Can You Overdose on Kratom? Toxicity, 7-OH, Withdrawal Timeline, and Tapering

Concentrated 7-OH acts on the same receptor as other opioids, and in one published case naloxone reversed a 7-OH cardiac arrest.

Can you overdose on kratom?

Yes, though the answer depends on what “kratom” means in the package. Deaths from plain kratom leaf alone are rare. Most deaths involving kratom involve something else too.

The best early count comes from the CDC. Of 27,338 overdose deaths in 27 states from July 2016 through December 2017, 152 tested positive for kratom, and medical examiners listed kratom as a cause in 91. Only seven tested positive for kratom and nothing else, and even then other substances could not be ruled out. Fentanyl was the most common companion drug, followed by heroin and benzodiazepines.

The picture since then has moved in the wrong direction. A 2026 CDC report on poison center data counted 14,449 kratom exposure reports from 2015 through 2025, rising from 258 in 2015 to 3,434 in 2025, a jump of about 1,200 percent. Of 233 kratom-associated deaths reported to poison centers in that period, 184, or 79 percent, involved more than one substance. The authors point to the market’s shift from leaf to high-potency extracts, particularly 7-OH.

Kratom overdose symptoms

The FDA warns of serious adverse events from kratom, including liver toxicity, seizures, and substance use disorder, and says deaths have been associated with kratom use in rare cases, confirmed by a medical examiner or toxicology. Signs that mean a call to 911: a seizure; extreme drowsiness or a person who cannot be woken; slow or stopped breathing; a racing or irregular heartbeat; confusion or agitation; or vomiting in someone who is not fully awake. With 7-OH or with another opioid on board, treat it like an opioid overdose.

Kratom toxicity and mitragynine toxicity

Mitragynine is the main alkaloid in the leaf. In the first human pharmacokinetic study, with data from nine regular users in Thailand, it reached peak blood levels in under an hour and had a terminal half-life of about 23 hours. A long tail means repeated doses through the day pile up, and the effects of a dose taken with alcohol, benzodiazepines, or another opioid add to whatever is already there. Combinations are where the worst outcomes cluster. In the 2026 CDC report, multiple-substance exposures made up 38 percent of kratom reports but were tied to more hospitalizations and more serious outcomes than kratom alone.

What is 7-OH, and why did it change the risk?

7-hydroxymitragynine is another alkaloid in the kratom leaf, where it is a minor one. The DEA’s October 2026 Federal Register notice puts it at under 2 percent of the plant’s total alkaloid content. It can also be made from mitragynine in one chemical step, and the body makes some of it from mitragynine as well. Sold on its own, in tablets, gummies, and shots, online and in retail shops and often labeled as kratom, it is far stronger than the leaf: the notice says these products contain a significantly higher concentration of 7-OH than the kratom plant itself. The FDA calls 7-OH a potent opioid and an emerging public health threat.

The evidence the DEA collected is specific. From January through July 2025, US poison centers logged 165 exposures to 7-OH; among people exposed to 7-OH alone, 35 percent had serious health problems and 67 percent were treated at a health care facility. The notice cites a published case of cardiopulmonary arrest reversed with naloxone, and another of 7-OH withdrawal that required inpatient buprenorphine stabilization. In children, a 2026 poison center analysis found that 7-OH or a related synthetic, mitragynine pseudoindoxyl, carried 2.5 times the odds of serious respiratory effects compared with mitragynine in children under 12.

Where the 7-OH ban stands

The Department of Health and Human Services first recommended scheduling in a July 28, 2025 letter to the DEA. On July 6, 2026, the DEA published a notice of intent to temporarily place 7-OH in Schedule I above a lower threshold; that order was never issued. On October 14, 2026, after a new HHS recommendation, the DEA published a new notice of intent and said it was withdrawing the July notice. The new proposal covers 7-OH and a related compound, mitragynine pseudoindoxyl, alone or combined, when a product contains more than 1 milligram per gram (solids) or 1 milligram per milliliter (liquids), or contains less than 100 times as much mitragynine as those two compounds. The DEA says the order will be published on or after November 13, 2026, and takes effect the day it is published. As of October 21, 2026, it had not been issued. Neither agency has found 7-OH safe to use below the threshold. A separate temporary order took effect on August 26, 2026, placing three related synthetics, mitragynine pseudoindoxyl, MGM-15, and MGM-16, in Schedule I with no threshold. It lasts until August 26, 2028, or until the DEA replaces it; the DEA has announced replacement orders that would keep MGM-15 and MGM-16 in Schedule I and move mitragynine pseudoindoxyl to the new threshold. The FDA says the 7-OH action is not meant to reach natural kratom leaf with only trace 7-OH. A temporary order lasts two years and can be extended for up to one more while permanent scheduling is considered. Check the Federal Register docket for the current status.

Is kratom safe? Is it bad for you?

The FDA says there are no kratom drug products legally on the market and has warned consumers not to use it. It has also warned about kratom products contaminated with Salmonella or heavy metals, and about newborns showing withdrawal after kratom use in pregnancy. NIDA is more measured: it notes that studies suggest mild to moderate withdrawal in regular users and that more research is needed. Both agencies agree on the core point. Kratom is not regulated like a medicine, so the dose and the contents of any given product are unknown.

Kratom and the liver

Liver injury is rare but documented. The national Drug-Induced Liver Injury Network identified 11 cases attributed to kratom. All the patients had symptoms and jaundice, appearing a median of 14 days after starting kratom; most were hospitalized; all eventually recovered. Itching, yellow skin or eyes, dark urine, pale stool, or pain under the right ribs after starting kratom are reasons to stop and see a doctor the same week.

Kratom withdrawal: symptoms and timeline

Regular kratom use produces physical dependence, and stopping produces withdrawal. A survey of 293 regular users in Malaysia found muscle spasms and pain, trouble sleeping, watery eyes and nose, hot flashes, fever, poor appetite, and diarrhea, along with restlessness, tension, anger, sadness, and nervousness. Users who drank three or more servings a day were more likely to have severe dependence and withdrawal. A 2019 systematic review concluded that kratom withdrawal looks like opioid withdrawal and should be approached the same way.

No controlled study has mapped kratom withdrawal day by day. What can be said is what follows from the drug and from opioid withdrawal generally. The table is a typical pattern, not a schedule.

The opioid course in the table is from NIDA’s heroin research report. Leaf kratom withdrawal is usually milder than that. Heavy daily use, concentrated extracts, and 7-OH products push it toward the heroin end, and a person who has been using kratom to manage an old opioid habit may find the old cravings come back with it.

Tapering off kratom

Stopping all at once is not dangerous the way stopping alcohol or benzodiazepines can be, but it is often the reason people go back. There are three routes, and they are best planned with a clinician who knows the whole picture, including any prescriptions. If kratom is being used alongside a prescribed medication, do not change that medication on your own.

• A gradual reduction. Cutting down over a set period, with a plan for sleep and symptoms. This works best for leaf users with lighter habits and no history of other opioid use.
• Symptom medication. Clinicians sometimes use non-opioid medications for withdrawal symptoms, such as clonidine or lofexidine for sweats and restlessness, alongside sleep and stomach support. Neither is FDA-approved for kratom specifically.
• Buprenorphine. For heavier dependence, a buprenorphine product is an option. A 2021 case series and literature review found the buprenorphine dose needed tracked closely with how much kratom a person had been using. In a case series of 28 patients treated long term, 68 percent had urine tests negative for mitragynine at 4 weeks and 82 percent at 8 and 12 weeks.

Not everyone agrees buprenorphine should come first. A 2023 expert forum, which disclosed honoraria from kratom industry groups, argued that leaf withdrawal is usually mild enough that methadone and buprenorphine should be used judiciously rather than as the default. The reasonable middle: the heavier and longer the use, and the more 7-OH involved, the stronger the case for medication.

Kratom and Suboxone

Does Suboxone block kratom? Largely, yes. Buprenorphine binds the opioid receptor tightly, so a person on a steady dose gets little from kratom. The risk is at the start. A first dose of buprenorphine taken while still under the effect of heavy kratom or 7-OH use, before withdrawal has begun, can cause precipitated withdrawal, a sudden, severe version of the same illness. The prescriber needs to know about kratom use, including the product and how often. Our Suboxone vs Subutex vs Sublocade guide covers the medications themselves.

Kratom detox: when it needs a medical setting

Most leaf kratom withdrawal can be handled in outpatient care with a prescriber. A supervised detox is the better fit when any of these is true:

• Daily use of concentrated extracts or 7-OH products
• Kratom used with alcohol, benzodiazepines, or other opioids, any of which may carry its own withdrawal risk
• Past attempts to quit that ended within days
• Pregnancy, a seizure history, liver symptoms, or a serious heart condition
• Depression or thoughts of suicide during past withdrawals

Our opioid detox guide explains what medically managed opioid withdrawal looks like, and the medication guide covers buprenorphine and the alternatives. If withdrawal brings thoughts of suicide, call or text 988.

In New Jersey

As of October 21, 2026, no New Jersey law bans kratom. Bills introduced in the 2026–2027 session would ban it (S829, “CJ’s Law”), restrict its sale, or regulate it as a consumer product (A4222); all were still in committee. A separate bill that would make 7-OH a Schedule I drug in New Jersey, S301, cleared the Senate Health Committee in March 2026 and is in the Senate Budget Committee; an Assembly version, A5359, was introduced in September 2026. Check current law before relying on that sentence. Federal scheduling applies in New Jersey either way, including the August 2026 order on the 7-OH-related synthetics and any 7-OH order that follows.

On coverage, under New Jersey law P.L.2017, c.28, fully insured New Jersey plans and the State Health Benefits and School Employees’ plans cannot require prior authorization for the first 180 days per plan year of in-network treatment your own physician, psychologist or psychiatrist finds medically necessary, or, during those same 180 days, for outpatient prescription drugs that treat substance use disorder, such as buprenorphine and naltrexone, when that clinician finds them medically necessary. Self-funded employer plans, Medicare and Medicaid are not covered by that rule, so verify with the plan. NJ FamilyCare, New Jersey’s Medicaid program, covers detox and addiction treatment under its own rules. Our insurance guides go plan by plan. ReachNJ, the free state treatment line, is at 1-844-732-2465.

Periscope Behavioral Health, which publishes this site, is opening a medical detox in Hammonton, Atlantic County, expected Summer 2027. For help independent of us, the state’s IME Addictions Access Center at 1-844-276-2777 screens NJ FamilyCare and uninsured residents and refers them to treatment. Until the Hammonton detox opens, the admissions line of our publisher, Periscope Behavioral Health, at (888) 313-3583, can talk through options in New Jersey and Florida, including facilities Periscope operates. What a plan covers depends on the plan and the facility’s network status.

Where this leaves you

Leaf kratom by itself rarely kills. Kratom with another drug sometimes does, and 7-OH sold as kratom is a different product with an opioid’s risks. Withdrawal is real and usually manageable, and it goes better with a plan than on a bad Tuesday. If you are taking more than you meant to, or cannot get through a morning without it, that is the point to talk to a prescriber, not the point after the next product change.