Kava and Kratom: What’s the Difference — and Why Are Both Showing Up at Poison Control Centers?

You can buy them at gas stations. You can find them at vape shops. You can order them online and have them delivered to your door.

Kava and kratom are everywhere right now — and most people have no idea what they actually are, how they work, or why mixing them together has become a serious public health problem.

A brand-new report from the CDC, published April 2, 2026, found that poison control center calls involving kava and kratom together jumped 383% between 2011 and 2025. The number of those calls that ended in serious health outcomes — seizures, heart problems, hospitalizations — has nearly tripled.

This is happening in New Hampshire. It’s happening at places you’ve been. Here’s what you need to know.

What Is Kava?

Kava comes from a plant called Piper methysticum. It is part of the pepper family. It grows in the Pacific Islands, where people have used it for thousands of years — at ceremonies, social gatherings, and community events.

The traditional way to prepare kava is to grind the root into a powder and mix it with water. The drink is mildly sedating. In the Pacific Islands, where it has been used for generations in controlled, cultural settings, it is considered relatively low-risk.

But what is sold in the US today is a very different product.

The kava you find in stores here — the shots, the drinks, the pills, the gummies — is not the same as traditional kava. According to the CDC’s April 2026 MMWR report, commercial kava products sold in the US are unregulated and can be anywhere from two to ten times stronger than traditional kava beverages. There are no rules about how strong they can be. Nobody is checking what is in them. The label does not have to tell you how much of the active ingredient you are actually getting.

How Does Kava Work in the Body?

The active ingredients in kava are called kavalactones. There are at least 18 different kavalactones that have been identified in the plant.

Kavalactones work mainly by acting on the brain’s GABA system. GABA is a chemical messenger in the brain that slows things down. It reduces anxiety, relaxes muscles, and creates feelings of calm. This is the same general system that alcohol, benzodiazepines (like Xanax and Valium), and sleep medications act on.

This is why kava makes people feel calm and relaxed. It is also why heavy or long-term use can lead to dependence — because the brain gets used to having kava around to keep that system balanced. When the kava stops, the brain can go into a kind of rebound — causing anxiety, irritability, and trouble sleeping.

Kavalactones also affect the dopamine system in the brain. Dopamine is the brain’s reward chemical. When dopamine is activated, it creates feelings of pleasure and motivation. Products that affect dopamine can be habit-forming over time.

What Does Kava Feel Like?

• Calm and relaxed
• Less anxious
• Muscles feel loose
• Slightly numb mouth or tongue (this is normal and expected)
• Drowsy at higher doses

Kava bars have opened across New England advertising kava as a healthy, non-alcoholic way to relax. These products are commonly sold near college campuses and marketed as healthy alternatives to alcohol.

Is Kava Safe?

The marketing says yes. The science says it is more complicated than that.

The FDA issued a consumer warning about kava and liver damage in 2002. The concern was liver toxicity — meaning kava can damage the liver, especially with regular or heavy use. Following that warning, kava-related reports to poison control centers dropped sharply. They have been climbing steadily ever since, as new and more concentrated products have entered the market.

The FDA classifies kava as a Drug of Concern. It is legal to buy and sell. But legal does not mean safe.

Quick Answer: Is Kava Addictive?

Yes, it can be. Despite what the marketing says, kava has been linked to psychological dependence, tolerance (needing more to get the same effect), and withdrawal. The CDC’s 2026 report specifically notes that kava is associated with psychological dependence and withdrawal — effects that are not typically disclosed in the way these products are marketed and sold.

What Is Kratom?

Kratom comes from a tree called Mitragyna speciosa. It is a member of the coffee family. It grows in Southeast Asia — mainly Thailand, Malaysia, and Indonesia. People in those countries have chewed its leaves for centuries, typically as a mild stimulant to get through long work days or to manage pain.

In the US, kratom is sold in powder form, capsules, tablets, and highly concentrated liquid shots. It is found in smoke shops, gas stations, and online stores across New Hampshire.

How Does Kratom Work in the Body?

Kratom’s leaves contain over 50 active chemicals. The two most important are mitragynine and 7-hydroxymitragynine, often called 7-OH.

According to the FDA’s official position on kratom, both mitragynine and 7-OH bind to mu-opioid receptors in the brain. Mu-opioid receptors are the same receptors that prescription painkillers like oxycodone, hydrocodone, and morphine attach to. They are the same receptors that heroin and fentanyl attach to.

When these receptors are activated, the brain releases feelings of pain relief, calm, and in some cases euphoria. That is why kratom works as a painkiller. It is also exactly why the brain can become dependent on it.

Here is an important detail about 7-OH specifically: research published in PMC found that 7-OH is approximately 10 times more potent at mu-opioid receptors than mitragynine. In natural kratom leaves, 7-OH is present only in very small amounts — less than 0.05% of the dry leaf. But many commercial kratom products, especially concentrated liquid shots and extracts, contain levels of 7-OH that are far higher than what nature produces. This is one reason concentrated kratom products are considered significantly more dangerous than traditional leaf preparations.

The FDA has specifically recommended scheduling concentrated 7-OH products as controlled substances because of these concerns.

Kratom also acts on serotonin and dopamine systems in the brain. This is part of why it affects mood, energy, and motivation — and part of why stopping it can cause serious emotional withdrawal symptoms even after the physical withdrawal has passed.

The Dose Makes the Difference

One thing that makes kratom different from most substances is that the dose completely changes what it does.

At low doses, kratom acts like a stimulant. Users feel alert, energetic, and focused. This is similar to having a strong cup of coffee.

At higher doses, kratom acts like an opioid. Users feel pain relief, sedation, and in some cases euphoria. This is similar in feel — though not identical in chemistry — to taking a prescription painkiller.

This dose-dependent effect is one reason people keep using more. They start at a low dose for energy or mild pain relief. Over time, they need a higher dose to get the same effect. That is tolerance — and tolerance is how dependence begins.

What Does Kratom Feel Like?

At low doses:

• More energy and alertness
• More talkative and social
• Sharper focus
• Reduced fatigue

At higher doses:

• Pain relief
• Calm or mild euphoria
• Sedation and drowsiness
• Nausea (very common, especially in new users)
• Constipation with regular use

Quick Answer: Is Kratom Addictive?

Yes. Kratom is physically addictive. Because it works on the same brain receptors as opioid drugs, the brain adjusts to its presence over time. When kratom is stopped, those receptors go into a kind of withdrawal — producing symptoms that look and feel very similar to opioid withdrawal.

A 2025 study published in Drug and Alcohol Dependence Reports surveyed 367 adults who used kratom or kava and found that 38% of people who used kratom in the past year met the clinical criteria for Kratom Use Disorder. That means more than one in three regular kratom users showed signs of a real substance use problem — including loss of control over use, cravings, withdrawal, and continued use despite harm.

As one New Hampshire treatment provider has documented, many people who develop kratom dependence never intended to. They started using it to manage pain, get through opioid withdrawal, or quiet anxiety — because it was marketed as natural and non-addictive. By the time they tried to stop, the withdrawal was far more severe than they ever expected.

How Are Kava and Kratom Different?

They come from different plants, different parts of the world, and they work through different mechanisms in the brain.

How Are Kava and Kratom Similar?

Despite working differently in the brain, kava and kratom share several important things in common.

1. Both are sold as natural and safe. Neither product is regulated as a drug. Both are sold as dietary supplements. No company has to prove these products are safe or effective before putting them on shelves. The word “natural” on the label carries no legal meaning when it comes to safety.

2. Both are unregulated. There is no legal standard for how potent these products have to be — or how potent they are allowed to be. There is no required third-party testing. There is no way to know for certain what you are getting in any given bottle or packet.

3. Both are widely available in New Hampshire. Gas stations. Smoke shops. Vape stores. Online retailers. Researchers at UVA Health’s Blue Ridge Poison Center found these products being sold “next to products like iced tea” in stores near university campuses. The same is true throughout New Hampshire, where there is no state law specifically regulating either substance.

4. Both can cause liver damage. Kava has a well-documented association with liver toxicity, which is why the FDA issued its 2002 warning. Kratom has also been linked to liver injury in some users, and the FDA has warned about kratom products contaminated with Salmonella and heavy metals. Because neither product is regulated, there is no guarantee of what is in what you are buying.

5. Both can cause dependence. People who start using these products for a specific reason — pain, anxiety, sleep, help getting off opioids — can find themselves dependent before they realize it has happened. This is true of both substances, though kratom’s dependence potential is considered significantly higher.

6. Both are increasingly being combined — and that combination is dangerous.

The Combination: Why Mixing Kava and Kratom Is a Serious Problem Right Now

This is the part that matters most right now.

According to the CDC’s April 2026 MMWR report, kava and kratom are now being sold together in pre-mixed drinks and shots at gas stations and vape shops across the country. By 2025, 30% of all kava-related poison control calls also involved kratom. That number was near zero before 2017.

One of the most well-known combined products is called “Feel Free,” made by a company called Botanic Gardens. A class action lawsuit alleged that the company used misleading advertising to promote the drink as a healthy alternative to alcohol. The company settled for $8.75 million. They agreed to add stronger safety warnings and limit sales to people 21 and older. In 2023, the FDA seized nearly 250,000 bottles of Feel Free.

Here is why the combination is so dangerous. Kava depresses the central nervous system — it slows things down, similar to alcohol. Kratom activates opioid receptors — creating opioid-like effects. When you take both together, the effects multiply each other in ways that the body may not be able to handle safely.

The CDC found that combined kava-kratom use is associated with:

• Seizures and tremors
• Dangerous changes in heart rhythm
• Higher rates of serious medical outcomes
• Hospitalization
• Death — 8 deaths were reported across the 25-year study period

Dr. Chris Holstege, Director of UVA Health’s Blue Ridge Poison Center and lead author of the CDC study, summarized it clearly: “It’s a dangerous combo.”

The serious outcome rate from kava-related poison control calls has gone from 12% in the year 2000 to 39% in 2024. That increase tracks directly with the rise of combined kava-kratom products entering the market.

Why Do People Use Kava and Kratom?

People do not usually start using these substances to get high. Most people start for a reason that makes complete sense given what these products claim to do.

Pain relief. Kratom’s opioid-like effects do reduce pain — that is real. People dealing with chronic pain, back injuries, or conditions for which they cannot get adequate prescription coverage sometimes turn to kratom as a cheaper, accessible alternative. The problem is that the body builds tolerance over time, requiring higher and higher doses to get the same relief.

Getting off opioids. Because kratom activates the same brain receptors as opioids, it can reduce opioid withdrawal symptoms. Some people who are trying to stop using heroin, fentanyl, or prescription painkillers use kratom to manage withdrawal on their own. The result is often that they trade one dependence for another. As one New Hampshire treatment provider notes, the gap between what people expect from kratom withdrawal and what they actually experience is one of the most difficult parts of treating kratom dependence.

Anxiety. Kava’s calming effects are real. People with social anxiety, generalized anxiety, or stress-related sleep problems are drawn to kava because it works — at first. Over time, the brain adjusts to having kava around to feel calm. When kava is not present, anxiety comes back stronger. That rebound effect is one of the hallmarks of kava dependence.

Alcohol replacement. This is how kava bars market themselves. For people trying to cut back on alcohol, kava sounds like a reasonable swap. The problem is that kava affects some of the same brain systems as alcohol, carries its own liver risks, and can cause its own form of dependence.

Energy and focus. Low-dose kratom is used by people who want a stimulant effect without coffee or energy drinks. Some people use it before work or exercise. Over time, tolerance builds and they need more to get the same effect.

Signs That Use Has Become a Problem

There is no single moment when use becomes a problem. But there are signs worth paying attention to.

Signs of kratom dependence:

• Using kratom every day, even when you do not want to
• Feeling sick, anxious, or unable to function without it
• Needing a larger amount to feel the same effect as before
• Trying to stop or cut down and not being able to
• Thinking about kratom before your current dose has worn off
• Hiding your use from people you trust
• Spending money on kratom that was meant for other things

Signs of kava dependence:

• Drinking kava every day
• Feeling anxious, irritable, or unable to sleep without it
• Needing more kava to feel the same level of calm
• A skin condition that looks like dry, scaly patches — called dermopathy — which can develop with heavy, long-term kava use
• Abnormal liver function tests (something a doctor can check)
• Wanting to stop but finding it harder than expected

Kratom Withdrawal: What It Actually Feels Like

Many people are blindsided by how hard kratom withdrawal is. They expected something sold at a gas station to be easy to stop. It often is not.

Kratom withdrawal happens because the brain has adjusted to having opioid receptor activation from kratom on a regular basis. When kratom stops, those receptors go without their usual input and the brain reacts.

According to the FDA, kratom withdrawal symptoms include:

• Muscle aches and cramps
• Sweating and chills
• Nausea and vomiting
• Insomnia
• Intense anxiety and restlessness
• Irritability
• Strong cravings
• Depression

The physical symptoms usually peak around 2–3 days after stopping and begin to improve within a week. The emotional symptoms — depression, anxiety, low motivation, difficulty feeling pleasure — can last significantly longer. This extended emotional phase, sometimes called post-acute withdrawal, is one of the most important reasons people benefit from professional support when stopping kratom.

Babies born to mothers who used kratom during pregnancy can also experience withdrawal symptoms after birth. The FDA has documented cases of neonatal abstinence syndrome — where newborns showed jitteriness, irritability, and muscle stiffness because they were exposed to kratom before birth.

Kratom, Kava, and Liver Health

Both substances carry risks for the liver and that risk is not always talked about clearly.

Kava and the liver: The FDA issued its consumer warning about kava and liver injury in 2002 after reports of serious liver damage, including cases requiring liver transplants. The risk appears to be higher with concentrated extracts — exactly the type of product being widely sold in the US today — compared to traditional water-based kava preparations.

Kratom and the liver: Kratom has also been associated with liver injury in some users. The FDA has additionally warned about kratom products contaminated with Salmonella and elevated levels of heavy metals — contamination that is possible precisely because these products are unregulated and do not require safety testing before sale.

The 7-OH Issue: Why Concentrated Kratom Products Are Especially Dangerous

Not all kratom products carry the same risk. This is important to understand.

In a natural kratom leaf, 7-hydroxymitragynine (7-OH) makes up less than 0.05% of the dry leaf weight — a very small amount. But 7-OH is approximately 10 times more potent at mu-opioid receptors than mitragynine, the main alkaloid in kratom. In fact, the FDA notes that 7-OH shows greater mu-opioid receptor potency than morphine.

Many commercial kratom products — especially the concentrated liquid shots sold at gas stations — have been manufactured to contain much higher levels of 7-OH than natural leaf kratom. Some products also contain synthetic 7-OH, which is lab-made rather than plant-derived and is considered even more dangerous.

In 2025, the FDA formally recommended that the DEA schedule concentrated 7-OH products as controlled substances. Some states have already acted on this. New Hampshire’s SB557 — the Kratom Consumer Protection Act currently moving through the legislature — would specifically make synthetic and semisynthetic kratom illegal in the state.

The practical takeaway is this: the small, inexpensive kratom shot you might see next to the energy drinks at a gas station may contain levels of opioid-receptor-activating compounds that are significantly more potent than the natural leaf product. There is no way to tell from the label.

Is Kratom Legal in New Hampshire?

Kratom is legal in New Hampshire — but the legal situation has more detail to it than most people realize, and it is changing quickly.

Current status: Kratom is legal statewide in NH for adults 18 and older. The one municipal exception is Franklin, NH, where kratom is banned within city limits. There is no statewide consumer protection law specifically for kratom, which means there are no required purity, potency, or labeling standards for products sold in New Hampshire.

Legislation moving right now: New Hampshire SB557, the Kratom Consumer Protection Act, had a public hearing on April 8, 2026 — just days ago. If passed, it would raise the legal purchase age to 21, make synthetic and semisynthetic kratom illegal, and establish labeling and testing requirements for kratom products sold in the state.

Regional context: Connecticut banned kratom entirely in March 2026, becoming one of the most recent states to criminalize it. Vermont has had a full ban in place for years. New Hampshire is moving toward regulation rather than a full ban, but the legal landscape around kratom across New England is shifting quickly.

Kava is legal throughout New Hampshire with no current state restrictions.

When Should Someone Seek Help?

There is no single answer to this question. But there are some things worth asking honestly.

• Do you use kava or kratom every day?
• Have you tried to stop and found it harder than you expected?
• Do you feel physically sick, anxious, or unable to function without it?
• Has your use increased over time as you needed more to feel the same effect?
• Has anyone in your life expressed concern about your use?
• Are you spending money on kava or kratom that was meant for other things?
• Are you using either substance to manage withdrawal from another substance?

If the answer to more than one of these is yes, that is worth talking to a professional about. Dependence on either of these substances is real, it is treatable, and getting support sooner makes the process significantly easier.

How Liberty Health Services Can Help

At Liberty Health Services in Derry, New Hampshire, we work with people dealing with all kinds of substance dependence — including kratom and kava. Many of the people who come to us started using these substances for completely understandable reasons. There is no judgment here.

Our medical team can help you stop safely, manage withdrawal symptoms, and address whatever brought you to these substances in the first place — whether that was chronic pain, anxiety, opioid dependence, or something else.

You do not have to figure this out alone.

This article is for informational purposes only and is not a substitute for professional medical advice. If you or someone you love is struggling with substance use, please reach out to a qualified treatment provider.