Federal regulators are drawing a firmer line between the kratom leaf and the concentrated, lab-altered compounds sold beside it in gas stations, smoke shops and online. The consequences of that second category are already showing up in poison center calls, emergency departments and addiction treatment intake.
Since July, the Drug Enforcement Administration has temporarily placed three 7-hydroxymitragynine-related substances in Schedule I, HHS has proposed potency limits to separate botanical kratom from enhanced products, and a growing list of states has restricted kratom outright. At the same time, Utah health officials have linked deaths to synthetic kratom compounds hidden in counterfeit cat’s claw supplements, and Georgia’s poison center has reported deaths tied to kratom-like products. Standard urine drug screens cannot detect many of these compounds. For behavioral health leaders, the stakes run on two tracks: patients may arrive dependent on substances they believed were herbal, and the rules governing those substances are shifting month to month.
Here are 10 updates to know:
1. HHS proposed a potency line between natural and enhanced kratom. On Oct. 9, HHS recommended Schedule I control for products in which 7-OH, mitragynine pseudoindoxyl (MGPI) or the two combined exceed 1 milligram per gram in solids or 1 milligram per milliliter in liquids. A product would also be covered if it contains less than 100 times as much mitragynine, kratom’s dominant alkaloid, as those compounds. Botanical kratom naturally contains only trace amounts of 7-OH, HHS said; the limits target products deliberately altered to raise their opioid content. The DEA is issuing two new notices of intent in response, one of which adopts the HHS limits for 7-OH and MGPI, the Justice Department said.
2. Three related compounds are already in Schedule I. The DEA temporarily placed MGPI, MGM-15 and MGM-16 in Schedule I effective Aug. 26, an order that runs through Aug. 26, 2028. The agency said the action was needed to avoid an imminent hazard to public safety. The compounds are chemically derived from kratom’s alkaloids and have been sold as kratom alternatives, often with “natural” or “botanical” branding, despite functioning as potent opioids, the DEA said.
3. The DEA has moved to schedule 7-OH, but it is not scheduled yet. The DEA filed a notice of intent July 1 to temporarily place 7-OH above a specified threshold in Schedule I, and its new notice adopts the HHS limits. No temporary scheduling order has been issued for the compound, so 7-OH remains outside federal controls. An FDA review of preclinical research found 7-OH to be roughly two to nine times as potent as morphine, depending on the study. Mo Sarhan, MD, medical director at Delray Beach, Fla.-based Caron Treatment Centers, told Becker’s that 7-OH is the drug he is watching most closely. “Functionally, it is an opioid marketed as a botanical supplement,” he said.
4. Senators are pressing to schedule the entire plant. Sens. Chuck Grassley, R-Iowa; Mike Lee, R-Utah; and Susan Collins, R-Maine, urged the DEA and FDA in an Oct. 7 letter to permanently schedule kratom and its derivatives and to regulate all levels of 7-OH. The senators noted that even after the 7-OH order takes effect, products below the threshold would remain easy to buy. Their letter cited National Drug Early Warning System data showing 3,672 suspected nonfatal overdose encounters with EMS involving 7-OH, mitragynine or kratom across 38 states from January 2023 to April 2026, more than half of them (2,007) in Southern states. The senators requested a response by Oct. 15 but have not yet received one.
5. Poison center exposures have climbed roughly twelvefold in a decade. U.S. poison centers logged 14,449 kratom exposure reports from 2015 to 2025, with 3,434 in 2025 alone — an increase of about 1,200% over 2015, according to National Poison Data System figures. Dr. Sarhan said America’s Poison Centers projects a nearly 68% increase this year and that about 1 in 4 people exposed to kratom or 7-OH alone were hospitalized. For context, a CDC report counted 233 kratom-associated deaths reported to poison centers from 2015 to 2025, 79% of which involved other substances.
6. Deaths are mounting in Utah and Georgia. Utah health officials linked four deaths to MGPI and MGM-15 found in herbal supplements, including products labeled as cat’s claw, on Oct. 5. In Georgia, the Georgia Poison Center has received 315 calls involving kratom-like products and recorded four related deaths in 2026, WSB-TV reported Oct. 14. Eight in 10 of those calls involve a hospitalized overdose patient, said Gaylord Lopez, PharmD, the center’s director, who said synthetic products can be 20 to 30 times more potent than kratom. Synthetic kratom is illegal in Georgia but remains on gas station and smoke shop shelves, WSB-TV reported.
7. Counterfeit cat’s claw is hiding opioid-like compounds. Health officials in Utah, Tennessee and Virginia have warned that some supplements sold as cat’s claw, an Amazonian vine generally considered harmless, are spiked with concentrated kratom-related chemicals, and the Washington Poison Center followed with its own alert Oct. 6. Utah testing turned up MGPI and MGM-15, and the products often claim to be legal and kratom-free while carrying 21-and-older warnings. As of Oct. 7, the Buzzers and Homiez brands had been tied to kratom alkaloids through state investigations, the Washington Poison Center said. Because labels omit the compounds and standard urine drug screens cannot detect them, clinicians may not recognize what is driving an overdose or withdrawal, Becker’s reported.
8. Treatment demand is shifting toward 7-OH. Northbrook, Ill.-based Brightside Recovery reported a threefold increase in patients seeking treatment for 7-OH in recent months, and 9 in 10 patients seeking treatment in the past month were using it, WTTW News reported Oct. 7. The five-clinic provider now treats more patients for 7-OH than for fentanyl, said Medical Director David Kushner, MD. Co-founder Phil Atteberry said pending restrictions may be pushing more patients into care, but he raised concern that people in withdrawal could turn to fentanyl or heroin. The Illinois Department of Public Health said kratom and 7-OH fatalities in the state have steadily declined over the last five years.
9. Standard opioid use disorder care works — if clinicians ask. Physical dependence on 7-OH can set in within two to three weeks of regular use, and withdrawal from concentrated products is especially severe, said Sarah Kawasaki, MD, of Penn State Health. Because the compounds act on opioid receptors, naloxone reverses overdoses and evidence-based treatments for opioid dependence are effective, Utah officials said; Dr. Kawasaki pointed to buprenorphine in particular, and Dr. Sarhan said repeated naloxone doses may be needed. Michael Moss, MD, medical director of the Utah Poison Control Center, urged providers to watch for addiction, withdrawal and overdose tied to these products. Dr. Sarhan advised clinicians to ask every patient directly about kratom and 7-OH use, since most will not volunteer it.
10. States and attorneys general are not waiting on Washington. Connecticut placed kratom and its derivatives in Schedule I effective March 25; Kansas and Tennessee bans took effect July 1; and Massachusetts placed all kratom products in Schedule I under an emergency regulation effective Aug. 28, which retailers have sued to block. Ohio made its synthetic kratom ban permanent in May, and Virginia enacted a law banning 7-OH products. Locally, Mount Vernon became the first Washington city to ban kratom in September. In Arizona, Attorney General Kris Mayes sued Botanic Tonics in what her office called a first-in-the-nation consumer protection case, alleging the company marketed its Feel Free kratom shots as energy products while downplaying addiction and withdrawal risks. The state identified 146 documented kratom deaths in Arizona from 2020 to 2023.
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