Kratom, a plant native to Southeast Asia and marketed in the United States as a natural remedy for pain, anxiety and opioid withdrawal, is once again at the center of a national debate over safety, regulation and the blurred line between supplement and drug.
The renewed alarm follows the discovery of packaged kratom among the belongings of two deceased University of Mississippi students. Investigators have not said kratom caused the deaths, but the finding has prompted officials to issue fresh warnings about its use and has revived long-running calls from anti-kratom advocates for tighter controls or outright bans.
For people like Jeffrey Deaver, a 58-year-old retired timber cutter in Washington state, the substance has been something else entirely: a last resort that made daily life bearable. Deaver said he began taking kratom four years ago after struggling with severe chronic hip and knee pain and failing to find relief through doctors while waiting for surgeries.
Scared at first, he said he "started small," then gradually took more until the pain eased. "It was like a miracle," Deaver said. "I could sleep. I could function. I just don't know what I'd do without it."
That tension — between personal relief and public-health concern — is at the heart of the kratom controversy.
Kratom comes from a tree native to countries including Thailand, Malaysia and Indonesia, where it has been used for centuries, often brewed like tea for its stimulant properties. In the United States, it entered the market as a supplement around 2016 and quickly spread into a booming gray zone of wellness products, pain aids and self-treatment options.
Dr. Shane Speights, dean of the New York Institute of Technology College of Osteopathic Medicine at Arkansas State University, said the shift into the U.S. supplement market is where "the problems began." In America, he said, kratom is often sold in highly concentrated forms — pills, powders and liquids — and is widely available in convenience stores, petrol stations and vape shops.
Because it is classified as a supplement, kratom products are not federally regulated by the U.S. Food and Drug Administration. That means, Speights said, there is no reliable way for consumers to know exactly what they are buying.
"There's no way to know exactly what you're getting," he said. "You could go and create something in your basement, market it as a supplement, and nobody's really going to check and see what's in it."
That lack of oversight has become one of the central arguments for critics who say kratom's popularity has outpaced the science and the safeguards. In some countries, including the United Kingdom, it is illegal. In the United States, however, legality varies by state, and it remains legal in places such as Mississippi.
Kratom's appeal is rooted in its unusual pharmacology. It is often marketed as a natural product that can help with pain management, anxiety and depression. In lower doses, Speights said, it can produce a stimulant effect similar to a "caffeine-kind of buzz." At higher doses, however, its opioid-like properties become more pronounced.
"It's almost like taking a narcotic," he said. "At higher doses, it can create more euphoria and give you more of a general high." Hallucinations are also possible.
The compounds in kratom, including 7-Hydroxymitragynine, interact with receptors and hormones such as dopamine, which helps explain why some users report both stimulation and pain relief. But those same effects can also create dependence, tolerance and, in some cases, serious toxicity.
Speights said the greatest danger comes from central nervous system depression, which can lead to cardiovascular collapse and loss of breathing. "That's where the deaths come in," he said.
Jana Wu, director of clinical integration at the addiction treatment centre Mountainside, said the risks extend beyond overdose. Withdrawal symptoms and addiction can be significant, she said, and the substance can take a heavy toll on families and finances.
"It affects marriages, relationships," Wu said. "I've seen people lose jobs, spend thousands of dollars a month on it."
The concern among clinicians and regulators is not only that kratom can be harmful, but that its easy availability may encourage people to treat it as harmless. Sold alongside energy drinks and nicotine products, it can appear more like a convenience-store wellness aid than a psychoactive substance with real risks.
That perception may be especially dangerous for people already vulnerable to substance use disorders, or for those seeking relief from chronic pain without access to consistent medical care. For some, kratom is a substitute for opioids; for others, it becomes a new dependency.
As officials in Mississippi and beyond revisit the substance in the wake of the student deaths, the broader question remains unresolved: whether kratom is a useful alternative medicine, a poorly regulated supplement, or a public-health problem hiding in plain sight. For now, it is all three at once — a product embraced by some as a lifeline, and feared by others as a fast-growing risk with too little oversight and too many unknowns.