to make sure that people know what they are actually getting, and right now there are no packaging requirements. There are no safety warnings. There are no labelling requirements. It’s the wild west for kratom, really.”
Both bills Prokopiak is co-sponsoring would not make possession or use of kratom products illegal, instead putting liability on sellers. The bills, however, differ slightly in terms of who would be responsible for enforcing them.
One would give the Department of Health responsibility for testing and regulating kratom products. Another would create a new board.
Sen. Tracy Pennycuick (R-Montgomery) has been pushing for kratom regulation in the Republican-controlled upper chamber, where she’s sponsoring a bill that would ban the sale of synthetic kratom products, or kratom products with more than 2% concentration of 7-OH.
She became aware of kratom three or four years ago after talking to an emergency room doctor who asked what she knew about it. He had seen people come in after taking kratom products they said they purchased at local shops.
“Then I actually went to a gas station, and I was stunned you could actually buy it,” she said. “That put me on this path of: As an adult, I don’t care what you do. But I do want to make sure that if you’re buying a product, you know what you’re buying. And you’re not getting something that’s adulterated with any other chemical, and that you know what the efficiency of the dosage is.”
The growth in interest in regulating kratom among Pennsylvania legislators is coinciding with similar pushes at the federal level and in states across the country.
A 2025 report by the Legislative Analysis and Public Policy Association found 24 states and Washington, D.C. had regulated kratom in some form. Five of those and the District of Columbia had made at least some kratom products a Schedule I controlled substance, along with drugs like heroin and LSD. Most had simply limited its sale, like what’s proposed in Pennsylvania.
In 2024 and 2025, 29 states, including Pennsylvania saw legislation proposed that would regulate kratom components or products.
More recently, the federal government has taken action to restrict some kratom products nationally.
The Drug Enforcement Administration (DEA) has classified three synthetic compounds as Schedule I on an emergency basis, meaning the designation will last two years. That includes mitragynine pseudoindoxyl, MGM-15 and MGM-16, potent compounds that produce opioid-like effects.
The DEA has also opened a public comment period on a proposed Schedule I classification for 7-OH.
Other states have recently taken action as well.
On Friday, North Dakota’s legislature passed a bill to ban synthetic kratom and regulate natural leaf products.
The governor of Iowa also called for a total ban on kratom last week after the state House passed a bill to do so earlier this year.
And in Montana, a panel of legislators just tabled a proposed bill to regulate kratom products on the grounds that it didn’t go far enough.
The lobbyist
Lawmakers who spoke with the Capital-Star all said they’ve spoken with lobbyists with a group called the American Kratom Association.
The group is ubiquitous when it comes to lobbying and advising on kratom regulation across the country, and has had a hand in crafting legislation in many states.
In 2024, the American Kratom Association reported $4.7 million in revenue, according to filings with the Internal Revenue Service. According to Mac Haddow, the group’s senior fellow on public policy, that’s primarily from businesses that manufacture and sell kratom products. He estimates there are around 250 in the country
Haddow says the association agrees with lawmakers that kratom needs to be regulated, but strongly opposes an all-out ban. They’ve advocated in Pennsylvania and other states to ban synthetic kratom products, as well as hyper-potent extracts, and to restrict its sale to people 21 and over.
“Back in 2018 when we saw, from a consumer perspective, that there were companies out there creating products that were dangerous, we started promoting our Kratom Consumer Protection Act,” he said. “That sets up specific criteria for product formulations, requires companies to label their products correctly, and makes sure they also have an age restriction.”
Haddow says he’s been a regular user of kratom for 10 years.
“When I was in college, I raced motorcycles and I banged myself up pretty good,” he said. “[Former U.S. Senator] Orrin Hatch recommended I start taking kratom, and I’ve been taking it for 10 years … He was a consumer of kratom.”
Haddow ran Hatch’s first Senate campaign in 1976, and then served as Hatch’s administrative assistant. Hatch retired in 2019 after serving for 42 years. He died in 2022.
Hatch was perhaps Congress’ strongest champion of the dietary supplement industry. He sponsored the landmark Dietary Supplement Health and Education Act of 1994. The law says vitamins and supplements do not have to meet the same strict safety standards as other drugs sold in the U.S. Instead they’re treated more like food.
Since its passage, the sale and use of dietary supplements in America have boomed.
That’s paved the way for the proliferation of kratom products, which are commonly sold and marketed as an herbal supplement.
“We’ve been working in Pennsylvania for three years,” Haddow said of the American Kratom Association. “We’ve been hard at work trying to educate members, and that’s been our effort so far.”
But as momentum builds for kratom regulation, Haddow says lobbying efforts will too.
“We’re going to step it up here now that we see there’s a pathway. So you’re going to see a lot of activity there.”
Filling the gaps
While there’s relatively little action at the state or federal level, local officials and law enforcement have been stepping up their calls for help.
Bucks County District Attorney Joe Khan co-signed a letter with a district attorney from Chester County asking the state Department of Health to use its emergency powers to make 7-OH and other kratom derivatives Schedule I controlled substances, a designation which would last for two years.
Unlike many of the bills being pushed by lawmakers in Pennsylvania, however, that would make possession of kratom a crime.
“At this time, DOH is reviewing the situation and considering all options to ensure any decisions support the health and safety of Pennsylvanians,” a spokesperson told the Capital-Star. “DOH is working to raise awareness and educate the general public …. These products are often sold in retail stores, which can make people assume they are regulated and safe when they are not.”
The spokesperson added that the department is performing additional outreach to health care providers and seeking feedback on what may be the best course of action.
“We have an emergency in Bucks County,” Khan said. “Over the summer, I became aware of this public health crisis in Bucks County, wherein we have these various smoke shops, gas stations, other retail establishments that are … luring children into stores and selling them all kinds of things. Some of those things are completely legal under Pennsylvania law. One of those things is kratom.”
Last week, Khan announced what is thought to be a somewhat historic action, getting an emergency preliminary injunction effectively shutting down a local smoke shop that he said was selling kratom to children.
Khan also wants lawmakers to act, but hesitated when asked exactly what they should do.
“I’m not in a position to really make recommendations about long-term solutions for people who are 21 or over,” he said. “What I am immediately concerned about is these substances falling in the hands of kids.”
