The number of Cleveland stores carrying synthetic kratom products has more than tripled since 2023.
The products — which are unregulated but widely regarded as addictive — are now being sold in 132 convenience stores, gas stations and smoke shops, up from 29 stores in 2023, according to new research from Case Western Reserve University.
Synthetic kratom can be misleadingly marketed to seem safe and natural, but in fact are very dangerous, Cleveland Public Health Director David Margolius said, citing a 2019 report in the journal Pharmacotherapy.
“It's similar to opioids," he said. "There is a concern for addiction. The challenge with this is it's completely unregulated. We don't really know what you're getting with different doses.”
While Cleveland will begin regulating smoke shops at the end of October, kratom is not included because the substance is not illegal.
The Food and Drug Administration concluded in a July report one synthetic version of kratom, 7-hydroxymitragynine (also known as 7-OH), is an opioid that is more potent than morphine and is as addictive as fentanyl and oxycodone. The agency is considering a national ban.
Packaging can be misleading, said Dr. Stephanie Pike Moore, a research scientist at the Prevention Research Center for Healthy Neighborhoods at CWRU.
Moore said she recently received a free sample that claimed the product was gluten-free, kosher and alcohol-free. But in small print on the back, there are warnings for those with a history of substance abuse, she said. The company that produces the product is currently involved in a class action lawsuit alleging false advertising.
Ohio has pending legislation to regulate kratom products, the American Kratom Association's Mac Haddow said.
“We've been promoting what we call our Kratom Consumer Protection Act with the legislature," he said. "I think that we're ready to move on it. It includes age restrictions. It includes regulations for registering the products to make sure that they meet product formulation standards and are safe.”
Haddow said he agrees synthetic kratom such as 7-OH should be banned. However, natural versions of kratom could potentially be safely used for pain relief and to treat opioid addiction, he said, citing a 2020 Johns Hopkins study of the substance published in Drug and Alcohol Dependence.
In that report, the researchers cautioned that self-reporting surveys are not necessarily reliable and that scientific studies have not been done to formally establish safety and benefits of kratom. But they said U.S. drug agencies should study and regulate rather than ban kratom sales outright because of its seemingly safe therapeutic potential, and as a possible alternative to opioid use.
