As kratom's presence increases in Pa. and beyond, doctors and lawmakers play catch-up

Jesse Golden still remembers the feeling of withdrawing from kratom, with persistent vomiting and cold sweats leaving him sleeping by the toilet.

The experience fractured relationships, Golden told Pittsburgh City Council in a May 26 public hearing about vape shop zoning, and he entered a 30-day treatment program.

What started as an opportunity to manage joint pain, anxiety and post-traumatic stress disorder as a Marine Corps veteran became chaos within days of his first dose.

After becoming dependent, Golden learned he had been taking 7-hydroxymitragynine, a chemical found in kratom in small doses, extracted from the plant and sold in potent products at smoke shops, gas stations and online. Also known as 7-OH, the substance activates the same receptors in the brain as heroin and is more potent than morphine.

"I had no idea any of this would happen," he told the council during an open public comment period. "It all started from the simple innocence of, ‘I don't want to be on any pain medication; I'm going to start taking something that's natural and see if it works.'

"It turned into something I couldn't control."

Golden is not alone: Signs of addiction and calls to U.S. poison centers for kratom and kratom products have increased 1200% over the past 10 years, per a new report from the Centers for Disease Control and Prevention and University of Virginia scientists.

Additional research suggests more than 5 million people - 100,000 of them children - have reported using kratom in their lifetime.

"From my perspective, this is a wolf in sheep's clothing," said Vita McCabe, director of addiction treatment services at the University of Michigan, who has seen patients visit her treatment center with addiction to both the natural kratom leaf and 7-OH.

Sean and Vita McCabe, who work in addiction medicine at the University of Michigan, co-authored a new paper that found more than 5 million people reported using kratom in their lifetimes.(Courtesy of Sean McCabe)

As with most substances entering the mainstream, doctors and legislators are playing catch-up to understand its true prevalence and long-term effects. With Allegheny County listed as the second-highest county in the northeast for emergency calls related to kratom, per the National Drug Early Warning System, Pittsburgh-area officials and experts are pursuing what could - and should - be done at the local and state levels.

Native to southeast Asia, the kratom tree (Mitragyna speciosa) has been used for centuries by the region's inhabitants to increase alertness and treat intestinal illness, its leaves chewed or ground into a fine powder and brewed as a tea. Mitragynine is the active ingredient, causing stimulant effects at low doses and euphoric and sedating effects at higher ones.

In the past 10 years, kratom has gained popularity globally as an herbal supplement, to help with anxiety, pain and fatigue. On its website, the Food and Drug Administration discourages its use as a dietary supplement.

In July 2025, the FDA announced it was cracking down on 7-OH products across the country and reminded Americans it has no medical use. Five months later, it reported seizing 73,000 units of the substance from three places in Missouri.

Some users have credited kratom as the sole reason they were able to stop using opioids like fentanyl or oxycodone, or they swear by its ability to soothe the worst of social anxiety. Because mitragynine is broken down in the body through a different pathway than other opioids, it's less likely to lead to respiratory depression.

Still, the kratom plant partially activates the brain's opioid receptors, leading others to claim it has hastened their spiral into an addiction that closely resembled prescription pills or heroin.

Kratom prevalence in Pa.

New evidence is mounting as multiple states, including Pennsylvania, craft legislation to limit the sale of these products, especially to minors. Six states - Alabama, Arkansas, Indiana, Louisiana, Vermont and Wisconsin - have banned the product outright, and dozens of others, including New York, Ohio and Connecticut, have regulated its sale.

In August, the Pennsylvania Department of Health announced a health advisory for kratom, noting a rise in calls to the Philadelphia and Pittsburgh poison centers.

The department tracked 167 calls over three years: Between 2023 and 2024, calls nearly doubled, and 7-OH entered the market last year. Age ranges for those exposed spanned 1 to 80 years old, and half were determined to have "significant illness"; 25 were given naloxone to reverse their overdose, and 14 were mechanically intubated.

Pittsburgh-area clinicians have seen patients with withdrawal symptoms for a few years now. In 2022 and 2023, when they saw a trickle of cases, they didn't know what kratom or 7-OH were. That changed in 2025, when 7-OH products became more accessible, and more people visited emergency rooms.

"We are seeing more than we used to, and we're going to see more," said Joshua Schulman, medical director for the Pittsburgh Poison Center and an emergency room physician with UPMC. "I see it in the hospital for bad withdrawal. They're asking for help in detoxing off of it. They're telling me they're using multiple bottles per day."

Brent Rau, director of emergency medicine at Allegheny General Hospital, said some patients have used kratom to manage withdrawal from other opioids; others were first-time kratom users who tried it at a suggestion from a friend.

He sees widespread availability as one of the biggest issues: "It's available like a bag of chips is available."

Kratom products are sold at many area vape shops and gas stations.(Pittsburgh Post-Gazette)

Chris Holstege, director of UVA's Blue Ridge Poison Center in Charlottesville and an author on the CDC poison center study, said his team became interested in tracking kratom-related calls after seeing a spike in their own clinic.

What began as a slow trickle turned into a sharp uptick last year with the arrival of 7-OH. Holstege has seen patients who needed life support after overdosing from a kratom product and had nothing but 7-OH in their system.

"I do worry significantly that the public doesn't fully understand the risk with these products," he said. "We're still trying to understand them too."

Local action against kratom products

The National Drug Early Warning System, in a report looking at data from Jan. 1, 2023, to April 30, 2026, deemed Allegheny County a hot spot for kratom-related emergency medical service encounters, ranking it second in the northeastern region, behind Erie.

Across Pittsburgh, neon-green signs advertising kratom and 7-OH in vape shop windows light the streets.

Local legislators are taking notice.

Pittsburgh City Council voted on June 9 to more tightly regulate vape shops and ban the opening of new ones, to crack down on supply of unregulated substances.

And as physicians in Pittsburgh and surrounding cities become accustomed to seeing kratom and 7-OH cases, some are stepping up to more clearly warn about their harms.

In December, a group of physicians with the Mechanicsburg-based Pennsylvania Society of Addiction Medicine (PSAM) wrote a letter to state lawmakers expressing their support for pending legislation that would ban kratom sales to those under age 21.

One of those physicians was James Latronica, president of the PSAM and a Pittsburgh-based addiction medicine physician, formerly at the University of Pittsburgh.

Latronica worked at Tadiso, a methadone clinic on the North Side, and saw people coming in with classic opioid withdrawal symptoms from kratom use. There, clinicians have noticed that patients need "relatively decent doses" of methadone to come off these products.

He nodded toward a Michigan kratom bill that passed in March and said he's not a prohibitionist: Banning 7-OH and kratom completely would drive an already unregulated product to the black market, he said.

One of the Pennsylvania bills PSAM supported, Senate Bill 899, was temporarily postponed in March by Senate majority leader Joe Pittman, R-Armstrong/Indiana, based on a desire to divide up the bill's demands.

In May, a cohort of Democratic House members announced it would introduce the Kratom Standards, Labeling and Consumer Protection Act, which would limit all kratom sales to those 21 and over, ban synthetic kratom products like 7-OH and strengthen labeling and advertising rules.

Dan Frankel, D-Allegheny and chair of the House Health Committee, is a cosponsor. In a memo, the group said it didn't want to wait for federal government movement on the matter, as the commonwealth has already seen negative consequences from kratom and related products.

"This is an emerging product on the market that needs to have better oversight," Holstege said.

‘It takes everything from you'

Like Golden, Andrew became unwittingly addicted to kratom and 7-OH. He had been in recovery from prescription opioids for 15 years.

The 40-year-old, who lives in the Philadelphia area, said everywhere he went he saw the flashing green signs advertising "kratom sold here." He heard it could treat anxiety, so he bought some powder. (Andrew is being referred to only by his first name due to privacy concerns about his addiction.)

After consuming the powder, a warm sensation filled his body and euphoria flooded in, similar to the pills he'd been sober from for nearly two decades.

"When I took it, I knew exactly what this was," he said. "This feels all too familiar."

Kratom products are sold in a variety of forms, tablets to powders.(FDA)

Andrew was withdrawing within a month of taking the powder sporadically: body aches, sweating, restless legs, diarrhea, dissociation. He tried to stop but said the mental obsession of kratom was stronger than any opioid; he switched to 7-OH tablets, which were more potent than the powder. At the height of his addiction, he was spending $80–$100 a day on kratom products.

After about a year, his wife found him an online support group, and he quickly accrued sober time. He attended outpatient rehab for kratom and 7-OH, and then got involved in leadership with the support group, which now has thousands of members from all over the world and holds meetings daily.

These meetings are filled with people that span age, gender and socioeconomic spectrums.

"People that find our organization, not everyone is coming from a background of addiction," Andrew said. "There are soccer moms that heard it on the Joe Rogan podcast or TikTok. We have doctors, lawyers, two air traffic controllers in our group.

"I've never experienced a substance that took hold like this," he went on. "It allows you to operate just enough to take everything from you."

The kratom vs. 7-OH debate

Kratom businesses stress the distinction between natural leaf powder and synthetic 7-OH products, emphasizing that the FDA has declared war on 7-OH but has vowed to leave kratom powders alone.

Because of the lack of regulation, consumers who think they're buying natural kratom powder could be purchasing products with contaminants or 7-OH. That mislabeling and dearth of control surrounding these stronger synthetic opiates is what's to blame for the spike in overdoses and poison center calls, said Mac Haddow, spokesperson for the American Kratom Association, an advocacy group based in Virginia.

"The consumer has to look at what they're purchasing and the label," he said. "There are bad-actor kratom manufacturers out there."

The American Kratom Association fully supports age restrictions as well as FDA's push to ban 7-OH, Haddow said.

Better surveillance, discrimination and testing of products will eventually help researchers and public health workers determine the cause of addiction or overdose.

Addiction medicine specialists, though, report they've seen many become dependent on kratom powder alone.

Andrew also takes issue with the narrative that kratom powder is natural and 7-OH extracts are the real problem. He became dependent on kratom powder alone and has seen it with countless members of his support group. He said his group does not see natural kratom as harm reduction and believes it would be more effective to ban the substance outright.

"It's phrased by advocacy groups as, ‘The extracts are the problem,'" he said. "What level of hell are you willing to accept? None of these are good."

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This story was originally published June 18, 2026 at 8:13 AM.