CRESCENT SPRINGS, Ky. -- In late April, the night before Zach Ziehm died, his mother said he called a friend about getting some heroin.
Ziehm started using heroin as a teenager, but he'd been sober for three years. He held down a job that he loved and was father to a newborn son.
Ziehm didn't fall right back into illegal drugs, though: His mother, Tami George, thinks an energy drink sold legally in some Northern Kentucky gas stations triggered a craving for opiates that led to a relapse and ultimately his death.
"(Ziehm) drank one, and it gave him that opiate effect and made him feel altered," she said. "It already gave him that craving."
Quick end to years of sobriety
Ziehm was 24 when he died. His mother, Tami George, found out he'd been using heroin when he was about 17 years old. She said he got hooked on painkillers at age 15.
Ziehm was predisposed to addiction; there was a family history of it, George said. He spent his late teens and early 20s in and out of rehab. George even had him arrested twice in Kentucky under Casey's Law, allowing an addict's family to ask a court to order treatment for them.
"I just had a sense of urgency," George said. "I was like, you know, he could die. He could die."
Ziehm met his fiancee in recovery; they got sober together, and by earlier this year, he seemed to be succeeding in his recovery. The couple have a newborn son, and George said Ziehm never missed a day of work at LaRosa's.
Then, in March, he started using energy drinks that contain Mitragyna speciosa extract, or kratom. The small shots are sold at certain gas stations and mini-marts.
"He said, 'Mom, it's like for after working out for sore muscles,'" she said.
But Ziehm's mood started to change: George said he was edgy, restless, discontent, "like he was coming out of his skin."
"I don't think he realized that these drinks were going to trigger that kind of response," George said.
Ziehm overdosed on heroin and died on April 24, one of 450 people who lost their lives to heroin addiction in Northern Kentucky from January to June.
George said her son first found out about kratom from a friend who'd relapsed and was using kratom to curb withdrawal symptoms. It was the same friend Ziehm called to get his final dose of heroin, George said.
Eventually, George learned that energy drinks containing kratom, and other forms of the substance, aren't regulated by the U.S. Food and Drug Administration.
Not regulated, easy to buy
Ashel Kreutzkamp, Nurse Manager at St. Elizabeth Health Care, tracks heroin-related deaths from the front lines of six emergency rooms in Northern Kentucky. The number of cases quadrupled between 2011 and 2015; Kreutzkamp said she thinks they're leveling out thanks to intensive outreach and education efforts.
She said she's now seeing some cases of heroin addicts using kratom.
Some drug treatment centers screen for kratom, but hospitals don't always test for it. Kreutzkamp compares a recovering addict using kratom to a game of Russian roulette.
"You can say that, once addicted, always addicted. And you always have to live your life like that because something is going to spark and get those (opioid) receptors to start firing again," she said.
Kratom doesn't contain opiates, but it is an opiate substitute. And that also concerns doctors in Ohio, where heroin overdoses are at epidemic proportions.
Ohio Attorney General Mike DeWine said he's concerned that the FDA doesn't regulate kratom sales due to its status as a dietary supplement. A recent warning from the Centers for Disease Control and Prevention labeled the supplement an "emerging public health threat" -- and DeWine said that's spot-on accurate.
"I think we need to take that seriously. This is sold, frankly, I don’t know how it's legally sold," DeWine said.
Kratom's other names:
Reported health effects include:
sensitivity to sunburn
loss of appetite
psychotic symptoms in some users
Source: National Institute on Drug Abuse
WCPO's I-Team found small shot bottles with kratom at several minimarts in Northern Kentucky. No Ohio stores that the I-Team surveyed carried them, but E.R. Beach sells pure kratom at his store in Sharonville.
"This is just the powdered form. It's basically just a tea more or less," Beach said.
Although the FDA doesn't regulate or approve kratom sales, the agency does warn it's risky because of serious side effects: hallucinations, severe withdrawal and delusions.
The FDA, however, does regulate what Beach can say about kratom.
"No one is allowed to give medical advice. It is a supplement, so it's really difficult to discuss why customers want it," Beach said.
Ohio already looking at possible ban
Kratom is already banned in six states and one county in Florida. Advocates say Indiana incorrectly labeled it a synthetic drug. Last year, lawmakers failed to ban it in Kentucky.
DeWine said his office is considering pushing for a ban in Ohio when the I-Team contacted him about the energy drinks.
"It causes us to take a look at this too," DeWine said.
The I-Team requested interviews with the manufacturers of those drinks, K-Chill and Vivozen. In an email, K-Chill declined the request, and Vivozen did not respond.
Beach wants more research into the risks of kratom before more states outlaw it. He said he doesn't believe kratom drinks could've triggered Zach Ziehm's need for a final hit of heroin.
"That's a situation he got himself back in because that's what addicts do," Beach said.
Ziehm's mother said she knows that part all too well. However, she can't ignore the risks that exist with kratom, or heroin, because she's not only Ziehm's mother, she's also a nurse.
She fought for Ziehm's life when he couldn't. Now, she must help his son, born just 10 months before Ziehm's overdose, remember his dad while she tries to make sense of his death.
"He was so excited about being a father. He was so proud of his sobriety," she said.