Kratom: What are the risks?

Kratom, a legal, unregulated, opiate-like herbal supplement, is gaining popularity in recent years, especially among youth. While the plant is native to Asia, use has become more common in the United States to reduce opioid withdrawal symptoms (Veltri & Grundmann, 2019) and as a psychoactive recreational drug (McCance-Katz, 2019). Traditional screening panels do not test for the substance,  rather, a special liquid chromatography or tandem mass spectrometry test is required (Eldridge, 2019). Because it is unregulated, Kratom can be purchased from smoke shops, gas stations, and online.

Kratom’s effect is unique, acting as either a stimulant or depressant, based on the dosage. In small amounts, Kratom can increase focus, physical energy, and talkativeness (Drug Enforcement Agency, 2022). In high doses, kratom creates sedative-like effects, similar to those of opiates (McCance-Katz, 2019). When consumed in very high quantities, kratom can cause hallucinations, delusions, and confusion (Drug Enforcement Agency, 2022). At any dose, the supplement can cause nausea, sweating, itching, frequent urination, and constipation (Drug Enforcement Agency, 2022).

The risk of addiction is high, as withdrawal symptoms are very commonly reported among regular users (Singh, et al, 2014).  Physical symptoms include hot flashes, pain, difficulty sleeping, and decreased appetite (Singh, et al, 2014). Mental and emotional symptoms include restlessness, anger, sadness, and anxiety (Singh, et al, 2024).

The supplement is also common among polysubstance abusers, and death can result when Kratom is combined with other narcotics. While it is infrequently listed on death certificates as the sole cause, it is sometimes listed in tandem with other substances. According to the CDC, Kratom is most identified as causing death with fentanyl, heroin, and benzodiazepines (Olsen, et al, 2019).

Kratom also poses a significant risk to children. Because of a lack of research into the effects of the supplement, a few expectant mothers have turned to Kratom to curb opioid cravings during pregnancy. Exposed infants are reported to have experienced withdrawal symptoms such as jitteriness, sneezing, excessive suck, and irritability (Eldridge, et al, 2018). Though there have been few cases, it seems that children who are diagnosed with neonatal abstinence syndrome (NAS) because of kratom are able to withdraw through medication assisted treatment within a few days (Eldridge, et al, 2018).

Additionally, the number of teenagers smoking Kratom leaves or mixing the substance into drinks has increased (McCance-Katz, 2019). It is reported that youth are smoking Kratom leaves or mixing the substance into drinks. Further, research finds a correlation between the use of kratom and other substances among teens (Sharma, et al, 2022). Youth who smoke cigarettes or marijuana are about 2.5 times more likely to report kratom use than their nonsmoking counterparts (Sharma, et al, 2022). With Kratom usage on the rise in the United States, there is an increased concern among professionals that youth will continue to be more and more affected by both maternal and individual use.

There are reports of Kratom poisonings, too. Annual calls to poison control regarding Kratom concerns increased by 195 calls from 2016 to 2017 (Post, et al, 2019). Additionally, there is evidence that long-term use has a negative impact on the body, including damage to the thyroid, liver, and lungs (Alsaffar, et al, 2019).

Concern for Kratom usage in the United States is rising. However, it is not yet regulated. Congress is hesitant to place it on a schedule and most states do not want to ban it completely. Instead, many states are researching how they might go about allowing for safe use. In Ohio, HB 236, which seeks to regulate Kratom, has gained bipartisan support. The bill will require the Department of Agriculture to develop a program to regulate Kratom production and distribution (Chandler & Tucker, 2023). A license would be required to process Kratom, but not to possess, use, or sell it (Chandler & Tucker, 2023). The bill is presently in committee in the state senate, and it appears it may pass. Lawmakers believe that ensuring the safe production of the supplement will be much more beneficial to the community than banning it in its entirety (Chandler & Tucker, 2023).

To share information about Kratom, please feel free to use our infographic!


Alsarraf, E., Myers, J., Culbreth, S., & Fanikos, J. (2019). Kratom from head to toe—case reviews of adverse events and toxicities. Current Emergency and Hospital Medicine Reports, 7, 141-168.

Drug Enforcement Agency. (2022, November 7). Kratom. Get Smart About Drugs.

Tucker, M., & Chandler, K. (2022, March 14). Ohio House of Representatives Passes Bill Regulating the Processing and Sale of Kratom Products. Benesch, Friedlander, Coplan & Aronoff LLP.

Eldridge, W. B. (2019). Kratom: An Opioid-like Herbal Supplement Pediatricians Should Know About. Journal of Pediatrics and Pediatric Medicine.

Eldridge, W. B., Foster, C. D., & Wyble, L. (2018). Neonatal Abstinence Syndrome Due to Maternal Kratom Use. Pediatrics, 142(6).

McCance-Katz, E. (2019). Urgent and emerging issues in prevention: Marijuana, kratom, e-cigarettes [PowerPoint]. Substance Abuse and Mental Health Administration.

Olsen, E. O., O’Donnell, J. S., Mattson, C. L., Schier, J. G., & Wilson, N. O. (2019). Notes from the Field: Unintentional Drug Overdose Deaths with Kratom Detected — 27 States, July 2016–December 2017. Morbidity and Mortality Weekly Report, 68(14), 326–327.

Post, S., Spiller, H. A., Chounthirath, T., & Smith, G. A. (2019). Kratom exposures reported to United States poison control centers: 2011–2017. Clinical toxicology, 57(10), 847-854.

Sharma, V., Cottler, L. B., Bares, C. B., & Lopez-Quintero, C. (2022). Kratom use among US adolescents: Analyses of the 2019 National Survey on Drug Use and Health. Journal of Adolescent Health, 70(4), 677-681.

Singh, D., Müller, C. P., & Vicknasingam, B. K. (2014). Kratom (Mitragyna speciosa) dependence, withdrawal symptoms and craving in regular users. Drug and alcohol dependence, 139, 132-137.

Veltri, C. A., & Grundmann, O. (2019). Current perspectives on the impact of Kratom use. Substance Abuse and Rehabilitation, Volume 10, 23–31.



Feedback from the Field


Last September, Elinam Dellor and Jennifer Price Wolf, two members of the Ohio State EPIC research team, sat down with Kim Stevens (EPIC program manager and supervisor in Pickaway County), Amy Hoar (EPIC caseworker in Pickaway County), and Cara Finney (EPIC supervisor in Fairfield County) to discuss how the EPIC program is working on the ground and how it can be improved. Check out the podcast in this post to learn more!

Substance Use Disorder and Housing

The housing crisis in the United States seems to be worse than ever, as many individuals and families lost their usual sources of income during the pandemic. The housing crisis affects families and children; leading them to live in unstable conditions and experience constant stress about the future of their housing situation.

In addition to mental and physical stability, housing is crucial for people in recovery of substance use disorders. Displacement can lead to relapses as people deal with unstable living conditions, including experiencing homelessness. Even though there are current policies that are limiting evictions during the pandemic, many people are unaware of these policies, and do not feel empowered to advocate for themselves.

Now that some members of society are considering the pandemic to have ended, housing protection policies may become less reliable. As we approach these hard times, you may think of someone you know who is struggling with housing stress alongside substance abuse disorder and offer your support. Currently, there are policies in place to prevent eviction; these policies rely on word of mouth awareness efforts to ensure that people are empowered to advocate for their rights. You may not be able to resolve the housing crisis as a whole, but you can help those around you take action to avoid eviction.

Recovery and Holiday Social Norms

People in long term substance use recovery have to go through various peaks and pits throughout each year that contribute to or take away from their journey to maintain sobriety. Data can offer insights into which times of the year might be more of a struggle, as well as the variety of risk and protective factors for a person in recovery. With the holiday season and winter now behind us, data confirms again that holidays are hard for many people working through substance use recovery.

The holiday season can present challenges that are unique, heavy, and emotional. Paired with the cold weather and the potential for seasonal affective disorder (SAD) it is reasonable that this time of year often sees an uptick in episodes of relapse. The season presents many possible triggers, like increased time with family and friends, the presence of alcohol, added stress, additional financial obligations, and parties, among other things. According to the National Institute on Drug Abuse, these stressors, as well as memories of the past and the reconnection with various friends and families may trigger a relapse.

Now that we are in the spring/summertime season, we have holidays approaching like Memorial Day and the Fourth of July. You might think about how someone you know in recovery may struggle with certain social norms and events related to these holidays and offer your support. If you are interested in learning more about how you can be an advocate for someone in recovery, there are many resources that can guide you. While there might not be very clear instructions on how to advocate for someone in recovery, you can start by learning more about the complex nature of substance use disorder, and doing your part to create healthy environments for your loved ones in recovery.

Caseworkers: Overworked and on the Decline

Caseworker overload and high turnover rates are frequent issues within child welfare. Unmanageable workloads impact the ability of caseworkers to provide adequate services and achieve positive outcomes for children and families, according to the Child Welfare League of America. Caseworkers who are overburdened have less time to allocate toward each family and, therefore, caseworker-client relationships falter.

Typical caseloads vary from agency to agency and from state to state, however, the average caseload for child welfare workers is between 24 and 31 children (National Association of Social Workers, 2004). A 2005 study in Illinois found that caseworkers could have no more than 15 cases per month in order to complete all legal and policy requirements. High caseloads not only affect quality of work, but also often lead to emotional exhaustion and job dissatisfaction.

These, along with feeling overwhelmed and ineffective, are primary factors for caseworker turnover. Annual turnover rates below 10–12% are considered optimal or healthy, according to Casey Family Programs. However, a 2018 study analyzing data of caseworkers in the child welfare workforce between 2003 and 2015 estimated that the average state has an annual caseworker turnover rate of 14-22%. In Ohio, approximately 1 in 4 caseworkers left their position in 2016 and 2017, according to an article from the Columbus Dispatch.

Staff turnover is costly for welfare agencies. Recruitment and training costs, worker overtime, worker separation, failure to meet federal performance standards and processing changes in placement are among the many costs associated with caseworker turnover. The expenses accrued after a caseworker leaves are estimated at 30-200% of the existing caseworker’s annual salary, and the National Child Welfare Workforce Institute concludes that the combined costs to replace one caseworker total $54,000.

What can be done to improve retention of caseworkers? Addressing caseload stress by hiring enough caseworkers to allow for and assign manageable workloads should be considered. Child welfare caseworkers who are gradually given a full caseload are more likely to stay than caseworkers who are given a full caseload immediately upon hire.

The Child Welfare League of America recommends that workplaces should consider gradually assigning cases, offering comprehensive training and supporting workers, including peer mentoring and mental health services. Lastly, the creation of a healthy working environment with reliable administrative support, staff recognition and appreciation have been shown to decrease caseworker turnover and bolster recruitment efforts.

Available and potential needed services for children (trauma from parental substance misuse)

A large portion of families receiving child welfare services are coping with parental substance misuse. The following conclusions have been retrieved from a publication by A 2009 study showed that about 12% of children in the United States live with a parent who is dependent on or misuses alcohol or other drugs. About 10% of births occur with the infant having been exposed to substances prenatally which can have severe long-term impacts on the child.

“Maternal drug and alcohol use during pregnancy have been associated with premature birth, low birth weight, slowed growth, and a variety of physical, emotional, behavioral, and cognitive problems (AIA, 2012; National Institute on Drug Abuse [NIDA], 2011).”

There are unique challenges child welfare agencies face when addressing parental substance use disorders. Some obstacles include insufficient service availability to meet existing needs, inadequate funds for services or lack of client insurance coverage, difficulties engaging parents in treatment, knowledge gaps among child welfare workers, and lack of coordination between child welfare systems and other healthcare services.

Innovative approaches and treatments do exist, including early identification of at-risk families in treatment programs, shared family care programs that connect families with a host family mentor, family peer mentors, family treatment drug courts, gender-sensitive treatment, and family-centered treatment services that involve the whole family. There are also numerous grant programs funded by The Children’s Bureau to support children and families, such as the Regional Partnership Grants.

Individualized treatment and case plans are crucial to a person or family’s recovery. Collaborative strategies with health professionals, mentors, and specialists have proven to be most successful in achieving long-term and permanent success.

Outdoor Activity Balances Leniency and Neglect

Outdoor activity is essential to the mental and physical development of children, but children may not get enough outdoor playtime if parents fear their decision to let their children play outside alone will be reported as neglect. Unfortunately, due to a lack of resources, some parents must choose between letting their children play outside alone or not at all.

Child Protective Services cannot always distinguish between neglect and more lenient parenting practices. The systems in place to protect children from neglect can sometimes have adverse effects, especially in vulnerable communities that are more strictly monitored by authorities.

False reports of neglect are harmful to the accused families and distract from actual cases of child maltreatment. A report called Rethinking the Parenting Paradigm includes a health assessment of child protection policies in Montgomery County, Maryland from 2015. The results showed that:

  • Fear of being reported to child protective services is one reason why parents limit outdoor freedom.
  • There is a higher risk of being reported for neglect than of actually being found neglectful.
  • Certain vulnerable populations are at higher risk of being reported and investigated, while not necessarily having a higher likelihood of neglecting their children or of leaving them unsupervised.

The amount of time that children spend playing outdoors has significantly decreased over the years, and that time has a direct impact on long-term health. The average American child spends as little as 30 minutes of unstructured outdoor play a day and spending half as much time outdoors as they did 20 years ago. The lack of outdoor play is connected to long-term health issues such as obesity, anxiety, depression, and other developmental concerns.

Public debate on acceptable styles of parenting is polarized, and spans between two extreme styles of parenting: “helicopter” and “free range.” While responsible parenting allows for a wide range of behaviors, parents that exercise “free range” are more at risk of getting involved in child welfare systems.

The Ohio Children’s Trust Fund defines neglect in broad terms: not providing a child with food, shelter, medical care, education, supervision or clothes. But without laws that distinguish between neglect and “free range parenting”, child protective services may unintentionally harm the children it seeks to protect.

This is an area that CPS should continue to refine to provide the most valuable care to those who need it most.

Purdue Pharma Offers Reparations for Individuals Affected by Opioid Crisis

The aggressive marketing and pharmaceutical sales of opioids in the past decade have left a devastating wake of addiction and death in the United States. Now, individuals who have been harmed by prescription opioids have the chance to file claims against Purdue Pharma, the maker of the painkiller OxyContin. Until July 30 of this year, people who have suffered from the effects of prescription opioid use will have the opportunity to seek compensation.

As of June 11, 2020, about 17,800 personal-injury claims have been filed by people who believe they or their loved ones were harmed by these prescription opioids.

Purdue Pharma is widely believed to be the instigator of the opioid epidemic. In 2019, the company declared bankruptcy which brought the more than 2,000 lawsuits against the company to a halt. “Purdue Pharma and its owner, the Sackler family, reportedly set aside $10 billion or more and put the company into a public trust to pay individual victims’ claims,” according to The company launched a $23.8 million advertising campaign to announce its opportunity for individuals to file claims.

This bankruptcy is unusual in that the implications of this company’s actions have spurred a national health crisis that has taken hundreds of thousands of lives and created a case for reparations beyond what can be quantified. It cemented a systemic crisis that will take years to undo.

It was also complicated by the sordid actions of the Sackler family, Purdue Pharma’s owners, who had transferred about $1 billion to foreign locations prior to filing bankruptcy. The case which involves Purdue Pharma filing for bankruptcy, also proposes a settlement worth more than $10 billion over time, plus $3 billion from the Sackler family over the next seven years, and an additional $1.5 billion from the sale of the family’s global pharmaceutical business, Mundipharma. It would also require that the family give up ownership of Purdue Pharma.

If you or a loved one has been harmed by the effects of opioids sold by Purdue Pharma, you can access a list of instructions on how to file a claim here.

Hotline Calls Spike During Stay-at-Home Orders

In a time of stay-at-home orders, heightened financial stress, and a lack of in-person resources that usually exist, incidents of child maltreatment and domestic abuse are increasing while reported cases are falling. Children are not receiving access to educators, who are often the front-line defense in keeping children safe. Child welfare workers are scrambling to ensure that children continue to receive the care they need despite the desperate circumstances.

An article by USA Today reported that educators including teachers, administrators, and counselors report about one in every five claims of child mistreatment. With children sequestered to their homes and limitations placed on who can visit them, reporting a case of mistreatment is becoming a task that is more precarious than ever. While child caseworkers are limiting visits to their clients’ homes for fear of spreading the virus, they will not become absent from these children’s lives.

Welfare officials are adapting to the virtual environment and setting up video calls to do walkthroughs of children’s home environments. They are also arranging in person visits with higher risk cases, or children who may be in immediate danger. These cases may be addressed through visits in the child’s backyard.

Parents are also facing heightened stress as they learn to manage 24/7 childcare, whether they are working remotely and/or are required to go into the office as essential workers. According to USA Today, “Calls to the group’s National Parent Helpline for families in crisis have spiked 30% in the past week, Pion-Berlin said. They’re coming from mothers and fathers stressed about child care, food insecurity and other fears arising from the coronavirus crisis.”

The Columbus Police Department has also seen an “alarming increase” of domestic violence calls since the stay-at-home order has been in place.

If you are dealing with a difficult home environment, you are not alone. Here are some resources that are available and ready to help during this time of crisis:

Franklin County Children Services Child Abuse Hotline: 614-229-7000

Ohio Domestic Violence Network


National Child Abuse Hotline: 800-422-4453

Generation O: Trapped in a Cycle of Addiction

In 2019, a New York Times reporter, Dan Levin, detailed the horrific experiences of children in Ohio who were removed from their homes after years of neglect, abuse and traumatic childhood experiences. He leads the story by writing that, “Nearly 27,000 children in Ohio were removed from their homes last year, many because of the opioid crisis. More than a quarter were placed in the care of relatives.”

The stories Levin recounted were those of children sent outside without sufficient food and water while their parents use drugs, as sister and brother Hannah and James experienced each summer. These children were also exposed to traumatic violence between their parents, as seven-year-old Hannah called 911 after her mother chased her father with a knife. Hannah’s father was later killed by her mother’s boyfriend.

Stories like these paint the picture of the lives of many of these 27,000 children. Parents in rehab, sick or dead from drug addiction are circumstances that young children are exposed to far too commonly. So commonly, that a name was dedicated to children trapped in these vicious cycles of addiction – Generation O.

Certain geographic areas are more dense with these concerns.

“In Portsmouth, Ohio, at least a quarter of the school district’s nearly 650 junior high and high school students have a close relative who uses drugs.”

As written in another NYT article by Dan Levin, this will have a long-lasting impact on the communities with heavy users, as more children are being born with a dependency on opioids, and many with severe learning disabilities and other types of disabilities. This poses a new challenge for educators as schools increasingly become places of refuge in the lives of maltreated children.

“Many students frequently come to school wearing the same, unwashed clothes days in a row, so shelves are stocked with clean garments, along with fresh shampoo, bars of soap and deodorant.

Yet some of the teenagers change back into their own clothes after the final bell rings and the last class ends, ‘because parents will take new clothes and sell them for drug money,’ said Drew Applegate, an assistant principal.”

In a sobering reality of family life in Portsmouth, an art teacher cannot think of any student who paints a two-parent family during their family portrait lesson.

As long as the opioid crisis presides over these communities, there will continue to be a shift that emphasizes the role of educators in children’s lives.