For centuries, people in Southeast Asia have brewed leaves of Mitragyna speciosa – known as kratom – into tea that provides relief from pain and anxiety. Its main alkaloids, mitragynine and the more potent 7-hydroxymitragynine (7-OH), act on opioid receptors.

Today, kratom is widely used in the United States, often as an alternative to prescription opioids or to ease withdrawal from drugs or alcohol. It’s sold in tea, capsules, powders and concentrated extracts. Increasingly, 7-OH products are sold at vape shops, convenience stores and online.

Now, pressure is mounting to ban kratom. In July, Food and Drug Administration Commissioner Marty Makary and Health and Human Services Secretary Robert F. Kennedy Jr. announced that they would ask the Drug Enforcement Agency (DEA) to classify 7-OH as a Schedule I drug, like heroin.

Florida issued an emergency ban in mid-August. Seven states already outlaw kratom entirely; others impose age limits or labeling requirements.

The DEA tried to designate kratom as a dangerous substance in 2016, but the agency backed down after a public outcry from medical patients and scientists.

Don't push the kratom market underground

Like opioids, alcohol, cannabis and nicotine, people can become dependent on these substances and experience withdrawal symptoms and kratom-use disorder. Because 7-OH is more potent than kratom, many individuals have been purchasing semisynthetic 7-OH at convenience stores, vaping shops, smoke shops and online.

Because of their opioid-like effects, kratom and 7-OH can cause respiratory depression. However, overdoses from 7-OH are very rare, and those from kratom are even less common.

In most of the few cases where coroners identified an overdose death as related to kratom or 7-OH, the victims had multiple other drugs in their systems. Nearly two-thirds of overdose victims had fentanyl in their systems, about one-third had heroin and just under 20% had prescription opioids or cocaine.

About 80% of people who died of overdose had histories of substance misuse, while 90% were not seeing clinicians for pain treatment.

When state governments ban kratom or 7-OH, people seeking these products can cross state lines to access them. However, if the federal government bans them, it will drive them into the black market.

Drug cartels would be happy to pick up the sales

Drug trafficking organizations efficiently supply Americans with heroin, fentanyl, cocaine, methamphetamine and, to a lesser extent, marijuana (as legalization in the United States has reduced the cartels’ market opportunities).

Drug cartels would welcome the opportunity to produce and smuggle 7-OH to recoup their lost market share in the marijuana trade.

Expanding drug prohibition to include 7-OH would not stop people from consuming it. It would only make using it more dangerous.

As with buying a counterfeit prescription opioid and succumbing to a fentanyl overdose, consumers can’t be sure of the strength or purity of 7-OH they buy on the black market – or if it is even 7-OH.

The same cartels that would supply the 7-OH are also busy making and mixing fentanyl, cocaine and meth. If kratom users haven’t already used any of those drugs, dealers would be more than happy to introduce them.

Educate people about how to minimize the risks

Driving 7-OH or kratom underground will not reduce the risks of using these drugs. The best approach is to educate people about the risks associated with using them and to expand access to harm reduction strategies and addiction treatment.

For example, the opioid overdose antidote naloxone works to reverse overdoses from kratom or 7-OH. The FDA finally allowed people to access the nasal spray over the counter in 2023. It should enable people to access the cheaper injectable form as well, as officials have been doing in Italy and Australia for years.

Also, lawmakers should expand access to methadone treatment for opioid or kratom addiction by allowing clinicians to treat people in their offices and clinics, as clinicians in Australia, Canada and the United Kingdom have been doing for more than 50 years.

The choice is clear: Either let 7-OH fall into the hands of cartels or regulate it to reduce harm. America doesn’t need another fentanyl crisis, especially one caused by our own actions.

Dr. Jeffrey A. Singer practices general surgery in Phoenix, and is a senior fellow at the Cato Institute.

This article originally appeared on USA TODAY: RFK Jr. wants to ban kratom and its compounds. The consequences could be deadly. | Opinion

Reporting by Dr. Jeffrey A. Singer / USA TODAY

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