Research In Action

The production, distribution, sale, and use of intoxicating drugs in Pennsylvania is an unregulated, wild frontier.

In August 2025, Pennsylvania’s Poison Control Centers alerted the public about an alarming volume of calls related to kratom-derived products. Since 2022, these calls continue to increase annually, with a total of 111 cases reported in Pennsylvania last year. This trend impacts young children, teenagers, and adults alike.

What Are Kratom and 7-OH?

Products marketed as “kratom” or “7-hydroxymitragynine” (7-OH) are increasingly available for purchase in smoke shops, convenience stores, and gas stations, and from online vendors.

Both are derived from Mitragyna speciosa, a tree native to Southeast Asia, and contain alkaloids that produce stimulant and opioid-like effects. Kratom has been embraced by many as a “natural alternative” for management of chronic pain and opioid withdrawal, but evidence also points towards substance use associated with kratom-derived products. Last year, 42 of the 111 cases in PA involved individuals taking kratom or 7-OH with the intention of gaining a psychotropic effect.

What Are the Dangers of These Products?

Acute toxicity from kratom and 7-OH can result in sedation and reduced respiratory drive. Regular use may also lead to withdrawal syndrome, sometimes requiring medications used to treat opioid use disorder, like buprenorphine.

People have been harmed by these products in Pennsylvania. In 2025, 10% of the 111 individuals reported to PA Poison Control Centers were placed on mechanical ventilation or noninvasive ventilation (e.g., BiPAP). Poison centers were contacted by healthcare providers across PA to assist in the management of 17 acute withdrawal cases. A total of 37 people in 2025 were eventually hospitalized for management of health issues related to kratom or 7-OH.

High-potency 7-OH products are of particular concern as they are often synthesized in unregulated laboratories. It was not until 2025 that PA Poison Control Centers received reports of 7-OH. In that same year, 7-OH accounted for 21% of all kratom-related cases reported to the Centers.

An All Too Familiar Problem

These products are unregulated at the federal level in the United States, and their composition and potency vary widely. We have shared similar public health concerns about “minor cannabinoids” like hemp, CBD, and delta 8 THC in a previous CIRP blog. Clinicians and public health authorities are joining us in raising concerns about their potential for significant harm.

What Can Be Done?

In Pennsylvania, these products are unregulated. They require no warning labels, and the public may assume that they are safe to consume, like anything else in the store. Consumers should not feel confident that the substance or even the dose on the label reflects what is in the product. As in many of these circumstances involving unregulated substances, young children are particularly vulnerable to the packaging that often resembles baked goods, soft drinks, or candy.

When lawmakers consider how to regulate any psychoactive chemical (e.g., kratom-derived products, intoxicating hemp), there are common-sense poisoning prevention policies that can protect the public:

• Intoxicating products should be clearly labeled and include appropriate warnings. (i.e., risk of substance use disorder and overdose).
• Assure that the ingredients and doses on the product label are accurate. Reasonable dose limits should be chosen to prevent severe “overdose” or severe harm.
• Prohibit the marketing and sale of psychoactive chemicals to minors. Psychoactive chemicals should not look like candy or kid treats, and should not even be sold near food items.
• Child-resistant packaging should be used in concordance with the Poison Prevention Packaging Act. Unit-dose packaging, like “blister packs", is best. Packaging should also be opaque.
• Income from sale of intoxicating products should be used to fund child injury programs.