In 2024, Maizie Hepner, 24, started visiting a bar in Dubuque, Iowa that did not serve alcohol and instead offered beverages containing kava and kratom, psychoactive substances derived from plants.

The drinks were marketed as “herbal tea mocktails”. Hepner, who works as a server and bartender, said. “I asked the guy who owns” Kava Kava “if it was addictive, and he said, ‘Absolutely not’”.

Hepner started going three to four times each week and then began purchasing a kratom powder from a liquor store and stirring it into her tea.

“I just didn’t feel like myself without it,” Hepner said. “I would start to get sweaty and irritable.”

Over the last decade, more people in the United States have started to use kratom, which can produce opioid-like effects. Some of them say they have become addicted to it and experienced bad side effects. Others argue it helps people with substance abuse issues stop using harder drugs.

A Reddit group, Quitting Kratom, has more than 40,000 subscribers.

In 2015, there were 43 hospitalizations in the United States linked solely to kratom, which is often sold at gas stations, smoke shops and convenience stores. In 2025, there were 538, according to a University of Virginia study. The authors stated that the spike in 2025 coincides with the emergence of synthetic versions of the drug, including one called 7-OH.

Lawmakers in Iowa and other states have decided that kratom can be dangerous and started pushing for bans on the substance despite opposition from some users and people in the kratom industry who claim that only the synthetic versions of the drug are unsafe.

“It is increasing the prevalence of opioid use disorder,” said Dr Andrew Kolodny, director of the Opioid Policy Research Collaborative at Brandeis University. “Being able to buy an opioid at a convenience store is going to make the opioid crisis worse.”

At least eight states – Alabama, Arkansas, Connecticut, Indiana, Louisiana, Tennessee, Vermont and Wisconsin – have banned kratom. Other state legislatures are considering doing the same. Some states have introduced different regulations, including bans on just synthetic forms of kratom.

Kratom, which has been described as “gas-station heroin”, is “the biggest bad, and it’s one of those things where it’s kind of hard to stop it,” Breyer Ferris, manager of a smoke shop in Tennessee, told Local 3 News.

The state’s ban takes effect 1 July.

In Idaho, kratom was listed as a contributing factor in the deaths of 47 residents between 2021 and 2023, the state Office of Drug Policy reported. Other substances, primarily opioids, appeared in the toxicology reports of all those who died too.

Earlier this year, Idaho lawmakers considered a bill that banned kratom and a bill that banned only 7-OH and would have only allowed people 21 and older to purchase kratom.

Meanwhile, a kratom business, Happy Hippo, and its parent company, Animal Farm, along with affiliated entities, donated more than $34,000 to campaigns for people seeking state office in Idaho between 2024 and 2026, according to a website tracking campaign contributions.

Both measures failed.

Still, some public officials were not deterred. In Bonneville county, Idaho, the coroner reported in October 2025 that four local deaths in the previous 18 months were due solely to acute drug toxicity of mitragynine, the primary active compound in kratom.

“This is a wake-up call for our community,” the coroner stated in a press release.

Earlier this month, Idaho Falls, the county’s largest city, approved a ban, which takes effect 1 July, on sales of the drug.

John Radford, a local city council member who also runs a nonprofit that aims to help economically disadvantaged individuals, said he has spoken with hundreds of people who were trying to quit using drugs and started using kratom because it did not show up in urine tests.

“They said it was harder for them to come off of kratom than it was some of their other drugs,” Radford, who voted in favor of the ban, said.

But Mac Haddow, senior fellow on public policy for the American Kratom Association, denies that kratom is addictive or dangerous.

“There are people that have an addiction personality, it’s called, and they are inclined to abuse whatever substance that they take, and so it is possible in that scenario” they have “a mental health issue rather than a physiological one”, said Haddow, who also claimed that there has not been any evidence “that kratom alone caused” deaths.

Instead, Haddow said the problem is 7-OH, which is much more potent than kratom powder. The association supported US Health and Human Services (HHS) secretary Robert Kennedy’s announcement in July 2025 calling for the Drug Enforcement Agency to ban 7-OH. But the agency has not since implemented any prohibition.

Kolodny, of Brandeis University, sees the messaging from American Kratom Association and other industry group as “deceptive”.

“Many policy makers seem to have fallen for” the argument “that all of the harms associated with kratom are limited to these 7-OH products and that the kratom leaf products are benign herbal supplements helping millions of Americans,” Kolodny said.

New York state assembly member Phil Steck co-sponsored bipartisan legislation that passed this month – which the governor must still approve – would ban 7-OH but not so-called natural kratom products. Steck sponsored legislation that the governor approved last year that required warning labels on the natural kratom items.

“I would not go out and say that you can use the so-called natural product to an unlimited extent, but the two products are substantially different,” Steck said.

Hepner, the Iowa woman, said kratom itself should be banned. The statehouse approved legislation in March that would criminalize possession of the drug. It has not been signed into law.

In a Facebook post, Kava Kava, the business where Hepner first consumed kratom, urged people to oppose the legislation because it stated that it not only affects kratom users but on the right of “kava and sober communities to access natural plant-based alternatives”.

The bill does not mention kava, and there do not appear to be any efforts in the country to ban it.

Eric Schiesl started frequenting Kava Kava as a customer and then started working there as a “kavatender”. He said its kava and kratom drinks and sense of community helped him stop using drugs, and he has been sober three years.

Schiesl said he has not heard customers say they became addicted to kratom.

“We definitely stress moderation,” he said.

Of the proposed criminalization of kratom, he said, “prohibition didn’t work, and it led to more crimes.”

Hepner decided to quit this month. She had read reports about its dangers and saw a fundraising page for an Iowa family stating that the dad died from a kratom overdose.

After quitting, Hepner had a fever for three days, tremors and difficulty eating solid food.

She is now feeling better and hasn’t had any cravings for it, she said.

“I think that it’s unsafe, and I think there’s not a lot of knowledge about it,” she said. “That is how people fall into it.”