She arrived at her first outpatient psychiatry appointment with me with her mother by her side. I had read over her chart and reviewed records from the hospital she was stepping down from. She had spent two days in an emergency room, then transferred to a psychiatry unit for a week. In her early twenties with no prior mental health history, raised by a single mother, she excelled in school and was even contemplating college. However, her life derailed when she met a boy who introduced her to a substance called kratom. He pitched it to her initially as a harmless supplement to improve her “energy” and “concentration.” She had never envisioned that it would drag her down a road to addiction.

Kratom did improve her energy and focus, but she required higher amounts to achieve the same effect, until she was consuming it multiple times a day. When she tried to cut down or stop, she experienced intolerable nausea, fatigue, and agitation. With her then boyfriend, they spent most of their time as a couple using together. She struggled to hold down a job and lost interest in planning for college.

This culminated over two years until one day, she tried to taper off for good, but the severity of the symptoms drove her to the emergency room, where she admitted to pondering suicide.

Kratom is a drug derived from a plant native to Southeast Asia. It contains two compounds, mitragynine and 7-hydroxymitragynine, which can bind to opioid receptors in the brain at high doses, and at low doses act like a stimulant. It is readily available in gas stations, vape stores, and online. It is legal in 44 states, including my home state of Oklahoma, where the Oklahoma Kratom Consumer Protection Act made virtually all forms of kratom legal.

Unfortunately, in my work, this story of young people stumbling upon kratom and winding down a dark path is becoming commonplace. I have started to ask about kratom use regularly during my psychiatric evaluations, and more patients are admitting to using, believing that it is a harmless supplement.

Kratom, like cannabis and alcohol, is not just a drug, but an industry, one that prioritizes profit over human consequences. A few miles from my clinic in Tulsa is the operating base of Botanic Tonics, a kratom company founded by a former oil executive named Jerry Ross. Ross is a close associate of Secretary Kennedy and now Secretary Markwayn Mullin, whose prior role was senator of Oklahoma. After he was nominated to the Department of Homeland Security, financial disclosures unmasked his approximately $1 million investment in Botanic Tonics.

Jerry Ross seems to be seeking to dominate the blooming kratom industry. His company markets kratom into two categories, synthetic versus natural, and sells the latter as a safer option. There is no current evidence to suggest a safer profile of synthetic kratom over natural.

The number of calls to the Poison Control Center related to kratom exposure increased tenfold between 2010 and 2015. In the last 15 years, 158 serious medical outcomes, including disability and death, have been found to involve kratom. Kratom overdoses are associated with nausea, tachycardia, agitation, irritability, and even seizures.

The Oklahoma legislature protects the kratom industry through its lax regulations. The industry is transforming into a lobby, which is trying to pressure the federal government to lessen restrictions, falsify claims regarding its safety, and prevent its classification as a controlled substance. Currently, the FDA only considers kratom to be a “drug of concern.” The public health infrastructure is not prepared to curtail an emerging addiction epidemic.

We could not curb the spread of the opioid epidemic, which led to surges in heroin and fentanyl for over two decades. Just like with kratom, Purdue Pharma prioritized profits and made false claims about their products, and the federal government did not act until communities were already ravaged by opioids. I believe we can still prevent kratom from wreaking similar havoc.

We need a national strategy to robustly research kratom, provide public health warnings on packages and labeling, and suppress the growth of the industry through regulation and taxes. We need to classify kratom as a controlled substance. As physicians and health professionals, we need to educate and update ourselves on emerging drug threats. Otherwise, we risk inviting another addiction to consume our patients and society.

Rehan Zafar is a psychiatry resident.