Kratom Pathway Session a Big Success

On January 14, 2026, Mark D’Agostino, MD, gave a fascinating talk on kratom and the kratom derivatives Mitragynine and 7-Hydroxymitragynine (7-OH), which are sold in CT Smoke Shops for pain relief, increased energy, or aid with opioid addiction recovery addiction. Similar to cannabis, kratom has many varients from the traditional leaf (consumed as a powder with 2-5% alkaloid content), to concentrated extracts that are up to 60% alkaloid content.

Mark emphasized the dose-dependent effects and product concentration risks. For instance, the traditional leaf is a stimulant at lower doses, but more of a sedative/analgesis can higher doses (3-7+ g). The derivative extracts, including 7-OH, are dangerous because they are more potent than morphine, highly addictive, and carry the risk of overdose and death when used with other substances. For instance, less than a week after our pathway, chess Grandmaster Daniel Naroditsky died at age 29 from a cocktail of drugs in his system, including methamphetamine and kratom.

Mark discussed how kratom derivative use is addressed, citing the need to try Narcan in the case of suspected overdose. Since products like 7-OH are opioids, the overdose-reversal medication Narcan will work in most cases but not all. It is worth trying. Mark advises treating withdrawal from a kratom addiction similarly to opioid withdrawal. In cases of mild to moderate dependence, medications like Advil, clonodine, and hydroxyzine are used to treat withdrawal symptoms.

For moderate to severe dependence, Mark uses suboxone like he would for addiction to prescription opioids. For long-term management of this kratom use disorder, Mark utilizes psychoeducation, behavioral therapy, and motivational interviewing.

Mark concluded his presentation by addressing some other products being unethically sold by gas stations and smoke shops, especially “gas station heroin”. This is tianeptine, which is sold as ZaZa, Tianna Red and Neptune’s Fix. He also descripted phenibut, sold online as a cognitive enhancer and anxiety aid. 44% of withdrawals cases from phenibut require ICU admission!

The CT State Assembly enacted Public Act 25-101 directing the Department of Consumer Protection to “schedule” kratom and its derivatives as controlled substances and thus banned from retail shops. This scheduling should be finanized by March 2026.

We are grateful to Mark’s patient, Campbell, for sharing his story of kratom and 7-OH addiction. He first tried kratom in powder tea form in college, but with urging of a smoke shop owner moved to 7-OH (which is 10X more potent than morphine). His dosage amounts went through the roof, to the point where it was either get help or die. Campbell’s warning? Legal does NOT mean Safe.

To view the replay of the Pathway Session, CLICK HERE. For Mark’s presentation slide deck, CLICK HERE.