Coroners in Butler, Warren and Hamilton counties say they're increasingly seeing the herbal compound kratom showing up in postmortem toxicology results. It's an unregulated substance that can produce opioid- and stimulant-like effects.
"In the region in the last couple of months, about 14 suspected cases involving kratom and kratom alkaloids," have occurred, according to Hamilton County Coroner Dr. Lakshmi Sammarco.
Leaders in some states, including Ohio and Kentucky, have called for banning kratom and 7-hydroxymitragynine (7-OH) products. They're widely available across the country, often found in smoke shops, convenience stores, and gas stations, and have been called highly addicted by the Food and Drug Administration, which has warned they could lead to the next wave of the opioid epidemic.
"What's surprising about it at this time is that our overall drug-related deaths due to fentanyl, other opioids, or methamphetamine, cocaine — those numbers are down this year," says Butler County Coroner Dr. Lisa Mannix. "Then all of a sudden, we see this spike of something that is not necessarily dealt on the street, but dealt right to your home, or that you pick it up at the gas station or the vape shops."
Warren County Coroner Dr. Russell Uptegrove also says other drug overdose deaths are also trending downward, though Sammarco says Hamilton County is on pace with last year. Still, the kratom-related deaths are disturbing.
"I think the problem is a lot of people probably don't understand the potential danger of it," Uptegrove says. "I guess that's the the most important point of this message is [this is a] buyer beware type situation. You don't know exactly what you're getting."
Kratom has been illegal in Indiana since 2014. A law banning kratom in Kentucky will take effect Jan. 1, 2027.
Those who support natural kratom say it treats pain, and boosts energy and focus with few side effects.
The coroners point to recent kratom-related deaths that have made headlines, including two students at Ole Miss, a 22-year-old on a recent Southwest Airlines flight, and other overdoses in San Francisco, Utah and elsewhere.
Earlier this year, Ohio banned synthetically modified versions of the Asian botanical herb. According to the Health Policy Institute of Ohio, citing data from Recovery Ohio, kratom-involved overdose deaths rose from 19 in 2019 to 54 in 2024.
"No matter what it says on the product label, obviously there's other stuff that's being mixed in it that are lethal products," Sammarco says. "The mitragynine (kratom) that we've seen in the pressed pill form and in liquid form, it's mixed with a lot of different things, and they do bind and they do act like opioids when you get higher level doses."
Mannix says dosing is part of the problem since there's no regulation about what's in various kratom products, nor standard dosage information.
"One of the instructions on one of the bottles that I saw, you took two eighths of a pill. Who cuts their pills into eighths?" she says. "Nobody's going to take two eighths when you have a whole pill there."
Sammarco says stores in Ohio have been directed to remove the non-leaf or powder versions from shelves, but enforcement seems unclear. Also, while the various other forms of kratom are illegal in Ohio, the federal government hasn't taken that step.
As NPR previously reported, about a decade ago, "the Drug Enforcement Administration (DEA) wanted to classify the active ingredients in kratom in the same category as heroin." That plan was shot down after large protests "from advocates and lawmakers — including people who said they used kratom products to wean themselves off opioids."
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