LA County Removes Kratom After Six Deaths; Experts Call for Better Research and Regulation

Los Angeles County public health officials recently ordered kratom products and items containing the potent kratom alkaloid 7-hydroxymitragynine (7-OH) to be red-tagged and removed from store shelves after linking six deaths from April to July to the presence of kratom or 7-OH in decedents' systems. The move reflects immediate safety concerns even as scientists warn the evidence on kratom's direct role in fatal cases remains inconclusive.

County records show the six adults, aged 19 to 39, had kratom and 7-OH detected alongside other substances including alcohol, prescription sedatives and muscle relaxants, and cocaine. Coroners listed mixed drug effects as the cause of death in five cases; the sixth death was attributed to a cocaine overdose.

Why the connection is complicated

Forensic toxicologists told reporters that while kratom's primary effects are increasingly documented, its role in deaths is muddied when other drugs are present. At low doses kratom typically produces stimulant-like effects and increased energy; at higher doses it can have sedative, opioid-like effects. The refined alkaloid 7-OH is far more potent than crude kratom and has raised alarm among public health officials because it is prone to adulteration and mislabeling.

Craig Smollin, medical director of the San Francisco division of the California Poison Control System, said the central concern is interactions: kratom or 7-OH may amplify the respiratory-depressing effects of opiates, benzodiazepines or alcohol, but the science on those interactions is sparse.

Adding to the uncertainty, toxicologists say current post-mortem testing can often detect whether 7-OH is present but cannot reliably quantify how much was in the body at the time of death. Donna Papsun, a forensic toxicologist at NMS Labs, noted that 7-OH is chemically unstable: it can be present at death but begin to break down by the time samples are collected and analyzed, complicating interpretation.

Voices from users and sellers

Many users and some retailers argue a blanket ban on all kratom products would do more harm than good. They say most consumers use crude kratom to manage chronic pain, opioid dependence or mood symptoms, and that responsible users would be penalized while illicit manufacturers and sellers continue to circulate concentrated or adulterated products.

Dee Mascalusco, 74, described using kratom to relieve chronic fatigue and breathing problems related to long-term lung illness. She said kratom has helped her maintain energy and daily activities and that she fears losing access if products are pulled from shelves.

Retailer Abdullah Mamun, founder of a local kratom business, acknowledged the risks posed by concentrated 7-OH products and urged regulators to target illicit or adulterated forms instead of banning ordinary kratom. He also said sellers would welcome stronger labeling and testing standards to protect consumers and legitimate businesses.

What experts recommend

Toxicologists and public health officials emphasize several priorities: expanded, rigorous research on kratom and 7-OH toxicology; development and validation of quantitative laboratory tests for post-mortem and clinical use; and targeted regulatory measures that reduce immediate risks from concentrated or adulterated products while preserving options for people who report benefits.

Until that evidence base improves, officials must balance reported benefits for some users against the uncertain but real dangers associated with potent or contaminated products. Removing products from shelves is one short-term way authorities hope to limit exposure while steps are taken to better understand and control risks.