Peer-reviewed Missouri Medicine article by Drs. Mark S. Gold and Nicole M. Avena is now indexed in PubMed
Washington, DC
The Global Kratom Coalition today highlights a newly published peer-reviewed medical review urging physicians to distinguish natural kratom leaf from the high-potency, semi-synthetic and synthetic alkaloid products increasingly falsely sold under the kratom name.
The article, Kratom in Clinical Practice: What Physicians Need to Know, by Mark S. Gold, M.D., and Nicole M. Avena, Ph.D., appears in the July–August 2026 issue of Missouri Medicine, the peer-reviewed journal of the Missouri State Medical Association, and is now indexed in PubMed (PMID: 42757335), with free full text available through PubMed Central. The review provides practical guidance for physicians screening, counseling, and documenting care for patients.
The authors explain that products marketed as “kratom” can have dramatically different compositions and risk profiles. Natural Mitragyna speciosa leaf contains a complex mixture of alkaloids, primarily mitragynine, with 7-hydroxymitragynine (7-OH) present only in trace amounts amongst high fiber and anti-oxidant content. By contrast, many newer products that falsely label themselves as natural kratom contain isolated concentrated synthetic 7-OH and other synthetic derivatives like MGM-15. The review reports that in some cases these concentrations exceed the levels found naturally in kratom leaf by more than 100 times, producing pharmacologic effects that differ substantially from natural kratom leaf.
“The public-health conversation has too often treated every product bearing the word ‘kratom’ as if it were the same,” said Nicole M. Avena, Ph.D., professor of neuroscience at the Icahn School of Medicine at Mount Sinai said. “It is not. Physicians, regulators and consumers need to know whether they are discussing natural kratom leaf or a concentrated synthetic 7-OH product. That distinction is essential to sound risk assessment and patient safety.”
The review also examines the safety record. Citing a 2024 toxicology review, the authors report that the available evidence is insufficient to support a causal association between natural kratom leaf alone and severe acute adverse effects. Across 2017–2023 poison center data, 23 reported deaths were associated with “kratom” ingestion — more than one-third involving documented polysubstance use — compared with more than 2,000 deaths reported in association with opioid-related calls. The authors caution that adverse-event surveillance often conflates natural kratom leaf with concentrated or synthetic alkaloid products, obscuring which product a patient actually used.
For the Global Kratom Coalition, the article reinforces the need for targeted policy solutions: keep high-potency and illicit synthetic products out of the marketplace while preserving responsible adult access to traditional kratom leaf.
“Consumers deserve care informed by facts, not labels that flatten important scientific differences,” said Matthew Lowe, Executive Director of the Global Kratom Coalition. “This review gives clinicians a clear framework: ask what product a patient used, document it precisely and respond to the actual risk. Policymakers should follow the same approach by targeting concentrated synthetic 7-OH products instead of advancing blanket prohibitions that miss the real problem.”
About the Global Kratom Coalition
The Global Kratom Coalition is an alliance of natural kratom consumers, experts, and industry leaders dedicated to protecting access to natural kratom leaf while advancing scientific research, driving consumer education, and developing robust regulations to protect consumers. For more information, visit globalkratomcoalition.org.
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