BLUE ASH, Ohio — Products marketed as natural supplements and sold at gas stations, vape shops and online are raising alarms among Greater Cincinnati coroners after a series of suspected overdose deaths linked to kratom and its chemical compounds.
About 14 suspected deaths involving kratom or related alkaloids have been identified across the region in the past couple of months, according to Hamilton County Coroner Dr. Lakshmi Sammarco.
Sammarco was joined Monday by Butler County Coroner Dr. Lisa Mannix and Warren County Coroner Dr. Russell Uptegrove to warn the public about products that can resemble ordinary energy shots, dietary supplements, gummies and pills but may contain dangerous, highly concentrated substances.
"Just because it's being sold in a store does not make it safe," Sammarco said.
WATCH: Tri-State coroners warn of deadly drugs sold at gas stations, vape shops
The warning comes as overall drug overdose deaths have declined in parts of the region, making the recent emergence of kratom-related deaths particularly concerning to local officials.
In Butler County, two deaths involving kratom-related substances have been confirmed, with a third suspected case under investigation.
Warren County has recorded three confirmed deaths involving mitragynine, the primary active compound in kratom, so far this year. Those deaths account for three of the county's 19 confirmed drug overdose deaths in 2026.
Hamilton County is investigating four suspected overdose deaths involving kratom-related compounds. Sammarco said one of those cases also involved fentanyl, although a mitragynine-related alkaloid was the predominant substance detected in the person's blood.
"I think the problem is a lot of people probably don't understand the potential danger of it," Uptegrove said. "You don't know exactly what you're getting."
What is kratom, and why is it dangerous?
Kratom comes from the leaves of a tree native to Southeast Asia. Its active compounds can produce stimulant-like effects at lower doses and opioid-like effects at higher doses.
Traditionally, kratom leaves have been used for purposes including pain relief and stimulation. But coroners say the products now being sold in concentrated forms can be substantially different from the plant's natural leaf.
Mannix explained that the concentration of potentially dangerous alkaloids increases when the compounds are extracted and processed into liquids, tablets and other products.
The amount of those substances can also vary significantly between products — and even between doses within the same package.
"What they get in one dose may not be what's in another dose, and maybe not even at all in the next pill that they get," Mannix said.
The compounds can suppress breathing at higher doses, potentially leading to fatal overdoses. Mixing them with alcohol or other sedating substances can increase the danger.
Uptegrove said people unfamiliar with these substances may face a greater risk because their bodies have not developed a tolerance to their effects.
"You get someone who's a non-experienced, non-habituated user, and you start taking things like this, they would be much more susceptible to having a bad outcome," Uptegrove said.
Products may be hiding dangerous ingredients in plain sight
During Monday's news conference, Sammarco displayed images of products that have been found to contain kratom-related compounds.
Some resembled small energy shots, while others were packaged as herbal supplements, pressed pills, capsules or flavored liquids.
Among the products discussed were supplements marketed as cat's claw and berberine, including products promoted for their supposed weight-loss benefits.
Sammarco said laboratory testing has identified potentially dangerous alkaloids in products that did not clearly disclose those substances on their labels.
"That's the problem: is that you can't trust the label because it may not be accurate about what's actually in the pill or the liquid that you're consuming," Sammarco said.
The Hamilton County Crime Laboratory has also documented an increase in drug seizure cases involving mitragynine and related compounds. Sammarco said the laboratory has received 38 cases involving mitragynine and MGM-15 so far in 2026, along with four cases involving 7-hydroxymitragynine.
By comparison, only a handful of mitragynine-related cases were documented in 2020.
The products are particularly concerning because they are not necessarily purchased through illegal street drug markets. Mannix said the individuals involved in Butler County's cases obtained the substances through retail establishments.
"They're not buying it off the street. I mean, they're going to a retail establishment to buy this," Mannix said.
That creates additional questions about whether retailers and distributors understand what their products contain.
The concerns extend beyond Greater Cincinnati, too.
The Ohio Attorney General's Office and the Ohio Narcotics Intelligence Center have also issued warnings about illegal drugs being sold in retail products marketed as natural or herbal supplements.
A new statewide public safety bulletin highlights concerns about products that may contain dangerous substances without clearly identifying them on their packaging.
The warning is particularly significant because some products are marketed under names unrelated to kratom, making it difficult for consumers to recognize potentially dangerous ingredients.
The Ohio Bureau of Criminal Investigation also published a kratom field guide in March, identifying several forms of potentially illegal products, including concentrated liquid shots, gummies, tablets and products advertised as enhanced or extra-strength kratom.
The guide warns that packaging alone cannot establish whether a product is legal. Laboratory testing is necessary to identify its chemical contents.
That uncertainty was a central concern raised by Sammarco during Monday's news conference.
"We don't know what's in it until we actually test it, and hopefully it's not testing in your body," Sammarco said.
Certain kratom compounds are illegal in Ohio
Ohio has classified certain kratom-related alkaloids as Schedule I controlled substances, although the natural leaf and ground leaf powder remain legal under state law, according to the coroners.
Despite those restrictions, concentrated products containing prohibited compounds continue to appear in retail stores and online.
Sammarco said Ohio officials have notified retailers selling kratom products about the restrictions and directed them to remove illegal substances from their shelves.
But enforcement is complicated by the wide variety of products, inconsistent labeling and constantly changing chemical formulations.
The coroners also emphasized that the legal status of natural kratom does not mean it is free of health risks.
Mannix said some consumers may be using the substances to self-medicate for pain, anxiety, low energy or opioid use disorder without understanding the potential consequences. She encouraged people seeking relief from those conditions to speak with medical professionals rather than relying on products sold at convenience stores.
Coroners hope warning prevents more deaths
The emergence of kratom-related overdoses comes amid broader progress in reducing drug deaths across the region.
Uptegrove said Warren County's overdose deaths have declined compared with previous years, while Sammarco said Hamilton County recorded fewer than 200 overdose deaths in 2025, down significantly from a peak of 567 in 2017.
But the recent cases have prompted concerns about another potentially dangerous trend. Mannix said public awareness and enforcement could help prevent the problem from escalating.
"Our job is to sound the signal, and unfortunately, when we're sounding the signal, you know that the upstream is much worse," Mannix said.
This story was reported on-air by a journalist and has been converted to this platform with the assistance of AI. Our editorial team verifies all reporting on all platforms for fairness and accuracy.
