North Dakota has pulled all kratom products from shelves following a public health emergency declaration, with 50 deaths associated with the substance since 2019. Governor Kelly Armstrong signed an executive order on August 5 that makes it illegal to sell, possess, or use kratom or its derivatives in the state. The ban runs for 30 days, giving the state time to hold a special legislative session beginning September 2 to write permanent restrictions into law.

What Exactly Is Kratom and Why Is It Causing Concern?

Kratom is derived from the leaves of a tropical tree native to Southeast Asia. People use it as an energy booster, for pain management, and to help manage withdrawal from drugs like fentanyl and heroin. At low doses, it produces stimulant effects; at higher doses, it creates sedative effects similar to opiates. The plant's main psychoactive alkaloid is mitragynine, which acts on opioid receptors in the brain.

The state Department of Health and Human Services has documented 50 deaths associated with kratom, 7-OH (a concentrated derivative), or pseudoindoxyl mitragynine since 2019. In 23 of those cases, these substances were listed as part of the primary cause of death. The concern has intensified because more people are using these products and more deaths are being recorded, according to state health officials.

7-hydroxymitragynine, known as 7-OH, is a second alkaloid present naturally in kratom leaves at trace levels. However, concentrated and synthetic forms are far more potent and act directly on opioid receptors. These concentrated products are sold as gummies, flavored drinks, tablets, shots, and powders. Armstrong separately signed an emergency rule classifying 7-OH as a Schedule 1 controlled substance, placing it in the same category as heroin and LSD.

How Does North Dakota's Ban Compare to Other States?

North Dakota now sits at one extreme end of a national spectrum. Kratom is banned outright in only a small number of states, while many set no minimum purchase age at all. Several states have taken a middle-ground approach through consumer protection acts that set purity standards, labeling requirements, age limits, and restrictions on synthetic derivatives rather than prohibiting the substance entirely.

At the federal level, kratom itself is not a scheduled controlled substance. The FDA has not approved it for any medical use and has issued import alerts and warning letters. However, in July, the Drug Enforcement Administration (DEA) moved to temporarily place 7-OH and three related compounds into Schedule 1, with that order taking effect as early as August 5 and remaining in place for at least two years.

What Does the Research Show About Kratom Safety?

The evidence base is incomplete, which is part of why experts disagree on how to regulate the substance. Centers for Disease Control and Prevention (CDC) analysis of poison center data found calls about kratom exposure rose roughly tenfold between 2010 and 2015. A separate CDC review of overdose deaths across 27 states found kratom was determined to be a cause of death in 91 cases between 2016 and 2017, with other substances present in nearly all of them.

These figures document association in the context of overdose deaths that frequently involve multiple substances. They do not establish that kratom leaf at typical doses causes death on its own, and the research base on the whole plant in humans remains thin. Both the enforcement case and the advocacy case are being made with incomplete evidence.

Steps to Take If You Use Kratom Regularly

• Talk to a clinician before stopping: Withdrawal is the more immediate clinical concern for people using these products daily. An abrupt supply cutoff for someone dependent on an opioid-receptor-active substance is a medical situation, not simply an inconvenience. Anyone who has been using kratom or 7-OH regularly should consult with a doctor before stopping, particularly after sustained use.
• Understand withdrawal symptoms: Withdrawal from opioid-receptor-active substances can involve agitation, muscle aches, sweating, nausea, diarrhea, and insomnia. These symptoms are more manageable with medical support, so seeking professional guidance is important.
• Explore treatment alternatives: People who were using these products to manage chronic pain or to stay off illicit opioids face the sharpest problem, because the ban removes what they were using without supplying a replacement. Buprenorphine and other treatments are available for opioid use disorder, and this conversation belongs with a primary care clinician or an addiction medicine provider.
• Contact support resources: State officials have pointed users and families toward existing help lines. Dialing 988 or 211 will connect people with resources appropriate to their situation.
• Dispose of products safely: The Attorney General's office has published a list of take-back sites at local law enforcement agencies and MedSafe locations at participating pharmacies for proper disposal of kratom products.

What Should You Do in a Medical Emergency?

Urgent medical care is warranted for severe sedation, difficulty breathing, confusion, or unresponsiveness in anyone who has used these products, which are signs consistent with opioid-type overdose. These symptoms require immediate emergency attention.

"Doing nothing is not an option," said Governor Kelly Armstrong, announcing the emergency action at a Capitol press conference.

Governor Kelly Armstrong, Governor of North Dakota

What Happens Next in North Dakota?

The executive order's 30-day emergency ban gives the state time to act on permanent legislation. Armstrong has called a special legislative session beginning September 2, expected to last about three days, to write restrictions into state law and address enforcement authority. A Republican-led working group headed by Senator Michelle Axtman and Representative Pat Heinert is drafting the legislation, and lawmakers have said they plan to take public input.

Meanwhile, the emergency rule classifying 7-OH as a Schedule 1 controlled substance runs for 180 days while formal rulemaking proceeds. The outcome of the special session and any federal scheduling action will shape how kratom is regulated in North Dakota going forward.