Gas Station Heroin: Understanding the Real Dangers of Kratom

Walk into a gas station or convenience store in many parts of the United States and you may see small bottles or packets marketed as “energy,” “focus,” “mood support,” or “natural pain relief.” These products are often placed next to snacks, energy drinks, or supplements and sold without age restrictions or meaningful health warnings. Some contain kratom, a psychoactive substance that has become widely available and widely misunderstood.

Kratom is not heroin. But it is also not a harmless supplement.

As a psychiatrist who treats severe mental illness and works closely with trauma, stress, and substance use, I have seen kratom play two roles. Some people turn to it seeking relief from pain, anxiety, or exhaustion. Others encounter dependence, worsening mental health symptoms, or withdrawal they did not expect. This article is not about panic or prohibition. It is about clear information, realistic risks, and safer choices.

So What Exactly is Kratom?

Kratom comes from the leaves of Mitragyna speciosa, a tree native to Southeast Asia. In traditional settings, the leaves were sometimes chewed or brewed as tea. The products sold in the United States today are very different. They are often highly processed and concentrated.

Kratom’s primary active compounds, mitragynine and 7-hydroxymitragynine, act on the brain’s opioid receptors. According to the National Institute on Drug Abuse, these interactions explain why kratom can produce stimulant effects at lower doses and opioid-like effects such as pain relief and sedation at higher doses.

A peer-reviewed pharmacology review describes kratom as having stimulant, analgesic, and opioid-like properties depending on dose and formulation.

Kratom is not approved by the FDA for any medical use. The FDA has warned consumers that kratom products are unregulated and have been associated with serious adverse effects, including liver injury, seizures, and substance use disorder.

The key issue is unpredictability. There is no standardized dosing, and product potency varies widely. Two products with similar labels may produce very different effects.

Why It Gets Labeled “Gas Station Heroin”

Kratom has earned the nickname “gas station heroin” for three main reasons: opioid-like effects, widespread availability, and a false sense of safety.

First, kratom produces opioid-like effects. Its active compounds bind to opioid receptors and can reduce pain, cause sedation, and produce feelings of relaxation or euphoria. Research has shown that regular use can lead to tolerance, dependence, and withdrawal symptoms.

Second, kratom is easily and widely available. It is sold in gas stations, convenience stores, and vape shops rather than in medical settings. This level of accessibility is unusual for a substance with opioid receptor activity and increases the likelihood of casual or uninformed use.

Third, availability creates an assumption of safety. When a product is legal, sold openly, and marketed as “natural,” many people assume it must be safe. Retail placement can feel like implicit approval, even though it is not.

Growing Concerns From Clinicians and Public Health Officials

Concern about kratom has grown steadily. The FDA has repeatedly stated that there are no FDA-approved kratom products and has warned about contamination, toxicity, and misuse.

Public health surveillance supports these concerns. A CDC analysis of poison control data found that kratom-related calls increased sharply over time. From 2010 to 2015, reported exposures rose tenfold.

In a later report, the CDC examined overdose deaths and found kratom listed as a cause of death in a substantial number of cases, often alongside other substances.

Dependence Can Happen, Even When Use Starts Innocently

Most people who try kratom are not seeking intoxication. They may be trying to manage stress, anxiety, physical pain from sports or other injuries, low mood, or burnout. Some believe kratom is safer than prescription medications or illicit drugs.

Dependence can still develop. With repeated use, tolerance may increase, leading people to take higher or more frequent doses. Withdrawal symptoms reported in studies include both physical and psychological effects: 

• muscle pain and spasms
• difficulty sleeping
• watery eyes or a runny nose
• hot flashes or fever
• decreased appetite
• diarrhea
• restlessness
• tension
• irritability or anger
• sadness
• nervousness

Mental Health Effects and Developmental Risks

Kratom can affect mood, sleep, and emotional regulation. Some users report increased anxiety, agitation, or worsening depression. For individuals with severe mental illness, psychoactive substances can complicate symptom stability.

For teens and young adults, whose brains are still developing, using substances to manage stress can interfere with learning healthier coping skills. For parents, warning signs may include sudden changes in mood, sleep, or motivation, social withdrawal, or secrecy around small bottles or powders.

The Danger of Mixing Kratom With Other Substances

One of the clearest risk factors for serious harm is mixing kratom with alcohol, benzodiazepines, opioids, or other drugs. Many kratom-associated deaths involve multiple substances.

The FDA and CDC both emphasize that polysubstance use significantly increases risk.

A Harm-Reduction Approach

A harm-reduction approach begins with honesty. Some people will use kratom despite warnings, often in an effort to manage pain, stress, or emotional distress. The goal of harm reduction is not to excuse risk, but to reduce it and prevent serious harm.

According to the American Psychiatric Association, kratom overdoses should be treated as opioid overdoses. This includes administration of naloxone (Narcan) and immediately calling 911. Individuals who use kratom should be educated about the risks of dependence, addiction, and overdose, should avoid mixing kratom with alcohol or other substances, and be trained in the use of naloxone and carry it when possible.

In clinical practice, many clinicians manage kratom dependence similarly to other opioid use disorders, using a combination of behavioral interventions and medications. Small studies and clinical reports suggest positive outcomes using medications for opioid use disorder, including buprenorphine, methadone, and naltrexone.

When to Seek Help

Call 911 for medical emergencies such as seizures, trouble breathing, or inability to awaken someone. Additional U.S. resources include:

• 988 Suicide and Crisis Lifeline: https://988lifeline.org/
• SAMHSA National Helpline: https://www.samhsa.gov/find-help/helplines/national-helpline
• Poison Control: https://www.poisonhelp.hrsa.gov/
• National Alliance on Mental Illness (NAMI): https://www.nami.org/

Bottom Line

Kratom is not heroin. It is also not a harmless supplement. It affects the brain, can lead to dependence, and carries real risks, especially when mixed with other substances. Calling it “gas station heroin” gets attention, but harm reduction turns that attention into safety, understanding, and better choices.

About the Author

Pranathi Mruthyunjaya, M.D., is a board-certified psychiatrist specializing in the treatment of severe mental illness. She serves as a staff psychiatrist at UCSF Health and Contra Costa Regional Medical Center in California. 

Reference List: 

1. National Institute on Drug Abuse. (2022, March). Kratom. https://nida.nih.gov/research-topics/kratom
2. Prozialeck, W. C., Jivan, J. K., & Andurkar, S. V. (2012, December). Pharmacology of kratom: An emerging botanical agent with stimulant, analgesic, and opioid-like effects. https://pubmed.ncbi.nlm.nih.gov/23212430/
3. U.S. Food and Drug Administration. (2025, December). FDA and Kratom. https://www.fda.gov/news-events/public-health-focus/fda-and-kratom
4. Singh, D., Müller, C. P., & Vicknasingam, B. (2014, June). Kratom dependence, withdrawal symptoms and craving in regular users. https://pubmed.ncbi.nlm.nih.gov/24698080/
5. Centers for Disease Control and Prevention. (2016, July). Notes from the Field: Kratom (Mitragyna speciosa) Exposures Reported to Poison Centers. https://www.cdc.gov/mmwr/volumes/65/wr/mm6529a4.htm
6. Centers for Disease Control and Prevention. (2019, April). Notes from the Field: Unintentional Drug Overdose Deaths with Kratom Detected.  https://www.cdc.gov/mmwr/volumes/68/wr/mm6814a2.htm
7. National Library of Medicine. (2023, August). Translating Kratom-Drug Interactions: From Bedside to Bench and Back/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10353077/
8. American Psychiatric Association. (2025, October). What is Kratom and Why Is It Raising Concerns? https://www.psychiatry.org/news-room/apa-blogs/what-is-kratom-and-why-is-raising-concerns