Dear Chair Klopfenstein, Vice Chair Newman, Ranking Member Miller, and members of the Committee:

My name is Jeffrey A. Singer. I am a Senior Fellow in Health Policy Studies at the Cato Institute. I am also a medical doctor specializing in general surgery and have been practicing that specialty in Phoenix, Arizona, for over 40 years. The Cato Institute is a 501(c)(3) non-partisan, non-profit, tax-exempt educational foundation dedicated to the principles of individual liberty, limited government, free markets, and peace. Cato scholars conduct independent research on a wide range of policy issues. To maintain its independence, the Cato Institute accepts no government funding. Cato receives approximately 80 percent of its funding through tax-deductible contributions from individuals. The remainder of its support comes from foundations, corporations, and the sale of books and other publications. The Cato Institute does not take positions on legislation.

I appreciate the opportunity to share my thoughts on HB 587, which this committee is reviewing. HB 587 establishes labeling, testing, and age restrictions for kratom products while effectively eliminating the market for concentrated 7‑hydroxymitragynine by restricting the compound to only trace levels in products sold in the state.

For centuries, communities in Southeast Asia have prepared teas from the leaves of Mitragyna speciosa—commonly referred to as kratom—for relief of pain and anxiety. The plant’s primary active compounds, mitragynine and the more potent 7‑hydroxymitragynine (7‑OH), interact with opioid receptors in the brain. In the United States today, people widely use kratom, often as a substitute for prescription opioids or to mitigate symptoms of withdrawal. They obtain it in a variety of forms, including teas, capsules, powders, concentrated extracts, and increasingly, as 7‑OH products sold through convenience stores, vape shops, smoke shops, and online platforms.

In 2016, the Drug Enforcement Administration proposed classifying kratom as a Schedule I substance.1 However, the agency withdrew its proposal after strong opposition from patients and researchers.2 Like alcohol, cannabis, nicotine, and opioids, people can develop dependence on kratom or 7‑OH and may go through withdrawal or what is medically recognized as kratom use disorder. Since 7‑OH is much more potent than kratom, many consumers now seek semi-synthetic 7‑OH through easily accessible stores and online sources.

Supporters of efforts to restrict kratom and 7‑OH argue that these products can fuel the next wave of overdose deaths, but the data tell a different story. While kratom and 7‑OH have opioid-like properties and can cause respiratory depression, fatal overdoses are very rare.3 In the few cases where coroners found kratom or 7‑OH in overdose deaths, other substances were almost always involved. Nearly two-thirds of these cases also involved fentanyl, about one-third involved heroin, and just under one-fifth involved prescription opioids or cocaine.4 Additionally, 80 percent of the decedents had a documented history of substance misuse, and 90 percent were not receiving medical care for pain at the time of death.

Against this evidentiary background, legislators in several states—including Colorado, Tennessee, and New Jersey—have introduced prohibition bills named for individuals whose deaths were attributed to 7‑OH overdoses. In Michigan, proponents of restrictions have likewise cited similar cases to support their proposals. These eponymous measures understandably appeal to sympathy, but they also suggest a straightforward causal story—that 7‑OH by itself was responsible for the fatality.

In several of the cases cited to justify prohibition, toxicology reports reveal the presence of multiple substances alongside 7‑OH. These reports frequently identify other drugs—such as fentanyl, amphetamines, tranquilizers, cannabinoids, or sedating medications—that are known to increase the risk of respiratory depression when combined with opioid-like compounds.

For example, Tennessee’s “Matthew Davenport’s Law,” which establishes criminal penalties for possessing, manufacturing, delivering, or selling kratom, is named for a man whose toxicology report also showed diphenhydramine and psychiatric medications in addition to 7‑OH.5 Colorado’s Daniel Bregger Act likewise followed a death in which the autopsy identified diphenhydramine, trazodone, and cannabinoids along with kratom.6 In New Jersey, proposed “CJ’s Law” would prohibit kratom entirely, even though the decedent’s toxicology showed a combination of amphetamines (Adderall), tranquilizers, cannabinoids, fentanyl, and kratom.7 And while Michigan’s House Bill 4969—which seeks to ban 7‑OH—is not formally named after Dakota Herrera, sponsors frequently cite his death despite toxicology findings showing anticonvulsant medications, cannabinoids, and kratom in his system.8

These cases are tragic. But they also illustrate an important point: the deaths often cited in support of prohibition involve complex polysubstance exposure rather than clear evidence that 7‑OH alone caused the fatality.

Age restrictions on selling these psychoactive substances are reasonable and align with those for alcohol and cannabis. However, if Ohio lawmakers effectively ban 7‑OH as HB 587 proposes, they will just drive users to buy the product in other states where it is legal, or in illegal markets.

A federal ban would deny thousands of patients with chronic pain, PTSD, or anxiety disorders the relief they get from kratom and 7‑OH. It would also increase public health risks by pushing the market underground. Drug trafficking organizations already have strong networks for heroin, fentanyl, cocaine, and meth. Having lost significant income from marijuana legalization, these groups would likely be eager to expand into supplying 7‑OH.9

Prohibition at the state or federal level will not eliminate consumer demand; it will simply drive users to illegal and unregulated suppliers. This will only increase the risks associated with use. As seen with counterfeit prescription opioids laced with fentanyl, illicit markets cannot ensure product strength, purity, or authenticity. Cartels that distribute 7‑OH are the same organizations mixing fentanyl, methamphetamine, and cocaine into other substances, raising the risk of contamination and polydrug exposure. Public health outcomes will not improve by pushing kratom or 7‑OH users into illicit markets.

Instead, policymakers should prioritize evidence-based strategies: providing accurate information about risks, expanding access to harm reduction tools, and ensuring treatment options for those with substance use disorders.

For example, naloxone—the well-known antidote to opioid overdose—is also effective in reversing overdoses related to kratom or 7‑OH. The Food and Drug Administration authorized over-the-counter access to intranasal naloxone in 2023, but the less expensive injectable form should also be available, as has been successfully implemented in Italy and Australia.10

Ohio’s federal representatives should pursue legislation requiring the FDA to permit over-the-counter injectable naloxone.

Similarly, policymakers should increase access to methadone treatment by allowing clinicians to start and oversee therapy in their offices, as is common in countries like Australia, Canada, and the United Kingdom. This approach has been safe and effective for over fifty years.11 Boston-area pilot programs where primary care clinicians prescribe methadone have demonstrated success.12 A Yale University-led randomized controlled trial where patients were randomly assigned to office-based methadone treatment by primary care practitioners and Opioid Treatment Programs supported the feasibility of transferring stable opioid-dependent patients to primary care physicians’ offices.13

Ohio’s federal representatives should advocate for legislation that permits clinicians to prescribe methadone in their clinics for people with opioid use disorder, as well as, potentially, kratom use disorder.

Public education programs, along with sensible regulations, such as age restrictions, public use restrictions, or restrictions on operating vehicles while under the influence, can reduce harms and protect public health.

However, if kratom sales are severely curtailed and 7‑OH is consigned to prohibition, they will become new commodities for drug cartels to market.

Respectfully submitted,

Jeffrey A. Singer, MD, FACS
Senior Fellow, Department of Health Policy Studies
Cato Institute