In 2015, American poison control centers fielded 258 calls about Kratom exposure. In 2025, they fielded 3,434, a 1,200 percent increase over the decade, documented this week in a CDC Morbidity and Mortality Weekly Report. The headline is alarming. But the number that has doctors most worried isn't the total volume. It is the composition of the 2025 surge.
The CDC report found that hospitalizations involving multiple substances alongside Kratom jumped 1,300 percent from 2015 to 2025, reaching 549 cases. Sixty percent of those multi-substance exposures resulted in serious medical outcomes, and roughly half required hospitalization. More than half of Kratom-linked deaths involved opioids; benzodiazepines, stimulants, and ethanol each appeared in roughly one in five fatalities. This is not the profile of a benign plant. It coincides precisely with the emergence of a new class of semisynthetic Kratom product that regulators are scrambling to contain.
The compound is called 7-hydroxymitragynine, or 7-OH. It occurs naturally in Kratom leaves in small amounts, but 7-OH products now sold in gas stations and smoke shops across the United States are concentrated, and according to FDA Commissioner Marty Makary, the compound "can be more potent than morphine". The FDA recommended on July 29, 2025, that the DEA schedule 7-OH as a Schedule I controlled substance, the most restrictive category. The agency clarified it was not targeting natural Kratom leaf, just the concentrated extracts.
That carve-out reveals a fracture line in the regulatory approach that has defined Kratom policy for a decade.
In 2016, the DEA attempted to schedule Kratom itself as a Schedule I substance, citing its opioid-like effects. The agency walked it back after public backlash, including a letter signed by more than 60 members of Congress. An estimated 2 million to 15 million Americans use Kratom annually, according to Johns Hopkins research, many of them chronic pain patients who had been using the substance to manage pain, anxiety, depression, or to taper off prescription opioids. Forty-one percent of Kratom users in that same survey reported using it specifically to reduce opioid use. A top federal health official later acknowledged that the 2016 scheduling request was based on "embarrassingly poor evidence and data," according to a March 2026 Pain News Network report.
When the FDA drew its July 2025 line between natural Kratom leaf and concentrated 7-OH extracts, it was explicitly not repeating the DEA's failed 2016 move. The agency learned, at least partly, that broad scheduling of Kratom would face the same political backlash. So it targeted the specific product driving harm: the concentrated, semisynthetic formulation.
State regulators have not waited for federal action. Florida's attorney general issued an emergency rule in August 2025 scheduling 7-OH as a Schedule I controlled substance at the state level, and the state has removed more than 17,000 packages of concentrated 7-OH products since the ban took effect. Ohio's Board of Pharmacy passed an emergency rule on December 12, 2025, banning synthetic Kratom and 7-OH products. California's Department of Public Health issued a press release on October 24, 2025, advising consumers that food and dietary supplements containing Kratom or 7-OH are illegal to sell or manufacture in the state.
The result is a patchwork that is less coherent than it appears. A product that is illegal to sell in Ohio and Florida and illegal to manufacture in California can still be purchased in states without explicit bans. The FDA has warned companies about 7-OH products, but enforcement is uneven. "We need regulation and public education to prevent another wave of the opioid epidemic," Makary said in announcing the FDA's recommendation. Whether that regulation will arrive in time is an open question.
Dr. Chris Holstege, director of the UVA Health Blue Ridge Poison Center, has watched the surge from the front lines. "The data reflects a concerning trend", he said. "We are experiencing a marked increase in Kratom-associated products being sold in the U.S. market."
The scientific picture adds another layer of complexity. Early research from Johns Hopkins suggests that mitragynine and 7-hydroxymitragynine "may not cause some of the more serious adverse effects associated with opioid use", a potentially significant finding given that conventional opioids kill primarily through respiratory depression. But that same research found that 12.3 percent of Kratom users qualify as having a substance use disorder for Kratom itself, and the emergence of high-potency semisynthetic formulations has changed the risk profile. The 2025 CDC data is a record year for both total exposures and multi-substance hospitalizations, suggesting that whatever mitigating factors exist in natural Kratom's pharmacology, they are not surviving the concentration process.
University of Florida medicinal chemistry professor Christopher R. McCurdy, who has studied Kratom for years, was more blunt in a Stateline interview: 7-OH is "a pure opioid that is available without a prescription, so it is akin to having morphine or oxycodone for sale at a smoke shop or a gas station. This is a public health crisis waiting to happen."
It is no longer waiting.
What regulators are left managing is a substance whose natural form has a genuine and contested medical constituency: pain patients, people tapering from opioids, people with anxiety and depression. And a concentrated derivative that appears substantially more dangerous and is proliferating faster than any federal or state framework was designed to handle. The FDA's narrow targeting of 7-OH may be the right regulatory move. Whether it will work before more people are hospitalized or killed is the question nobody in Washington or state capitals seems able to answer yet.
The poison control data will be updated again next year. Based on the trend line, the numbers are unlikely to improve before the regulatory architecture catches up.
