Dubuque County Public Health officials are warning residents about serious health risks linked to kratom, particularly concentrated products containing 7-hydroxymitragynine (7-OH).

Iowa has recorded 45 kratom-associated deaths since 2024 across 23 counties, including 16 deaths in the first seven months of 2026. Iowa Poison Control also logged 68 kratom exposure calls in the early part of 2026—a reported 467% increase over two years.

Kratom is commonly sold as a powder, capsule, gummy, tablet, beverage, or energy shot. It is marketed for pain relief, energy, anxiety reduction, and help with opioid withdrawal and is often promoted as a natural or herbal product. Officials stress that “natural does not mean safe.”

Kratom contains psychoactive compounds with both stimulant-like and opioid-like effects. Concentrated 7-OH products raise additional concerns because they can contain substantially higher levels of this opioid-active compound than are naturally present in kratom leaf.

“The newer, concentrated and synthetic forms of kratom are similar in effect to very high-potency opioids. This includes increasing the risk of death by reducing breathing and heart rate. This substance is also addictive, and the body becomes dependent on it. Additionally, there is little oversight or regulation of kratom currently, as it is marketed as a natural substance,” said Dr. Preeti Joseph, MD, a member of the Dubuque County Board of Health.

Dependence, Impairment, and Other Risks

Regular use can lead to tolerance and physical dependence. Stopping after regular use may cause withdrawal symptoms. Potential adverse effects include seizures and liver injury. Risks increase when kratom or 7-OH products are combined with other substances.

Local law enforcement reports that kratom can cause impairment and intoxication. Although kratom is not currently a scheduled or controlled substance under the law, its use can still affect public safety. Officers have reported multiple kratom-related operating while intoxicated (OWI) arrests in Dubuque over the past two years. Residents are advised not to drive after using kratom or products containing 7-OH.

Signs of possible dependence include:

•  Needing increasingly larger doses to achieve the same effect

•  Feeling anxious, irritable, or physically unwell between doses

•  Repeatedly trying and failing to reduce or stop use

•  Spending excessive time obtaining or using kratom

•  Continuing to use despite harm to health, relationships, work, or daily life

“Seeking help early for kratom use and dependence can help prevent serious health complications. The FDA has provided warnings of potential adverse effects, such as liver toxicity and seizures. We hope with early education, recognition and access to care and support can reduce potentially negative health effects, leading to better health outcomes,” said Sarah Milner, Public Health Project Coordinator and lead of the Dubuque County Substance Use Disorder Working Group.

What Residents Should Do

Dubuque County Public Health encourages these precautions:

•  Avoid concentrated or synthetic 7-OH products. Do not assume they are safe simply because they are sold legally or marketed as supplements, herbal products, or natural remedies.

•  Recognize the risk of dependence. Regular use can lead to tolerance, physical dependence, and withdrawal.

•  Do not drive while impaired. Kratom can affect judgment, alertness, and the ability to drive safely.

•  Take overdose symptoms seriously. Call 911 if someone is unresponsive, having a seizure, or experiencing difficulty breathing. If an opioid-type overdose is suspected, administer naloxone if available and follow emergency dispatcher instructions. Note that naloxone may not reverse all effects of kratom or 7-OH.

•  Contact Poison Help for exposure concerns at 1-800-222-1222.

•  Seek support early. People concerned about their use, dependence, or withdrawal can contact local treatment providers or Your Life Iowa.

For immediate crisis support, call or text 988. For confidential 24/7 substance-use and behavioral health support, contact Your Life Iowa at 855-581-8111 or text 855-895-8398.

Local Treatment and Support Resources

•  Area Substance Abuse Council (ASAC)
1940 Elm Street, Dubuque, IA 52001
563-582-3784

•  Hillcrest Family Services
2005 Asbury Road, Dubuque, IA 52001
563-583-7357

•  MercyOne Dubuque Turning Point Treatment Center
250 Mercy Drive, Dubuque, IA 52001
563-589-8291

•  Operation Empower Liberty Recovery Community
2216 White Street, Dubuque, IA 52001
563-213-5552

“Kratom is often perceived as a safe alternative to opioids, alcohol, or other substances, but we’re seeing more people seek treatment after finding themselves dependent on it in ways they never expected. If you’re concerned about your use or struggling to cut back, don’t wait for a crisis to seek help. The earlier someone reaches out, the better the opportunity for recovery,” said Courtney Runde, Director of MercyOne Dubuque Turning Point Treatment Center.

Dubuque County Public Health is incorporating kratom and other commonly misused substances into its prevention, education, and community partnership efforts. The goal is to increase awareness of the risks, encourage early intervention, and connect residents with appropriate care and support.

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