King: I Am Treating the Consequences — Merrimack Can Help Prevent Them

I recently treated a 19-year-old patient with intravenous fentanyl use disorder. While obtaining her detailed history, she told me her first exposure to an opioid-like substance was kratom—at just 14 years old. She bought it legally, marketed as a “natural” and safe supplement. She had no idea it acted like an opioid. She quickly developed tolerance, cravings, and dependence. Over time, she escalated to fentanyl just to avoid withdrawal.

To date, she has not been able to achieve sustained sobriety.

As a board-certified Family Nurse Practitioner and the Director of Nursing at an inpatient medical detox here in New Hampshire—and as a mother—I am witnessing firsthand a rapidly rising and deeply concerning trend in kratom use and dependence.

Previously, I would treat patients with kratom dependency and withdrawal intermittently. Today, in my small 24-bed facility, we treat one to two patients on any given day detoxing from kratom. The frequency and severity have changed rapidly.

For many readers, this may be the first time hearing about kratom. Derived from a tropical tree in Southeast Asia, earlier forms in the United States were raw leaf powders, often consumed as tea. Today, however, products on store shelves are frequently lab-modified and processed in ways that cause them to act on the brain’s opioid receptors. The FDA has repeatedly warned that kratom has opioid-like properties and carries serious risks, including addiction, abuse, and dependence.

Yet here in Merrimack, these products are sold openly in smoke shops and convenience stores with zero regulation—no age restrictions, no oversight, and no standards for safety or potency.

As a mom, this is what alarms me most: it is perfectly legal for my 9- and 11-year-old children to walk into a local store and purchase a substance that acts like an opioid.

We should all be concerned.

Kratom acts on the same receptors as opioids. At higher doses, it produces dependence and a withdrawal syndrome that includes anxiety, insomnia, gastrointestinal distress, and dangerous cardiovascular symptoms. In our facility, we now treat kratom withdrawal with the same medications we use for opioid and fentanyl use disorder, including buprenorphine and clonidine.

What is especially concerning is that we are now seeing patients experience prolonged withdrawal symptoms well beyond the point when kratom is detectable in their system—sometimes lasting for weeks or even months. These extended symptoms can include persistent anxiety, insomnia, mood instability, physical discomfort and visible tremors making recovery more difficult and increasing the risk of relapse.

The issue is not just the drug itself—it is the complete lack of regulation. Patients often cannot tell us what they are taking, how much they are taking, or what contaminants may be present. Potency varies widely. Some products are labeled “7-OH” or “enhanced,” and patients report these are significantly stronger and more addictive.

Kratom is widely marketed as “natural” and “safe.” Because of that, many people—especially young people—do not understand the risks.

I have seen how very dangerous that misunderstanding can be.

Last spring, I treated a patient who was readmitted with a known severe alcohol use disorder. His withdrawal did not follow the expected clinical course—he developed severe tremors and dangerous autonomic instability, requiring an extended inpatient stay. His toxicology screen later came back positive for kratom, which he had not previously disclosed- because he didn’t think it was a drug. Someone had suggested he try it as a “natural supplement” to reduce his alcohol intake.

He died last August.

In another case, I diagnosed a patient with arsenic toxicity. Her skin had developed a permanent metallic blue hue. The source was unregulated kratom. With no labeling requirements or quality control, consumers have no way of knowing what they are ingesting.

To date, she has not been able to achieve sustained recovery.

Merrimack does not need to wait for state or federal level action to protect its residents. We can—and should—act locally.

In 2019, Franklin, New Hampshire took decisive action by banning the sale and possession of kratom. They saw the warning signs early—that this is a problem, and that without intervention, it will only get worse.

And it is getting worse. Heartbreakingly worse.

Merrimack should act now—before we lose more of our neighbors, and more of our children, to addiction.

New Hampshire has begun to recognize this growing concern. Senate Bill 557 would prohibit synthetic and semi-synthetic kratom compounds, including the most prominent one, 7-hydroxymitragynine (commonly referred to as “7-OH”). This is an important step toward addressing the most dangerous and highly potent forms of kratom on the market. However, it does not go far enough.

All three of the patients I reference were not using 7-OH products. They were using mostly a powdered form kratom- readily available, unregulated, and marketed as safe. And yet, even these “standard” products led to severe addiction, medical complications, and, in one case, death.

I urge our town leaders and council to pass an ordinance banning the sale of kratom within Merrimack. We should take a stronger stance and remove these unregulated, potentially dangerous substances from our community altogether.

SB 557 is a start—and Merrimack can do better.

Additionally, I also urge parents to talk to their children. Do not assume they know the risks. Products marketed as “natural” or sold openly in stores can still be dangerous—and addictive. These conversations matter.

This is not a theoretical issue. It is already here. Let's protect our children before they become my patients.