Kratom products are now illegal to sell, possess or use in North Dakota, after the governor declared a public health emergency and ordered them off shelves with almost no notice to retailers or the people using them daily.
Gov. Kelly Armstrong announced the action alongside Attorney General Drew Wrigley at a Capitol press conference, saying North Dakotans are overdosing and dying from a product sold in convenience stores, gas stations and smoke shops with no regulation and no age requirement. "Doing nothing is not an option," Armstrong said. His executive order took effect August 5 and runs for 30 days, barring people from knowingly creating, manufacturing, delivering, distributing, selling, purchasing or possessing kratom or related products.
The state Department of Health and Human Services has received reports of 50 deaths since 2019 associated with kratom, 7-OH, or another derivative called pseudoindoxyl mitragynine. In 23 of those cases, the substances were listed as part of the primary cause of death.
Two Substances That Get Treated as One
The most important distinction in this story is one the executive order itself does not draw, and it is where most of the disagreement sits.
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 cope with withdrawal from drugs such as fentanyl and heroin. In low doses, it produces stimulant effects; in higher doses, sedative effects similar to opiates, according to the DEA. Its main psychoactive alkaloid is mitragynine.
7-hydroxymitragynine, known as 7-OH, is a second alkaloid present naturally in the leaf at trace levels. Concentrated and synthetic forms are far more potent and act on opioid receptors. Those concentrated products are sold as gummies, flavored drinks, tablets, shots and powders.
Armstrong separately signed an emergency rule from the state Board of Pharmacy classifying 7-OH as a Schedule 1 controlled substance, placing it in the same category as heroin and LSD. That rule is valid for 180 days and triggers an emergency administrative rulemaking process.
The natural leaf ban is the contested part. A Bismarck retailer told the North Dakota Monitor she was surprised Armstrong banned natural-leaf kratom in addition to 7-OH, particularly after he said at the news conference that he had first learned about kratom three weeks earlier, and said she hoped lawmakers would take time to understand leaf products before writing a permanent prohibition.
Armstrong's position rests on state health advice. State Health Officer Sherry Adams said part of what has escalated the issue is that more data is emerging, with more people using these products and more deaths being recorded.
A Patchwork That Runs from Prohibition to Purity Rules
North Dakota now sits at one end of a wide national spread.
Kratom is banned outright in a small number of states, while many set no minimum purchase age at all. Several states have taken a middle path through consumer protection acts that set purity standards, labeling requirements, age limits, and restrictions on synthetic derivatives rather than prohibiting the substance.
At the federal level, kratom is not a scheduled controlled substance. The FDA has not approved it for any medical use and has issued import alerts and warning letters. In July, the 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.
North Dakota's own legislature had previously declined to act. A bill to prohibit kratom failed, and the Senate converted a regulation bill into a study. Armstrong has called a special 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 Sen. Michelle Axtman and Rep. Pat Heinert is drafting the legislation, and lawmakers have said they plan to take public input.
The Evidence, and What It Does Not Settle
Kratom's alkaloids act on opioid receptors, which explains both the pain relief people report and the dependence risk regulators cite.
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.
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.
Steps for People Affected by the Ban
Anyone who has been using kratom or 7-OH regularly should talk with a clinician before stopping rather than after, particularly after sustained use. Withdrawal from opioid-receptor-active substances can involve agitation, muscle aches, sweating, nausea, diarrhea, and insomnia, and is more manageable with medical support.
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. That conversation belongs with a primary care clinician or an addiction medicine provider, and buprenorphine and other treatments are available for opioid use disorder.
State officials have pointed users and families toward existing help lines. Adams said dialing 988 or 211 will connect people with resources appropriate to their situation.
For disposal, the Attorney General's office has published a list of take-back sites at local law enforcement agencies and MedSafe locations at participating pharmacies. Retailers with questions have been directed to the North Dakota Board of Pharmacy.
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.
The special session convenes September 2, and the emergency 7-OH rule runs 180 days while formal rulemaking proceeds. MedicalDaily will report the legislative outcome and any federal scheduling action.
Key Questions Answered
What exactly is banned in North Dakota? All kratom products, including natural leaf, plus concentrated derivatives. The executive order took effect August 5 and runs for 30 days.
Is 7-OH the same as kratom? No. 7-hydroxymitragynine occurs naturally at trace levels in the leaf but is far more potent in concentrated and synthetic forms.
How many deaths are linked to kratom in the state? Fifty deaths since 2019 have been associated with kratom or its derivatives, with the substances listed as part of the primary cause in 23 cases.
Is kratom banned nationally? No. Federal law does not currently schedule kratom itself, though the DEA has moved to temporarily schedule 7-OH and three related compounds.
What should a regular user do? Talk with a clinician before stopping, particularly after sustained use, because withdrawal is a medical issue.
Where can products be disposed of? At take-back sites listed by the attorney general's office, including law enforcement locations and MedSafe sites at participating pharmacies.
What happens next? A special legislative session begins September 2 to write restrictions into state law.
