Document Type
Oral Presentation
Location
Oxford Conference Center
Event Website
https://oxfordicsb.org/
Start Date
23-4-2026 10:30 AM
End Date
23-4-2026 12:00 PM
Description
Kratom’s U.S. market has rapidly evolved from largely botanical powders and capsules to products enriched in 7-hydroxymitragynine (7-OH), a potent mu-opioid receptor agonist that is typically present only at trace levels in leaf material. To quantify downstream behavioral health burden and contextualize it with real-world signals of product diffusion, we analyzed National Survey on Drug Use and Health (NSDUH) data (2021-2023) alongside public health alert trends and systematic online product surveillance. In NSDUH, 5.8% of adults met criteria for serious mental illness (SMI). SMI increased by 150% among adults with combined opioid use disorder (OUD) and kratom use between 2021 (weighted n=44,329) and 2023 (weighted n=112,387). The three-year increase in SMI was fastest in the combined OUD plus kratom subgroup, with survey-weighted models estimating predicted SMI prevalence rising from 20% in 2021 to 50% by 2023 (interaction p=0.01). In parallel, we compiled federal and state public health communications (health advisories, press releases, safety communications, and outbreak notices), coded their primary substance focus, and observed an abrupt spike in 2025: total alert volume increased by 300% relative to 2024, and most 2025 alerts centered on 7-OH rather than kratom, reversing the pattern of prior years. To characterize the consumer-facing marketplace, we conducted automated crawling and scraping of online vendors (December 2025 to January 2026), deduplicated listings into distinct products, and identified more than 3,000 unique items; 67% were confectionary and/or explicitly flavored, with product naming, taste descriptors, and form factors consistent with adolescent-oriented marketing. Together, these convergent signals indicate that the contemporary “kratom” environment increasingly reflects high-potency 7-OH exposures and that this shift is unfolding alongside rapidly worsening SMI among people with concurrent OUD and kratom use. At a time of strained U.S. treatment systems, high overdose rates, and a mental health crisis, these findings support urgent differentiation of 7-OH products from botanical kratom in surveillance, risk communication, and policy responses, including attention to flavored confectionary formulations that may amplify youth appeal. For clinical settings, the sharp rise in SMI among people with OUD who also use kratom underscores the need to assess kratom and 7-OH exposure during intake and to coordinate addiction treatment with mental health care. For regulators and surveillance programs, the alert spike and marketplace metrics provide practical early-warning indicators to track diffusion, prioritize testing and enforcement, and evaluate the impact of platform or policy actions over time.
Recommended Citation
Koturbash, Igor; Alsbrook, Scott; and Pro, George, "Determinants of opioid-relevant exposure from 7-hydroxymitragynine products in the evolving U.S. marketplace" (2026). Oxford ICSB. 37.
https://egrove.olemiss.edu/icsb/2026_ICSB/Schedule/37
Publication Date
April 2026
Included in
Determinants of opioid-relevant exposure from 7-hydroxymitragynine products in the evolving U.S. marketplace
Oxford Conference Center
Kratom’s U.S. market has rapidly evolved from largely botanical powders and capsules to products enriched in 7-hydroxymitragynine (7-OH), a potent mu-opioid receptor agonist that is typically present only at trace levels in leaf material. To quantify downstream behavioral health burden and contextualize it with real-world signals of product diffusion, we analyzed National Survey on Drug Use and Health (NSDUH) data (2021-2023) alongside public health alert trends and systematic online product surveillance. In NSDUH, 5.8% of adults met criteria for serious mental illness (SMI). SMI increased by 150% among adults with combined opioid use disorder (OUD) and kratom use between 2021 (weighted n=44,329) and 2023 (weighted n=112,387). The three-year increase in SMI was fastest in the combined OUD plus kratom subgroup, with survey-weighted models estimating predicted SMI prevalence rising from 20% in 2021 to 50% by 2023 (interaction p=0.01). In parallel, we compiled federal and state public health communications (health advisories, press releases, safety communications, and outbreak notices), coded their primary substance focus, and observed an abrupt spike in 2025: total alert volume increased by 300% relative to 2024, and most 2025 alerts centered on 7-OH rather than kratom, reversing the pattern of prior years. To characterize the consumer-facing marketplace, we conducted automated crawling and scraping of online vendors (December 2025 to January 2026), deduplicated listings into distinct products, and identified more than 3,000 unique items; 67% were confectionary and/or explicitly flavored, with product naming, taste descriptors, and form factors consistent with adolescent-oriented marketing. Together, these convergent signals indicate that the contemporary “kratom” environment increasingly reflects high-potency 7-OH exposures and that this shift is unfolding alongside rapidly worsening SMI among people with concurrent OUD and kratom use. At a time of strained U.S. treatment systems, high overdose rates, and a mental health crisis, these findings support urgent differentiation of 7-OH products from botanical kratom in surveillance, risk communication, and policy responses, including attention to flavored confectionary formulations that may amplify youth appeal. For clinical settings, the sharp rise in SMI among people with OUD who also use kratom underscores the need to assess kratom and 7-OH exposure during intake and to coordinate addiction treatment with mental health care. For regulators and surveillance programs, the alert spike and marketplace metrics provide practical early-warning indicators to track diffusion, prioritize testing and enforcement, and evaluate the impact of platform or policy actions over time.
https://egrove.olemiss.edu/icsb/2026_ICSB/Schedule/37
Comments
Igor Koturbash is a Professor and Chair at the Department of Environmental Health Sciences and the Founder and Co-Director for the Center of Dietary Supplements Research, at the College of Public Health, University of Arkansas for Medical Sciences (Little Rock, AR). He received his M.D. from the State Medical University in Ivano-Frankivsk, Ukraine (2001), and his Ph.D. in Biomolecular Sciences from the University of Lethbridge, Canada (2008). The major focus of Igor’s research is safety, efficacy and mechanisms of action of dietary supplements and understanding how diet and dietary supplements can modulate tissue response to cancer therapy. Dr. Koturbash is heavily involved in a number of studies on various dietary supplements and herbs, including methionine supplementation, green tea extract, cannabidiol, and kratom. He has published over 120 peer-reviewed articles and book chapters, is a past President of the South-Central Chapter of the Society of Toxicology, and serves as an Editor-in-Chief peer-reviewed professional journal Pharmaceutical Biology and an Associate Editor the Journal of Dietary Supplements.