The Los Angeles County Department of Public Health recently reported that it had linked the deaths of six Los Angeles County residents last spring and summer to the use of kratom, a widely available but unregulated supplement marketed as a cure for all sorts of health problems.
The deaths prompted health officials announce November 7th, what They I would put a red tag and remove all products from store shelves containing either kratom or the synthetic alkaloid 7-hydroxymitragynine, also known as 7-OH, derived from kratom. Both are currently not regulated or approved for use in the United States or the State of California as a drug, dietary supplement, or approved dietary supplement, according to US Food and Drug Administration.
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10:16, November 20, 2025A previous version of this article misspelled Di Macaluso's last name as Mascalusco.
It's no surprise that business owners who sell kratom feel the health department has crossed the line by going too far without understanding how the supplement helps many Los Angeles residents. According to them, death occurs not necessarily due to kratom products, but due to interaction with other substances.
Perhaps more important are the benefits that kratom users and some experts claim the drug provides. Many say the problem lies with 7-OH—a highly concentrated synthetic version of natural kratom that is susceptible to adulteration and deceptive marketing—and that banning the sale of all kratom products could create an even more dangerous underground market for both kratom and 7-OH.
Indeed, many kratom sellers and users would welcome improved regulation so that they can continue to use the affordable and widely available substance as a way to treat physical pain and mental health problems with greater confidence in the effectiveness and safety of the products they sell and buy.
During April and July, a total of six adults in Los Angeles County, ages 19 to 39, died from kratom and 7-OH in their systems, as well as from other substances including alcohol, prescription sedatives, muscle relaxants and cocaine.
The medical examiner's reports listed the cause of death for five of the deceased as being due to “mixed drug effects”; the sixth was listed as being caused by a cocaine overdose.
The Times spoke with three different toxicologists to review coroner's reports to better understand what role kratom or 7-OH may have played in the deaths.
Experts told The Times that while toxicologists understand the possible effects that kratom alone can have on the body, the picture becomes unclear when other drugs are introduced.
Kratom is an herbal extract obtained from the leaves. Mitragyna is beautifultree native to Southeast Asia. It is sold in tobacco stores and online in a variety of forms, including powders, tablets, and liquid extracts.
In low doses, kratom produces a stimulating effect, with users reporting a surge of energy. In high doses, it has a sedative effect, according to Donna Papsun, a forensic toxicologist at NMS Labs.
Researchers say most kratom users consume the plant to relieve pain. In some cases, people report using it effectively to treat opioid addiction. Others use it to relieve mental health problems such as anxiety and depression.
Over the past few years, a synthetic version of kratom, purified to the psychoactive compound 7-hydroxymitragynine, or 7-OH, has grown in popularity. A much more potent form of the largely unregulated drug has begun to worry officials and public health advocates.
But toxicologists say there isn't enough research to provide a full understanding of what concentrations of kratom or 7-OH can be extremely toxic to the body when found in its pure form.
Experts say it's likely they can also cause dangerous reactions when combined with other drugs that can enhance their effects, but a lack of research means doctors simply don't know what they are. That's where the most dangerous risks lie, said Craig Smallin, medical director of the California Poison Control System's San Francisco office.
In cases where kratom and 7-OH are found in the bodies of recent accidental deaths, toxicologists typically find evidence of polysubstance use—when two or more drugs are taken together, either intentionally or unintentionally.
“I don’t claim to have investigated every reported death from kratom, but I haven’t seen too many reports of kratom being used as a single drug resulting in death,” Smallin said.
While there is an effective method for testing the amount of kratom in the body, there is no equally accurate test for 7-OH. Current tests can only tell whether it is present or not. This was the case in all six deaths in Los Angeles County.
But as Papsun notes, when kratom is metabolized in the body, part of the breakdown includes 7-OH, meaning it will likely show up in medical examinations whenever this happens with kratom.
Toxicology laboratories face significant challenges in quickly developing tests for new drugs, such as 7-OH, for use in post-mortem medical research, Papsun said. “Adding something to the testing scope is challenging from a forensic standpoint because you have to develop it, validate the test, have commercial material available, and it has to be scientifically rigorous because those results could end up in court,” Papsun said.
Another challenge when testing for 7-OH in particular is that the compound is “incredibly unstable,” she said. It can be detected in the body at the time of death, but by the time the sample is collected and tested, the compound may have already begun to break down, leading to inaccurate results.
Robert Powers, a forensic toxicologist at the University of New Haven, agreed that it is difficult to say whether kratom and 7-OH played a direct role in the deaths in Los Angeles County. “Most of the problems that arise with this drug occur in combination with other drugs that depress breathing: opiates, benzodiazepines, alcohol,” he said, although he added that the deaths are a “difficult picture” to understand.
That's why he said the Los Angeles County Department of Health's decision to remove these products from shelves makes sense. “I think it's reasonable to acknowledge that kratom may indeed have played a role in these cases. And I understand the interest in trying to limit the potential effects of this drug in these mixed cases, so I understand why people would be interested in monitoring this drug.”
Smallin, director of the San Francisco Poison Control Center, agreed, noting that the county is still unaware of kratom and 7-OH.
This lack of information extends to consumers, who often rely on advice from local, state and federal agencies about the risks associated with products like kratom and 7-OH.
Indeed, Di Macaluso, 74, said she had to take it upon herself to find other sources of advice and experiment with different daily dosage levels to relieve symptoms of fatigue and difficulty breathing resulting from years of chronic lung disease.
When she learned of the county's decision, “it scared the crap out of me that they were going to pull” kratom products. “I told my husband I don’t know what I’ll do if I don’t have him and then I won’t be able to get out of bed or paint or do the few things I can do,” she said.
Macaluso was an actress and comedian who lived in Park City, Utah, in her 60s, but more recently moved to Los Angeles when her health declined due to pneumonia that developed into debilitating lung infections.
Macaluso used to live an active lifestyle, but because of her lung damage, she could barely walk up and down the stairs of her Utah home without feeling tired. She also felt that the altitude in Park City was detrimental to her health—one of the reasons she decided to move to Los Angeles, which is mostly low-altitude.
She saw several specialists, but none of them offered any options to help relieve her symptoms. Then she came across a documentary that highlighted the benefits of kratom for chronic pain and mental health. She decided to try.
“I didn’t use it very often, but when I did, I found that it helped me with a lot of my problems,” Macaluso said.
She described the effect as a burst of energy, which in turn gave her the motivation and strength to get out of bed. “It was more of a subtle feeling of just relief from being a bad, tired person,” Macaluso said. “I loved it and still use it.”
As her illness progressed, Macaluso continued to rely on kratom whenever she knew she would have a long day or would have to attend an event and be social.
“It made me feel like my old self – smart, funny and fast. I was a stand-up comedian, doing all these things and becoming an old tired woman who was out of breath walking up the stairs, and it made me angry,” she said.
Macaluso isn't advocating 7-OH, but she doesn't want kratom to be banned; she would prefer it to be regulated and available to the public.
“I think the government should give us the freedom to educate ourselves,” she said. “There will always be people who abuse it, but I don't think those of us who use it responsibly and benefit from it should be punished.”
Business owners like Abdullah Mamun, who founded Authentic Kratom 12 years ago, agree with Macaluso's point.
Authentic Kratom began as an e-commerce business based in Canoga Park and has since grown into three brick-and-mortar locations in Canoga Park, Woodland Hills and Hollywood.
Mamun believes that 7-OH poses a real risk and that Los Angeles County should focus its efforts there. However, a complete ban on all kratom products is counterproductive, he said. First of all, based on what his clients have told him over the last decade or so, he believes that “kratom doesn't cure you, but it gives people the relief they're looking for and the ability to manage their pain.” Secondly, red labeling of kratom products will directly impact his authentic kratom and the livelihood of his seven full-time employees.
And he welcomes regulation of kratom products.
“We want them to be labeled appropriately for consumers because people need to know what they're putting in their body,” he said.
