Kratom addiction catches people off guard. For years, the plant was sold in gas stations and smoke shops as a natural pick-me-up. It was marketed as an energy booster, as a focus aid, for pain, and even as a way off opioids. None of that prepared people for stopping.
Massachusetts temporarily placed kratom in Schedule I under an emergency regulation effective August 28, 2026. People affected by the restriction can seek help for dependence or withdrawal rather than replacing it with an illicit product.
New Wave Recovery Center’s drug addiction treatment programs sit on the North Shore. We treat kratom use disorder as a part of our intensive outpatient program.
What Kratom Is and Why It Acts Like an Opioid
Kratom comes from the leaves of a tree in Southeast Asia. In those Asian countries, people chewed or brewed the kratom leaves for generations.
In the United States, it is sold as powder, capsules, extracts, gummies, and shots. The plant is Mitragyna speciosa.
Mitragynine is the principal kratom alkaloid. 7-hydroxymitragynine, usually called 7-OH, occurs in much smaller amounts in natural leaf; concentrated products can have a very different risk profile. Both activate mu-opioid receptors, the same ones opioid drugs work on. Mitragynine may bind to other receptors too. Those handle adrenaline, serotonin, and dopamine.
That mixed action is why the guide on the signs of drug addiction applies here the same as anywhere.
Low Doses and High Doses
Many kratom users report that small amounts feel like a stimulant and large amounts feel like an opioid or a sedative. Increased energy and an increased heart rate come with the first. Relaxation, pain relief, and other opioid like effects come with the second.
One caution matters. The National Institute on Drug Abuse says research has not yet confirmed that these effects depend on the amount or the method of use.
People report using kratom for energy, pain, or sleep, but these reports do not establish safety or effective treatment. The chapter on whether Adderall is habit-forming discusses another substance sometimes used for perceived performance benefits.
Why Natural Did Not Mean Safe
The Food and Drug Administration says kratom is not lawfully sold in the United States as a drug or a dietary supplement. It also cannot be added to food.
The agency has documented liver toxicity, seizures, and substance use disorder [1]. It has also found salmonella and heavy metals in some products. Newborn withdrawal has been reported after use in pregnancy. Those medical complications are the documented health risks.
Potency is the other problem. Mayo Clinic notes that the amount of active ingredient in kratom leaves varies a great deal, and that some sellers add more of it than the plant contains on its own.
Is Kratom Addictive? How Kratom Dependence Develops
DSM-5-TR does not name a separate kratom-specific disorder. That does not prevent clinicians from assessing a problematic pattern under substance use disorder criteria. NIDA reports that dependence and withdrawal can occur [2]; comparative addiction risk remains uncertain.
Dependence means the body has adapted and withdrawal may occur. Addiction involves a problematic pattern, including impaired control or continued use despite harm. Dependence does not automatically progress to addiction.
In one withdrawal study, people used kratom for more than six months. They reported symptoms like opioid withdrawal [3].
Medicines used for opioid use disorder, such as buprenorphine with or without naloxone, have been used for some people with kratom-related problems. They are not required for every person, and evidence is more limited than for established opioid use disorder. Tolerance can develop with repeated use, but not everyone follows the same course. Increasing amounts or difficulty cutting back warrants assessment.
Who Is Most at Risk
People with a history of opioid use disorder may be vulnerable to problematic kratom use, including when trying to manage opioid withdrawal themselves.
Many of them already showed the signs of opioid addiction before kratom entered the picture. For them, the substance changed, but the pattern did not. Problems can also develop in people without prior opioid use. Concentrated products may expose them to more potent opioid effects than they expect.
FDA describes 7-OH as less than 2 percent of natural leaf’s total alkaloid content, with substantially greater mu-opioid receptor potency than mitragynine or morphine [1]. Receptor potency is not a direct measure of a safe human dose or an individual’s addiction risk.
Prescription pain medicines can be part of the history, but are not a universal starting point. The chapter on Percocet and its liver risk discusses an additional risk of a common opioid combination.
Kratom Withdrawal Symptoms and Timeline
Kratom withdrawal can resemble opioid withdrawal. Its severity and duration vary; it is not reliably a milder or longer version.
Massachusetts health officials list what people report: craving, nausea, diarrhea, muscle aches and headaches, sniffling, sneezing, sweating, and irritability [4]. Many people also describe chills, anxiety, depression, restlessness, and trouble sleeping.
Symptoms may begin soon after reducing or stopping regular use, but there is no well-established timeline that applies to every product and person. Some symptoms ease over days, while sleep, mood, or craving problems may persist. Persistent or severe symptoms warrant assessment rather than an assumed one- or two-week recovery deadline. How rough it gets depends on the dose and frequency, and most of all on the product.
Natural leaf and concentrated 7-OH products differ substantially. Concentrates can cause stronger opioid effects and serious dependence, but their exact withdrawal course is not predictable from the label alone.
Withdrawal can be distressing and may lead to dehydration or worsening mental health. Other substances can add dangerous withdrawal risks. Seek clinical advice and urgent help for severe symptoms.
Other medicines can also cause dependence. The chapter on is gabapentin addictive explains why dependence and addiction need separate assessment. Replacing kratom with illicit opioids or counterfeit pills can introduce serious overdose risk. Seek treatment guidance rather than an uncertain substitute.
The American Psychiatric Association reports an increase in kratom involvement in opioid-related deaths between 2016 and 2022 [5]. Detection alongside opioids does not establish kratom as the sole cause or describe the overdose risk for every user.
Anyone using kratom daily should talk with a doctor before stopping. This chapter gives no taper schedule; that is a prescriber’s job.
What Changed in 2026
Kratom’s legal status moved further in 2026 than in the whole decade before. Anyone using it in Massachusetts needs both layers.
The Federal Action on 7-OH
Kratom itself has never been federally scheduled. The Drug Enforcement Administration proposed listing its derivatives in Schedule I back in 2016, then quickly withdrew the proposal.
On July 6, 2026, DEA published a notice of intent to temporarily control 7-OH above specified thresholds. A notice of intent is not an effective scheduling order.
The July notice described more than 0.050 percent 7-OH by dry weight in plant material, or more than 1 milligram in a finished article [6]. It specified that an order could not issue before August 5, 2026. Those thresholds describe that proposal, not a safe dose or proof that a final order took effect.
Federal rulemaking can change. As of this review, the July document is a notice of intent; confirm any later effective order before relying on it as current federal law.
The Massachusetts Emergency Order
Massachusetts went further. The Commissioner of Public Health issued an emergency regulation on August 13, 2026. It made kratom a Schedule I controlled substance under state law.
The regulation took effect August 28, 2026, and states it remains effective for one year unless the commissioner determines earlier that it is no longer necessary [4]. It temporarily controls kratom as defined in the regulation; local boards of health assist with enforcement.
The state was clear about what that means for daily users. They are likely to face opioid tolerance and withdrawal, and should seek medical care or treatment.
Kratom With Other Substances
Some people combine kratom with other substances, including to manage stimulant after-effects. The chapter on the comedown after cocaine discusses that concern.
People may also be trying to manage pain, anxiety, or sleep problems. A clinician should assess those needs rather than assuming the reason for use.
Mixing kratom with alcohol, opioids, benzodiazepines, or other sedating drugs can increase harm. The evidence does not establish alcohol as the most common pairing or explain most emergencies.
The state advises anyone still using to avoid mixing kratom with opioids, alcohol, benzodiazepines, or sedatives. It also advises keeping naloxone nearby.
For suspected overdose, call 911 immediately and give naloxone if available [5]. If normal breathing has not returned, repeat according to the product instructions and follow the dispatcher’s CPR guidance. Stay until help arrives.
Treatment Options for Kratom Use Disorder
Treatment for kratom-related problems is individualized. Some clinicians use approaches drawn from opioid treatment, but there is no definitive kratom-specific treatment guideline. A clinician assesses use pattern, withdrawal, other substances, physical and mental health, and available support to choose the setting and plan.
New Wave does not provide detox. When it is needed, our drug and alcohol detox page explains how the referral works and how care steps down afterward.
Some people can receive outpatient care, while others need more intensive support. The product label or reported dose alone cannot decide that, and program schedules vary.
Small studies and case reports describe use of medicines for opioid use disorder, including buprenorphine [5]. No medication is FDA-approved specifically for kratom use disorder, so a qualified prescriber must weigh the evidence and individual risks.
Care then runs at the day treatment level. That is the Massachusetts term for a partial hospitalization program. It also runs as an intensive outpatient program or as weekly outpatient visits. Care can also address pain, anxiety, sleep, and other co-occurring problems. Coordinated support may help recovery, but does not guarantee its course.
Frequently Asked Questions About Kratom Addiction
Is Kratom an Opioid?
Not exactly, though it acts on the same receptors. Mitragynine and 7-OH both activate mu-opioid receptors, which is why the effects and the withdrawal resemble opioids. Mitragynine also touches adrenaline, serotonin, and dopamine receptors, so the profile is mixed rather than purely opioid.
How Long Does Kratom Withdrawal Last?
There is no universal withdrawal timeline. Symptoms may start soon after stopping regular use and last for varying periods. Dose, frequency, product composition, other substances, and health all matter.
Is Kratom Legal in Massachusetts?
No, not since August 28, 2026. An emergency order from the Department of Public Health made kratom a Schedule I controlled substance under state law, covering all kratom products and letting local boards of health clear retail shelves. The order stays in force for up to a year.
Is Kratom Bad for You?
The FDA has documented liver toxicity, seizures, and substance use disorder, plus products contaminated with Salmonella and heavy metals. Mayo Clinic lists weight loss, nausea, constipation, dizziness, and trouble breathing among the effects. Deaths are rare and nearly always involve other drugs as well.
Does Kratom Help With Opioid Withdrawal?
Kratom is not FDA-approved to treat opioid withdrawal or any other condition. Some people report relief, but reliable evidence of safety and effectiveness is limited, and dependence can develop. Ask about approved medicines for opioid use disorder.
Where to Start
If kratom was part of your day and the ban took it away, do not white-knuckle the withdrawal. Do not replace it with something from the street.
Getting professional help starts with one call. Try your doctor, or the Massachusetts Substance Use Helpline at 800-327-5050, free and confidential at any hour. You can text HOPE to the same number. The Substance Abuse and Mental Health Services Administration runs a national helpline at 1-800-662-HELP, or 4357. It covers substance use and mental health conditions, and it is free and confidential too.
New Wave Recovery Center’s drug addiction treatment programs on the North Shore can assess kratom-related concerns and co-occurring needs. Ask which program and schedule fit your situation. When you call, you can speak with someone in recovery.
This article is for information only. It is not a substitute for medical advice, diagnosis, or treatment. Do not stop regular kratom use abruptly without talking to a healthcare provider. If someone may be overdosing, call 911.
Sources
- U.S. Food and Drug Administration. FDA and Kratom. Content current as of December 2, 2025. https://www.fda.gov/news-events/public-health-focus/fda-and-kratom
- National Institute on Drug Abuse. Kratom. Last updated March 11, 2026. https://nida.nih.gov/research-topics/kratom
- Mayo Clinic. Kratom: Unsafe and ineffective. June 18, 2024. https://www.mayoclinic.org/diseases-conditions/prescription-drug-abuse/in-depth/kratom/art-20402171
- Massachusetts Department of Public Health. Kratom. Emergency regulation 105 CMR 726.000, issued August 13, 2026, effective August 28, 2026. https://www.mass.gov/info-details/kratom
- Fenno L. What is Kratom and Why is It Raising Concerns? American Psychiatric Association, October 22, 2025. https://www.psychiatry.org/news-room/apa-blogs/what-is-kratom-and-why-is-raising-concerns
- U.S. Drug Enforcement Administration. Schedules of Controlled Substance: Temporary Placement of 7-Hydroxymitragynine Above a Specified Threshold in Schedule I (notice of intent). 91 FR 40917, July 6, 2026. https://www.federalregister.gov/documents/2026/07/06/2026-13580/schedules-of-controlled-substance-temporary-placement-of-7-hydroxymitragynine-above-a-specified