Twenty-three deaths in North Dakota since 2019 were linked to kratom and related compounds, part of a pattern that has worried officials and sparked talks of a special legislative session to do something about it.
Kratom is derived from a tropical tree in Southeast Asia. It’s been used as an energy booster, for pain management and to cope with withdrawals from drugs such as fentanyl and heroin. Two psychoactive ingredients known as mitragynine and 7-OH are found in kratom leaves.
Officials are concerned about synthetic substances derived from kratom and made into a highly potent form, causing overdoses, North Dakota Board of Pharmacy Executive Director Mark Hardy said.
Reports from treatment and healthcare professionals and law enforcement indicate “emerging threats and imminent peril” to the public in North Dakota and the nation with deaths and emergency room visits, Hardy told the Monitor.
From 2019 through June 2026, kratom, 7-OH and/or another related compound called mitragynine pseudoindoxyl were part of the primary cause of death for 23 people, according to the State Epidemiology Office.
That means “the medical examiner or certifying physician determined that (kratom’s) effects contributed to, whether alone or in combination, the fatal toxicity,” an office spokesperson said.
The substances were part of the contributing cause of death for one other person, and were present in the toxicology results of 26 other cases during the same time period, according to the office.
Locations or the ages of those who died were not available.
While a primary cause of death is what killed a person, a contributing cause helped the death along faster, said Dr. Selly Strauch, interim chair of the University of North Dakota School of Medicine and Health Sciences Department of Pathology.
For deaths in which kratom-related substances were present in toxicology results, the forensic pathologist probably thought the levels were too low to contribute to those or make it the cause of death, Strauch said.
“You can’t count those cases towards killing somebody, towards death,” Strauch said.
Kratom and its derivatives can mix with other drugs a person has taken and act as a depressant or a stimulant, depending on the levels, she said.
“I do think it probably would be our responsibility to educate people and probably restrict this,” Strauch said.
Kratom-related calls to Poison Control in North Dakota have risen in recent years, from seven in 2024 to 22 last year, according to a state epidemiologist report. That threefold spike suggests “a true increase in kratom-related exposures,” the report said.
At least three-fourths of the 36 calls from 2021-2025 were for males, and nearly half were for people ages 20-39. Burleigh, Williams and Ward counties had the most calls at nine, seven and six, respectively. Cass County, home to one-fourth of North Dakota’s population, had five calls.
Pharmacy board to propose emergency rules
Substances such as 7-OH have drawn federal scrutiny. Earlier this month, the U.S. Drug Enforcement Administration moved to temporarily classify 7-OH and three related substances as controlled substances. The U.S. Food and Drug Administration has endorsed restricting certain 7-OH products.
North Dakota’s pharmacy board is pursuing similar emergency rules to make the substances illegal, Hardy said. The process, separate from the Legislature, includes hearings and public comment after the governor authorizes the rules as emergency in nature, Hardy said.
North Dakota Senate Republicans this week received an invitation to a Sunday caucus meeting in which a potential special session is expected to be discussed, in part related to addressing kratom.
It is unclear what scope of legislation lawmakers might consider. Gov. Kelly Armstrong and Republican Senate Majority Leader David Hogue have so far declined to comment. Potential action from the Legislature might supplement the rules, Hardy said.
“That’s not going to impede what the board feels is the right public health effort to make sure that we take care of what we feel is the worst of the worst there,” Hardy said.
The substance 7-OH has been an evolving, growing issue similar to fentanyl compounds, synthetic cannabinoids, bath salts and various illicit chemicals created, sold and marketed “in a way that is misleading and leads to some terrible issues for the public that may interact with them,” Hardy said.
Kratom can be synthesized and put into a pill or other form and then sold and marketed as a nutritional supplement, Hardy told lawmakers last year. But it’s more potent when chemically synthesized into a different derivative that acts like an opioid, he said. His testimony came during a legislative committee hearing to consider a ban on a kratom compound. The bill failed.
People are purchasing and ingesting 7-OH in the forms of tablets and gummies or mixed with drinks, available at gas stations and smoke shops, Hardy said. As an unregulated product, there is little consistency in how they are created, which can be dangerous for people who ingest them, he said.
During a July press conference detailing the state’s 2025 crime report, Attorney General Drew Wrigley said many of the kratom items sold in smoke shops are mislabeled and harmful to users.
“It’s a hallucinogenic. It’s highly addictive. It’s highly dangerous. It’s not tested or certified by the FDA,” Wrigley said earlier this month. “We need to wrestle with that in North Dakota and we need to have serious proposals.”
Jacki Gervais, CEO and founder of The Ridge, an addiction and mental health treatment center in Fargo, said she would like to see kratom banned.
Gervais said many people are introduced to kratom products when seeking out cannabis products. They are often sold by the same retailers, but people buy kratom without knowing what it really is, she said.
Gervais said she sees more problems with synthetic substances, but both are highly addictive. She said people’s tolerance and need for more kratom can escalate quickly. People suddenly find they can’t afford to keep buying as much as they need to avoid withdrawal symptoms. Some people will start waking up during the night feeling sick and realize they’re starting to go through withdrawal.
Local responses to kratom substances
The northwestern North Dakota city of Ray, which has fewer than 800 residents, voted in July to ban the sale, possession and distribution of products containing concentrated levels of 7-OH or other similar synthetics. The ordinance also limits the sale of kratom products to people 21 and older.
Troy Kupper, president of the Ray City Commission, said he and the law enforcement commissioner were prompted by a desire to protect the community after learning that the son of an acquaintance died of a kratom product overdose.
In Williston, the city commission passed a resolution in July warning the public about the addictive nature of kratom products, the possibility of overdoses and synthetic additives found in the products.
“We had some concerned citizens raise concerns of addiction,” said Tori Siemieniewski, a Williston city commissioner. “And we thought the resolution was the best way to quickly support the concerns we were hearing and bring awareness to the community.”
Evan Mouritsen, general manager of Vapes, a Bismarck shop, said he welcomes a federal ban on 7-OH products, but hopes city and state policymakers will differentiate between those products and natural kratom supplements.
Mouritsen said he uses kratom to help manage his attention deficit hyperactivity disorder and he has customers who use it to help with anxiety or sleep. But he said he has concerns about the concentrated extract 7-OH.
“The 7-OH is the bad guy, in my opinion,” Mouritsen said. He added 7-OH and kratom supplement sales made up about 35% of the store’s revenue over the past 18 months. He said the store will stop selling 7-OH in August to comply with the new DEA substance scheduling.
The National Conference of State Legislatures said 22 states have placed age restrictions on the sale of kratom products. Oklahoma and Ohio have placed restrictions on synthetic 7-OH and drawn a distinction between those products and the natural kratom leaf. Seven states have placed kratom and kratom components on their lists of schedule I controlled substances.
After rejecting a proposed ban on a kratom compound in 2025, North Dakota lawmakers considered a separate bill to regulate kratom products. That bill was amended to recommend a study, but legislative leaders decided not to pursue the study this interim.
North Monitor Reporter Jack Dura can be reached at jdura@northdakotamonitor.com.
Reporter Michael Achterling can be reached at machterling@northdakotamonitor.com.
Deputy editor Jeff Beach can be reached at jbeach@northdakotamonitor.com
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