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Ohio’s Kratom Emergency Rule: What Behavioral Health Operators Need to Know

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The Short Answer: What Ohio Did, When It Took Effect

On December 12, 2025, the Ohio Board of Pharmacy issued emergency rule OAC 4729:9-1-01.1, making it illegal to sell, possess, or distribute kratom-related derivatives in Ohio, with a narrow carveout for products composed solely of mitragynine (natural kratom leaf in its vegetative form). The rule targets synthesized and concentrated derivatives, most notably 7-hydroxymitragynine (7-OH).

The Board’s consumer and retailer notice confirms the emergency rule effective date of December 12, 2025, with the permanent rule effective May 19, 2026. The notice explicitly names the prohibited compounds: 7-hydroxymitragynine, mitragynine pseudoindoxyl, dihydro-7-hydroxymitragynine, and 7-acetoxymitragynine.

For Ohio treatment center operators, this is not a theoretical policy update. Patients presenting for admission may have been actively using 7-OH gummies, tablets, or vape liquids purchased at gas stations weeks before the ban dropped, often at retail prices of $15 to $40 per package. Intake teams, medical directors, and utilization management staff should treat 7-OH as an opioid on the assessment side and adjust ASAM Criteria 4th Edition level-of-care determinations accordingly.

Why DeWine and the Board of Pharmacy Moved (and Why RFK Jr. Is in the Story)

Governor Mike DeWine first asked the Ohio Board of Pharmacy to schedule kratom compounds in August 2025. He paused after a call with HHS Secretary Robert F. Kennedy Jr. On December 11, 2025, he renewed the request. The Board issued the emergency rule the next day.

DeWine drew the distinction that matters for operators. He separated immediate action on synthetic derivatives from the slower process for natural leaf. In his statement, DeWine said pursuing the regular rule process for a ban on natural kratom will allow for “hearings, testimony, and a deliberative process,” as reported by the Ohio Capital Journal. On January 6, 2026, per the Ohio State University Moritz College of Law Drug Enforcement and Policy Center tracker, the Board initiated rulemaking to place both natural and synthetic kratom under Schedule I in Ohio.

Two named regulators. One product category. A window of less than 30 days from executive request to permanent-rule initiation. That should tell operators something about surveyor focus for the next 12 months.

The Data Behind the Rule: Ohio Deaths, National Exposures, FDA Findings

Compliance leaders writing policy or briefing clinical leadership should commit these numbers to memory:

  • Ohio overdose deaths: Preliminary Ohio Department of Health data attributes kratom as a cause of death in more than 200 unintentional overdose deaths in Ohio between 2019 and 2024, per the Ohio Capital Journal.
  • National poison control exposures: Poison control centers logged 1,690 kratom exposure cases in the first seven months of 2025, per WFMJ reporting on the Board notice.
  • User base: The 2023 National Survey on Drug Use and Health estimates roughly 1.6 million annual kratom users in the United States.

This is not a niche exposure risk on any intake floor.

The pharmacology drives the regulatory urgency. FDA Commissioner Marty Makary, announcing the July 29, 2025 scheduling recommendation to the DEA, said: “7-OH binds to the mu receptor, which means scientifically, by definition, it is an opioid,” per Healio’s coverage. Makary added that these products are “sold in vape stores, smoke shops, convenience stores and gas stations,” per Medscape’s coverage. Medical directors and UM reviewers should quote that language directly in charting; it holds up in an appeal.

Five Concrete Changes for Ohio Treatment Center Operations

If you run a treatment center in Ohio, the ban changes intake, clinical, and compliance work in five concrete ways. Read this as a checklist, not a think piece.

  1. Intake screening. Intake staff should add 7-OH, mitragynine pseudoindoxyl, dihydro-7-hydroxymitragynine, and 7-acetoxymitragynine to substance-use history questions. Patients will not volunteer “kratom gummies” unless intake asks by product and brand.
  2. ASAM level-of-care determinations. Under the ASAM Criteria 4th Edition, a patient presenting with dependence on concentrated 7-OH looks pharmacologically like an opioid case, not a supplement discontinuation. Clinical leaders should assess withdrawal severity accordingly and place patients at the appropriate withdrawal-management level of care.
  3. Medical director protocols. Every medical director should have a written protocol for 7-OH withdrawal. There is no FDA-approved treatment for 7-OH use disorder, and Makary himself flagged that many clinicians would not know to ask about the substance.
  4. Contraband policy. As of December 12, 2025, kratom derivatives are illegal to possess in Ohio. Compliance officers should update EOC tour language, patient search protocols, and staff training, and treat this as a controlled-substance issue on the property.
  5. Payer readiness and documentation. UM reviewers will see a rise in 7-OH-related admissions and may not have a diagnosis code they like. Document opioid-receptor activity, cite the FDA’s July 2025 scheduling recommendation, and reference OAC 4729:9-1-01.1 in medical necessity notes. A single residential withdrawal management admission can run $800 to $1,500 per patient per day in billed charges; if the UM team cannot defend medical necessity because the substance is not on standard payer lists, the operator eats the denial.

Federal action is not standing still. Per the HHS release, FDA, DOJ, and the U.S. Marshals Service seized approximately $1 million worth of unlawful 7-OH dietary supplement and food products from three firms in Missouri in December 2025, and the FDA had already issued warning letters to seven companies marketing 7-OH products in July 2025.

What Happens Between Now and the Permanent Rule (and What Other States Should Watch)

Two tracks are running in parallel in Ohio. The Board of Pharmacy’s emergency rule expires June 10, 2026, and the permanent rule took effect May 19, 2026 per the Board’s own consumer and retailer notice. Separately, the Ohio General Assembly is working SB 299 and companion HB 587, which would regulate natural kratom and ban the synthetic version through statute rather than administrative rule.

Operators outside Ohio should watch this closely. On July 1, 2026, the DEA announced the start of the temporary scheduling process through a Notice of Intent for 7-OH above a proposed threshold, along with three synthetic derivatives (mitragynine pseudoindoxyl, MGM-15, and MGM-16). Florida already moved via an emergency rule from Attorney General James Uthmeier in August 2025, per the FDA statement. Multi-site operators in Florida, Tennessee, Texas, and Georgia should assume regulators there feel pressure to move next.

If you are running a multi-site behavioral health operation, put your compliance program on a 90-day cycle to track state-by-state kratom and 7-OH scheduling, and brief clinical leadership monthly. Operators who moved first on training, intake protocols, and documentation will not get caught flat-footed on a mock survey.

Frequently asked questions

When did Ohio’s kratom ban take effect, and how long does it last?

The Ohio Board of Pharmacy’s emergency rule (OAC 4729:9-1-01.1) took effect December 12, 2025 and runs 180 days, expiring June 10, 2026. The Board’s permanent rule took effect May 19, 2026, continuing the prohibition on kratom derivatives per the Board’s consumer and retailer notice. On January 6, 2026, the Board also initiated rulemaking to place both natural and synthetic kratom under Schedule I in Ohio.

Is all kratom illegal in Ohio, or just 7-OH and synthetic derivatives?

The rule prohibits kratom-related derivatives, including 7-hydroxymitragynine (7-OH), mitragynine pseudoindoxyl, dihydro-7-hydroxymitragynine, and 7-acetoxymitragynine. Products composed solely of mitragynine, including natural kratom leaf in its vegetative form, are the current exception. Governor DeWine has publicly said he still wants natural kratom addressed, but through the regular deliberative rulemaking process.

How should a behavioral health treatment center adjust intake and clinical protocols for 7-OH?

Treat 7-OH as an opioid on assessment. FDA Commissioner Marty Makary stated that 7-OH binds to the mu opioid receptor and, by definition, is an opioid. Intake staff should screen by product name (gummies, tablets, vapes, drink shots); medical directors should have a written withdrawal-management protocol; and utilization management documentation should reference the FDA’s July 29, 2025 scheduling recommendation and OAC 4729:9-1-01.1 to support medical necessity for the appropriate ASAM Criteria 4th Edition level of care.

Which other states have restricted kratom, and where is federal action headed?

Florida moved via an emergency rule from Attorney General James Uthmeier in August 2025 classifying concentrated 7-OH as a Schedule I controlled substance under state law. Federally, on July 29, 2025 the FDA recommended DEA schedule 7-OH under the Controlled Substances Act; on July 1, 2026 DEA issued a Notice of Intent to temporarily place 7-OH above a specified threshold, along with mitragynine pseudoindoxyl, MGM-15, and MGM-16, into Schedule I.

References

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