Kratom poisoning calls climb in Texas as the state fails to enforce ban on synthetic version

From The Texas Tribune:

As Texas lawmakers debate a ban on the synthetic THC industry, another unregulated, but deadlier synthetic drug known as kratom is lying in wait to take over the ever-growing statewide demand for recreational drugs.

Data provided from the Texas Poison Center Network reflects a slow climb in kratom-related cases, from 83 in 2019 to 123 in 2022 and dipping to 100 in 2024. This pales in comparison to the sharp increase in marijuana-related calls during the same time period after hemp-derived THC was federally legalized, culminating in 2,592 calls in 2024.

However, of the 602 total kratom-related calls over the six years, more than 40% of them were severe or moderate reactions and five of them resulted in deaths in Texas. Texas Poison Control Center has reported eight THC-related poison calls that resulted in death, but the federal Drug Enforcement Administration reports there have been no overdose deaths from marijuana. In contrast, the DEA reported 15 kratom-related deaths nationally from 2014 to 2016.

Kratom, which is being sold as energy-boosting drinks and pills in gas stations and smoke shops across the state, comes in two forms — one that is naturally derived from the kratom plant and the other that is synthetically pulled from the plant and chemically altered to be much more potent. Texas banned the manufacturing of the latter and retailers from selling it in 2023, which likely contributed to the decline in poison calls the following year, but public safety agencies don’t have the resources to enforce the ban. People are still using it and getting hurt — at least one of the kratom calls in Texas resulted in a death in 2024.

“I have seen people who have taken a 7-OH product become crippling addicts in under a week. This is something we have never seen,” said Tiffini Steding about the synthetic compound found in the manufactured version of kratom. Steding co-owns 1836 Kratom, a statewide natural kratom distributor based in Pflugerville.

According to studies, 7-OH is up to 13 times more potent than morphine and is linked to dependency, withdrawal, and overdose symptoms similar to opioids.

Gaining in popularity in recent years, the drug has flown under the radar in Texas compared to THC, but debates around them are similar. Many members of both industries are advocating for regulation instead of a ban of their respective drugs, and producers of the natural forms of their drugs say the synthetic market is undermining the safety of the natural plants.

“One of the major reasons kratom has avoided the attention that THC has gotten is that it’s not federally regulated. It’s not listed in the Controlled Substances Act,” said Katherine Neill Harris, drug policy fellow for Rice University’s Baker Institute for Public Policy.

On July 29, the federal Food and Drug Administration recommended listing synthetic kratom as a controlled substance, heeding the call from natural kratom producers.

This year, the Texas Senate passed a bill to ban kratom products, including the plant, but it died in the House. Natural producers said it would have had dire consequences for many who use the natural substance to self-treat substance use disorders, mental illness, and pain. They urge more enforcement of the anti-synthetic laws that are already on the books.

Simply 7OH, a producer of these synthetic products that can often be found in Texas despite it being illegal, said their customers have testified that this chemical has been life-changing, helping them stay off hard drugs and avoid relapse and relieving them from chronic pain. A federal ban would hurt people who need their products, the company told The Texas Tribune.

“We receive countless messages from people who say our products have given them the ability to play with their kids, work, and function as contributing members of society again,” the organization said in a statement. “The only negative feedback we consistently hear is that 7OH can be habit-forming, which we are transparent about with customers, as seen with our disclaimer.”

Kratom risks

A federal survey estimated that about 1.6 million Americans age 12 and older used kratom in 2022, the latest data available.

Kratom is an herb derived from a leafy Southeast Asian tree and contains two psychoactive compounds that can bind to opioid receptors in the brain and produce a response similar to effects produced by opioids.

The herb, which is considered a cousin to the coffee plant, gained popularity in the United States in the early 2000s during the opioid epidemic, as many were looking for anything to supplement their deadly addiction to pills.

Kratom can be a safer alternative to opioids because it is less harmful to the body, according to advocates, and it can help with pain, anxiety, depression, and more.

However, natural kratom does have addictive properties, and some side effects might include hallucinations, seizures, liver damage, confusion, high blood pressure, and slow breathing.

Those in the kratom industry say that these side effects were considered rare for many years. Still, with the proliferation of the synthetic version, the industry has become a minefield for the unsuspecting, the Stedings say.

“This has been used for hundreds of years in Southeast Asia safely, so it’s safe to assume that it’s probably 7-OH,” said Jeremy Steding, co-owner of 1836 Kratom.

The Holistic Alternative Recovery Trust, an organization created in 2023 to advocate regulation of 7-OH, said the synthetic version of kratom is also an invaluable harm reduction tool that thousands of people rely on. Instead of being banned, synthetic kratom should get the same shot as its natural peer because the data hasn’t shown which segment of the industry is causing problems.

“Together, the stories reveal a disturbing pattern: while everyday Americans fall victim to addiction, withdrawal, and predatory marketing, federal officials are refusing to go after the actual source of danger, instead targeting 7- hydroxymitragynine (7-OH), an industry competitor that the FDA’s own databases have shown to have far fewer adverse events,” the organization said in a statement.

State poison control data does not distinguish if cases are caused by synthetic kratom or the natural kratom. Of the 602 total kratom-related calls between 2019 and 2024, 250 of them involved a patient having more pronounced, prolonged, or systemic symptoms that usually required treatment, 61 of them resulted in life-threatening symptoms that resulted in significant residual disability or disfigurement, and five led to death.

Unlike THC poison control data that shows children and teenagers most impacted, kratom data shows 30-to 39-year-olds making up the largest affected group — 185 — followed by 20 to 29-year-olds at 144.

Many consuming these products don’t know what’s in them — sometimes because they are vaguely labeled — either overdosing on what they thought was a small bottle of energy or getting addicted to the product until an overdose occurs, the Stedings say.

“I went into a convenience store to check out some of our product, and the guy behind the counter offered me a bottle of 7-OH that had just came in. This small bottle was a chemical boosted version of the synthetic, but he just knew it as strong kratom,” said Tiffini Steding. “I had to tell them this is a super addictive compound in a bottle you are giving out.”

How to regulate kratom

As of this year, 24 states and the District of Columbia regulate synthetic kratom, including Texas.

The 2023 Texas Kratom Consumer Protection Act mandates that the total alkaloid content in a kratom product chemical that is used to create 7-OH shouldn’t be more than 2% of the product composition and any products containing synthetic 7-OH shouldn’t be sold.

The problem is that the lack of enforcement has led to bad actors overshadowing the good ones.

“Texas needs to step up enforcement, and kratom manufacturers need to adhere to state and local laws in order for kratom to be safe and accessible for Texans,” said Matthew Lowe, executive director of the Global Kratom Coalition, in 2024, when the organization warned that illegal products mislabeled as kratom were being sold around Texas.

The Stedings and others in the natural kratom derivative industry reached out to Texas lawmakers over the past couple of years, asking for enforcement from the state to get synthetic kratom off the market. The answer they received from Sen. Charles Perry, R-Lubbock, who carried the kratom bill this year, was a complete ban on all kratom, which would have thrown people like the Stedings out of business.

“It was originally meant to be for 7-OH when we talked to his staff, then it changed to all kratom products, then an outcry happened, he said he would change it, he didn’t, and passed it anyway,” said Tiffini Steding. “It was concerning.”

The Stedings have become even more concerned as Texas lawmakers have often confused kratom with hemp products during the debate over THC.

“I was terrified because these people are about to make this huge decision to make a plant illegal that helps people, and they don’t even know what it is or does,” Tiffini Steding said.

Industry leaders want lawmakers to give more time before banning the kratom plant so that scientists can continue to research what this herb can accomplish. They fear a ban will force people back onto opioids.

How to regulate kratom while removing 7-OH is complicated because the chemical is also naturally occurring in the plant.

Holistic Alternative Recovery Trust, the organization advocating for synthetic kratom, supports states’ efforts to ensure synthetic products are manufactured safely, are marketed transparently, and are banned from children.

Products containing primarily synthetic 7-OH should not be commercially categorized as a kratom product, a team of University of Florida and John Hopkins medical school kratom researchers have suggested.

“Companies making such claims that such products are kratom products should not be considered to be making credible or factual claims,” the statement said.

Those in the kratom industry have suggested adopting stricter regulations similar to what California has in place, which limits 7-OH content to 1% in kratom products, and doesn’t allow for the amount of chemicals in the products to go above the amount that naturally occurs in the plant.

This ensures natural kratom is still available to the public but removes the chemically boosted products from the shelves.

Another option is removing kratom products from gas stations and convenience stores and limiting them to locations where the retailer is more educated in what they are selling, said researchers at John Hopkins Medical or have it be regulated by the FDA where it can only be found in pharmacies or supplement shops.

“If it were in the pharmaceutical world, we should see true control of the industry in a heavily regulated environment. I don’t know if that is the answer, but this must be controlled,” said Jeremy Steding.

Synthetic drugs’ foothold in Texas

History has shown that Texas is a very profitable market for synthetic drugs.

Some Texas lawmakers are blaming synthetic THC-derived products like delta-8 for hurting young children and are now attempting to ban all types of THC as a result. Similar to kratom, delta-8 is a naturally occurring compound found in cannabinoids, but can be chemically boosted for greater potency.

A report by Whitney Economics, an economic study group for hemp and cannabis, found that while the demand in Texas is higher for more natural THC products such as delta-9 and THCA, the third largest revenue producer for Texas cannabinoid businesses is the synthetic delta-8. The state also sources most of their product, meaning a majority of these products are being grown, made and sold by Texans.

“Synthetic cannabis products aren’t cannabis — they are chemical imitations that can cause serious harm to people. The only reason these products even exist is because prohibition makes it easier to sell a dangerous knockoff than the actual real plant,” said Roger Volodarsky, head of Puffco, a Los Angeles-based cannabis company that sells to thousands of Texas customers online.

Before delta-8, it was K-2 and Spice. While products like delta-8 and 7-OH are considered synthetic because they are chemically altered compounds of the natural plant, K2 and Spice were entirely artificial made to mimic the psychoactive effects of THC.

This synthetic first appeared in Texas in 2009, and by November 2016, forensic laboratories had identified 35 varieties of these strains on the streets.

This led to a spree of overdose incidents, from Amarillo to Austin over the years, with people suffering permanent injuries and even death. It wasn’t until delta-8 and other natural THC-derived products became available in the state that the incidents started to taper.

It is a cycle that plays out again and again in Texas. One substance gets banned, and it leads to another version being created.

There isn’t a specific reason Texas is a hotbed for synthetic drugs. The vast amounts of land in the state, the business-friendly environment, the large population, and the large number of veterans and first responders who work here could all contribute, experts say.

Still, if history is any indicator, a ban on a popular recreational drug could lead to something else, most likely synthetic, proliferating in its place in Texas.

“Black markets are created by regulation,” said Volodarsky.

While some drug experts have said a THC ban might lead to those who want to follow the law to try kratom, Harris said most will probably seek out the black market.

“There may be a slight substitution effect, where individuals who can no longer access their preferred hemp products legally try or use more kratom products,” Harris said. “But the effects of these substances are different, and in the event of a THC ban, many users would return to the illicit market for THC.”

Texans seeking help for substance use can call the Substance Abuse and Mental Health Services Administration’s free help line at 800-662-4357. They can also access services in their region through the Texas Health and Human Services website.

Disclosure: Rice University has been a financial supporter of The Texas Tribune, a nonprofit, nonpartisan news organization that is funded in part by donations from members, foundations and corporate sponsors. Financial supporters play no role in the Tribune’s journalism. Find a complete list of them here.