(Note: Updated to reflect emerging drug trends and clinical insights from a 2026 expert forum)
Walk into a gas station, vape shop, or convenience store and you may see small bottles, powders, or gummies labeled kratom — often advertised as a natural solution for pain, anxiety, mood, or even opioid withdrawal. Some have even called it “gas station heroin.”
But legality does not equal safety.
In a recent BrightView virtual forum on emerging drug trends, Medical Director Dr. Gilbert Schmidt described kratom and similar products as part of a rapidly expanding “gray market” of substances — legal to purchase, widely accessible, and increasingly associated with dependence, withdrawal, and serious health risks.
What is Kratom?
Kratom is derived from the leaves of Mitragyna speciosa, a tree native to Southeast Asia.
The plant contains more than 40 alkaloids, the most prominent being mitragynine. Another compound — 7-hydroxymitragynine (often shortened to “7-OH”) — is present in very small amounts in the natural leaf but becomes far more significant in concentrated commercial products.
At lower doses, users report stimulant-like effects. At higher doses, kratom acts on opioid receptors in the brain, producing pain relief, mild euphoria, and sedation.
Dr. Schmidt emphasized that kratom’s alkaloids bind to the mu-opioid receptor — the same receptor targeted by heroin, fentanyl, and prescription opioids — which explains why withdrawal symptoms can closely resemble opioid withdrawal.
From Traditional Leaf to High-Potency Products
Historically, kratom leaf was chewed or brewed into tea in Southeast Asia. What has changed in the United States is the rise of highly concentrated extracts, including products that isolate or amplify 7-hydroxymitragynine.
These products are sold as gummies, capsules, chewable tablets, or liquid “shots.” Some are marketed using branding that intentionally mimics prescription opioids.
Concentrated versions may be significantly more potent than the natural leaf and can increase the risk of:
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Dependence
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Escalating dose patterns
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Respiratory depression
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Overdose, especially when combined with alcohol or benzodiazepines
In addition, some newer products are chemically altered derivatives that do not naturally occur in the plant but are still marketed as “kratom.” These synthetic or modified compounds raise additional safety concerns and have little clinical research behind them.
Who Is Using Kratom?
National survey data suggest kratom use is most common among adults ages 18–50, with higher prevalence among males. It is often used by individuals attempting to self-treat:
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Chronic pain
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Anxiety or mood symptoms
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Opioid withdrawal
Many users believe kratom is safer because it is plant-based or sold legally. However, “natural” does not mean risk-free.
The Drug Testing Challenge
One of the most concerning issues for clinicians is detection.
Standard 5-, 10-, or 12-panel urine drug screens do not typically detect kratom or its alkaloids. Confirmatory testing such as liquid chromatography/mass spectrometry (LC-MS or GC-MS) is required and is more expensive and less commonly used in routine settings.
This creates situations where a patient may present with opioid-like withdrawal symptoms while routine toxicology screens appear negative.
Clinicians must specifically ask about herbal supplements, energy shots, or products purchased at gas stations or vape shops.
Withdrawal and Health Risks
Kratom withdrawal can include:
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Anxiety
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Muscle aches
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Insomnia
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Nausea and gastrointestinal distress
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Irritability
Some individuals describe withdrawal as less intense than heroin or prescription opioids but lasting longer — sometimes more than a week.
There have also been documented case reports of neonatal abstinence syndrome in newborns exposed to kratom during pregnancy.
Highly concentrated products increase overdose risk, particularly when combined with other central nervous system depressants.
It’s Not Just Kratom
Kratom is part of a broader trend of gray-market substances sold over the counter with significant medical risks.
Tianeptine (“Gas Station Heroin”)
Tianeptine is marketed as a mood enhancer or energy supplement but behaves like a short-acting opioid at high doses. It can produce rapid tolerance, severe withdrawal, and hospitalization. Some states have classified it as a controlled substance, but it remains widely available in others.
Phenibut
Phenibut is a synthetic compound marketed as a nootropic or anxiety aid. It acts on GABA receptors and can cause dependence. Abrupt discontinuation may result in agitation, hallucinations, and even seizures.
Dextromethorphan (DXM)
Commonly found in over-the-counter cough medications, DXM can produce dissociative and hallucinogenic effects at high doses. It is frequently misused by adolescents and young adults.
Like kratom, many of these substances are not detected on routine drug screens and require intentional screening during assessment.
Regulation: Legal Does Not Mean Approved
Kratom is not approved by the U.S. Food and Drug Administration for any medical use. Federal scheduling efforts have been proposed in the past but remain unresolved.
Several states have adopted versions of a Kratom Consumer Protection Act, regulating labeling and age restrictions rather than banning the product outright. Other states have moved to restrict or classify certain concentrated or synthetic derivatives as controlled substances.
This patchwork regulatory environment leaves consumers navigating inconsistent protections depending on where they live.
What Families and Clinicians Should Know
Because these substances are sold legally and marketed as supplements, many individuals do not perceive them as dangerous — even when use escalates or withdrawal develops.
Education and awareness are critical. Asking direct questions about over-the-counter products, energy supplements, and gas station purchases can uncover use that would otherwise go undetected.
The Bottom Line
Kratom and other gray-market substances are easy to buy and often promoted as safe, natural alternatives. But their interaction with powerful brain receptors, their potential for dependence, and the lack of consistent regulation make them far more complicated than their packaging suggests.
If you or someone you love is struggling with kratom or similar substances, comprehensive addiction treatment — including medical support and counseling — can help people stop safely and build long-term recovery.
BrightView Health provides comprehensive, outpatient addiction treatment — including medical support, counseling, and recovery planning — to help patients safely stop using and build long-term recovery.
Call 833.510.HELP (4357) or find a BrightView center near you »
