Kratom

Find information on the temporary placement of kratom and resources for the public, health care providers, and municipalities.

Read the emergency regulation, published August 13th, 2026: 105 CMR 726.000 Temporary placement of kratom in Schedule 1 pursuant to MGL c. 94C s. 2A

What is kratom and how does it work?

Kratom (Mitragyna speciosa) is a plant native to Southeast Asia. Depending on the amount used and its potency, kratom may produce different effects. Lower doses cause stimulant-like effects, such as increased alertness. Higher doses cause opioid-like effects, such as pain relief and sedation. 

Kratom plants contain naturally occurring compounds that affect the brain, primarily mitragynine and trace amounts of 7-hydroxymitragynine (7-OH). These compounds can also be altered in a lab to create highly potent “synthetic” products that have more intense opioid-like effects. Specifically, synthetic products may contain high amounts of 7-OH, as well as mitragynine pseudoindoxyl (MP), dihydro-7-hydroxymitragynine (MGM-15), and 9-fluoro-7-hydroxymitragynine (MGM-16). 

Kratom products may vary greatly. It may be difficult to know how a specific product will affect you, what compounds it contains, and how potent it is.

Recent state and federal actions will reduce the amount of kratom products, both synthetic and natural.

Are there risks associated with kratom products?

Kratom use can cause many physical, mental, and behavioral symptoms. These symptoms include nausea, dizziness, constipation, hallucinations, and withdrawal effects similar to opioids. It can also cause dry mouth, delusional thinking, psychosis, itching, seizures, excessive urination, and sweating. 

Overdose can happen, especially when: 

• Using highly potent products;  
• Using highly potent products that are mixed with unknown substances; and  
• Using other substances with kratom, especially opioids (like fentanyl, heroin, oxycodone, or methadone), alcohol, benzodiazepines, or sedatives.  

For people who have an overdose from kratom, use naloxone. If they have reduced or stopped breathing, naloxone should be administered as though it were an opioid-related overdose.  

Although rare, kratom-involved deaths have been reported. Patients are especially at risk when combining kratom with other substances and/or when they have a chronic health condition.  

Physical dependence develops when an individual takes kratom products often and consistently. This results in unpleasant withdrawal symptoms when they stop taking it. Many people take kratom products and do not realize that it could be harmful or that dependence can occur. 

Withdrawal can happen when regular or daily use of kratom products is stopped. People can experience symptoms similar to opioid withdrawal, such as anxiety, agitation, muscle spasms, runny nose, hot flashes, loss of appetite, diarrhea, restlessness, and fever. 

Kratom use disorder (addiction) can occur when people using kratom products compulsively crave these products despite adverse consequences including overdose, withdrawal, or disruptions in their relationships and ability to work, go to school, or take care of their family. 

What kinds of treatment work for kratom use?

For people using kratom products who have an overdose and have reduced or stopped breathing, naloxone should be administered as though it were an opioid-related overdose. Naloxone is widely available without a prescription in retail stores and pharmacies.

Medications used to treat opioid use disorder, like buprenorphine, have been found to be effective for treating kratom use disorder. They can also improve withdrawal symptoms. Withdrawal Management Service (also known as ATS/detox), Community Behavioral Health Centers, Office-Based Opioid Treatment (OBOT) and Office-Based Addiction Treatment (OBAT) programs can support patients who are experiencing kratom withdrawal or kratom use disorder. Counseling and mutual support groups are also effective treatments to support recovery. The Massachusetts Substance Use Helpline is available 24/7, 365 days a year to assist individuals in seeking these services. Call or text “HOPE” to 800-327-5050 to reach the Massachusetts Substance Use Helpline.  

It is important for a healthcare provider to be informed about a person’s use of kratom products and their use of any other substance (like opioids, alcohol, benzodiazepines, or sedatives). This helps with providing appropriate treatment.  

If you have a complaint about a substance use disorder treatment program, call the BSAS confidential complaint telephone line at [phone]. 

The Massachusetts Substance Use Helpline is available 24/7, 365 days a year to assist individuals in seeking treatment services. Call or text “HOPE” to 800-327-5050. 

Safety guidelines

If you or a loved one uses kratom products: 

• Have a safety plan. Use kratom products with a trusted person present who could help you or call 911 in case of a crisis. If using kratom products alone, you can call SafeSpot 24/7 at 800-972-0590 to reach a trained operator who can call for help in case of crisis. 
• Use the lowest amount possible and monitor for slowed or difficulty breathing. 
• Avoid mixing kratom with other substances including opioids, alcohol, benzodiazepines, or other sedatives. 
• Keep naloxone nearby. To find out where to get naloxone in Massachusetts, please visit Stop an Overdose with Naloxone. 
• Call 911 immediately if someone is difficult to wake, stops breathing normally, or becomes unresponsive. 
• Call the Massachusetts and Rhode Island Poison Center for information and emergencies at 1-800-222-1222 (available 24 hours/7 days a week). 

State actions

The Commissioner of the Department of Public Health has issued an emergency order that designates kratom as a Schedule I Controlled Substance under Massachusetts law, and gives municipalities, including local boards of health and other municipal officials, the authority to remove all kratom products from retail establishments. This order takes effect on August 28th, 2026 after a 14-day notice period and remains in effect for up to a year.  

With this emergency order, Massachusetts retailers that sell any type of kratom product will receive notification explaining this action and the dangers associated with the products. It will also highlight the new Schedule 1 classification under state law, the legal requirements regarding possession of Schedule 1 substances, and the potential for criminal enforcement for violation of the order. Schedule I controlled substances are considered to have a high potential for abuse and no accepted medical uses. 

The Department of Public Health (DPH) and the Bureau of Substance Addiction Services (BSAS) expects disruptions in the availability of all kratom products. These products can act like potent opioids. Therefore, people who regularly use these products are likely to experience opioid tolerance and withdrawal symptoms when they stop or reduce their use, including craving, nausea, diarrhea, muscle and head aches, sniffling, sneezing, sweating, and irritability. They should seek medical care and/or substance use treatment.

Additional resources

• To get connected to harm reduction, treatment, or recovery services, call or text “HOPE” to 800-327-5050 to reach the Massachusetts Substance Use Helpline 
• BMC Grayken TTA has developed a one page Kratom Info Sheet PDF 
• 9 Facts about Kratom and 7-OH (Drug Policy Alliance) 
• Broyan, Viktoriya R., et al. "Long-term buprenorphine treatment for kratom use disorder: a case series." Substance Abuse 43.1 (2022): 763-766. 
• Kiyokawa, Miki, et al. "Kratom use disorder: case reports on successful treatment with home induction of buprenorphine-naloxone." Family Practice 40.4 (2023): 596-598. 
• Smith, Kirsten E., David H. Epstein, and Stephanie T. Weiss. "Controversies in assessment, diagnosis, and treatment of kratom use disorder." Current psychiatry reports 26.9 (2024): 487-496. 

Resources for providers

• Grayken Center for Addiction Training and Technical Assistance offers monthly trainings on kratom 
• Kratom: What Clinicians Need to Know (New York Department of Health) 
• National Institute on Drug Abuse (NIDA) Research Topics: Kratom

Resources for Boards of Health