Kratom Crackdown Could Lead Ohioans to Fentanyl and Other Dangerous Drugs, Says Dr. Ryan Marino

Taking dietary supplements to augment nutritional diets, lose weight or address other physical and mental ailments has become a norm to many, but it’s being abused by others to get their next high, as you can easily pick up the colorful packaging goods at a gas station, vitamin stores, online and even brick-and-mortar stores like Whole Foods.

One of the more popular “gas station drugs” is kratom, which is created from extracts of the tropical tree Mitragyna speciosa from Southeast Asia. Kratom, with its two main chemical components, mitragynine and 7-hydroxymitragynine, acts on users' opioid and serotonin receptors. It is often used to self-treat pain, anxiety, depression, opioid use disorder and opioid withdrawal, but it’s also being used as a recreational drug.

These supplements hit the market with their medically intended and self-discovered recreational uses because the FDA is not authorized to regulate them the same way it regulates drugs. There is no pre-market approval for safety, effectiveness or the truth of their range of health benefits. It’s up to the manufacturer to ensure their products are safe for public use, and now states like Ohio are stepping in where the FDA or manufacturer are not for kratom.

With kratom being labeled as a dietary supplement, there are no age restrictions on the supplement in Ohio. That’s because dietary supplements range from vitamins and herbs to other ingredients. Young people may be taking kratom to help stay up to finish an essay, and older people may be using it to help with chronic pain.

Those who take kratom find that the drug carries its own risk of addiction and, when abused, has been found to cause severe effects like psychosis, seizures, insomnia, hallucinations and possibly death.

In reality, it's not just a small group of people picking up kratom from their gas stations. A national survey by the Substance Abuse and Mental Health Services Administration found that 1.7 million Americans used kratom in 2021. With a large number of Americans taking these supplements and some abusing them, the lack of regulation from the FDA concerns some medical experts and policymakers.

Gov. Mike DeWine’s Kratom Ban Push

On Aug. 25, Ohio Gov. Mike DeWine recommended that the Ohio Board of Pharmacy “immediately designate all natural and synthetic kratom compounds as illegal drugs,” according to a press release from his office. 

In that same press release, DeWine’s office cites that kratom was found to be the cause of 200 unintentional overdose deaths in Ohio from 2019 to 2024.

However, medical experts have a different outlook on those deaths. Dr. Ryan Marino of University Hospitals says that these deaths often involved multiple substances and that the overdose risk of kratom is not considered as high as that of other drugs, but also are not inherently any safer.

In a 2019 study, the CDC looked at 27,338 overdose deaths that occurred during July 2016 to December 2017. Only seven of those deaths had kratom as the only substance to test positive on postmortem toxicology. 

DeWine’s push to ban Kratom in Ohio was short-lived after the governor spoke with Health and Human Services Secretary Robert F. Kennedy Jr., DeWine proceeded to suspend the meeting to reconsider the ban on Kratom but did not rule out a future ban from the state. 

“I received a contact from Secretary Kennedy. We're looking at some of the things that he has said and we're going to continue this discussion. Yes, I was contacted by the secretary," DeWine told ABC6 on Aug. 29.

Marino, who specializes in addiction medicine and medical toxicology, is also a professor at Case Western Reserve University School of Medicine. He says that if the ban goes through, it would make it harder to study kratom, understand its medical effects on humans, advise patients and treat complications effectively.

"We don't have a ton of good information on kratom because it's not used medically in the United States. It's only available as a supplement,” Marino says. “So there's not a lot of research and data on it and especially on its effects in humans."

Who Is Taking Kratom and Other Dietary Supplements?

What we do know is that kratom, like other dietary supplements, is popular. A study in the AMA Journal of Ethics states that, in 1994, the dietary supplement industry grew from a $4 billion value with 4,000 products on the market to a $40 billion market by 2022, with 80,000 products on the market.

While the marketing and packaging of these supplements are often designed to target young people, Marino notes that he sees a wide range of individuals coming in who use these supplements.

“It seems pretty evenly distributed. And I would say the same for even the cannabis products. There's a tendency to assume that these substances are mostly just used by young people trying to get high,” Marino says. “But the reality is that people in their 70s and 80s will buy lumped fentanyl on the street to try to treat their arthritis. So it's not uncommon to see every age range across the entire spectrum.”

Studies have shown that low socioeconomic status has been associated with long-term opioid use both among people of working age and older people. Like these supplements, opioids have also been used to treat chronic pain by people. 

It also may be true that people of lower socioeconomic status are also turning to supplements like kratom, tianeptine, delta-8 THC and others because they don’t have access to healthcare, Marino says.

“It’s usually people who have less access to healthcare, whether that's because they are of a lower economic status or whether they have a history of drug use or something, and nobody will treat their pain,” Marino says. 

Quality-wise, the products in gas stations and grocery stores are about the same, Marino says.

"There's really no difference in taking a supplement from (grocery stores) as opposed to taking kratom from a gas station in terms of what you could be getting. The regulation and the safety risks are pretty similar for both products," Marino says.

Lack of Regulation From the FDA

Kratom’s safety risks stem from the fact that the FDA has little legal authority and limited resources to regulate dietary supplements. The FDA hasn’t approved kratom or its two main chemical components, mitragynine and 7-hydroxymitragynine, for consumption or medical use. 

The lack of regulation has led to significant concerns about the quality of the products, as kratom could vary widely in potency, and could be contaminated with other drugs (like tramadol) or bacteria (like salmonella).

In 2018, kratom was the source of 199 Salmonella cases that caused 54 people to be hospitalized across 41 states.

Earlier this year, Feel Free, a tonic tonic drink mixed with kratom and kava root, went viral on social media after a TikTok describing how addictive it was got 23 million views. 

“You’re playing with fire,” Dr. Robert Levy of the University of Minnesota Medical School told NBC. “As an addiction medicine doctor, I would never suggest that somebody consume [Feel Free] that’s in recovery.” 

Levy also told NBC that he wouldn’t recommend it to anyone in general because it’s not regulated. 

Feel Free is marketed as a herbal drink that offers relaxation, productivity and focus. The creator of Feel Free, Botanic Tonics, settled a 2023 class action lawsuit paying out $8.75 million after it failed to warn users about the risk of kratom and advertising the drink as a safe replacement for alcohol.

Banning vs Regulation

Banning kratom, mitragynine and 7-hydroxymitragynine wouldn’t make those substances safer, Marino says. While kratom might cease to be sold at gas stations and other shops, he stated in his own opinion, there’s a very high likelihood people will look for it on the dark web or turn to readily available substances that are more dangerous than kratom, like fentanyl.

Along with DeWine’s push to ban kratom, the FDA in July of this year recommended a scheduling action to control certain 7-hydroxymitragynine products under the Controlled Substances Act.

"The easy answer is banning them when in reality there's a lot of evidence that these bans can actually make things worse,” Marino says, “and (the ban isn’t) going to address the problems that are leading to the overdoses, the toxicity, the salmonella infections, et cetera." 

The legalization and regulation of cannabis in Ohio helped lead to the disappearance of synthetic cannabinoids like spice and K2. Meanwhile, it helped create a gray market for Delta-8 THC. 

“Spice and K2, which were causing pretty significant problems, were making people act very bizarrely and did not really function like THC or other cannabinoids in the body,” Marino says. “Those (cannabinoids) disappeared. But with that said, it’s because a more legal, predictable form was available.”

Users claim that delta-8 THC helps with health issues and chronic pain. Yet Marino expressed concern that there is no regulation for delta-8 THC products, saying that hemp plants have different doses compared to those in cans, edibles, and that these products have led to an increase in overdoses, especially in children. 

In 2024, the Nationwide Children’s Hospital and the Central Ohio Poison Center saw a rise in exposure to delta-8 THC, including among children. Hemp products, like Delta-8 THC, are also often marked as a dietary supplement.  

The Ohio House passed a bill on Oct. 23, 2025, that would allow only licensed hemp dispensaries to sell hemp products to those 21 and older, provided the products meet testing, advertising and packaging standards.  

“I’ve heard throughout this process now for a very long time from folks in the hemp industry, ‘regulate us like marijuana, regulate us like marijuana.’ And that was the theme of this bill,” Ohio Rep. Brian Stewart told Ohio Capital Journal. 

Last year, DeWine tried to push for a full ban on delta-8 THC, just like he currently did with kratom. 

But the tug of war over banning or regulating kratom has been happening for almost a decade on the federal level. In 2016, the Drug Enforcement Administration intended to classify kratom as a Schedule I controlled substance under the Controlled Substances Act, which would make it illegal to possess kratom and a felony to distribute it. The DEA quickly withdrew its intention to classify the substance.

More recently, in 2023, Congress introduced the bipartisan Federal Kratom Consumer Protection Act. It never received a vote in either chamber, and the act would prohibit the FDA from applying regulations to kratom that are stricter than those of food or dietary supplements. 

At the state level, kratom advocates at the American Kratom Association are calling on DeWine and state officials to align with the FDA to control certain 7-hydroxymitragynine products and synthetics, as they express that “natural kratom products that have been safely used in the United States for decades.”

This is what Ohio Sen. Louis Blessing proposes in Ohio Senate Bill 299. The bill, if passed, would regulate synthetic 7-hydroxymitragynine by limiting it to no more than one milligram per product. Natural kratom products will also be regulated, with manufacturers, distributors and sellers registering with the Ohio Department of Agriculture.

Blessing said this bill is a starting point, as the Department of Agriculture could establish additional rules for the kratom industry. However, Blessing also supports a full ban on kratom but wants to start having hearings on the issue. 

“Kratom consumers in Ohio and across the country want safe access to products they can trust,” Mac Haddow, Senior Fellow on Public Policy for the American Kratom Association, said in a press release. “By focusing on removing dangerous synthetics while regulating natural kratom responsibly, Ohio can set a strong example for other states to follow.”

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