Coroners from three southwest Ohio counties said Monday they are seeing a spike in suspected overdose deaths tied to kratom and related compounds, including concentrated products sold as supplements in gas stations and vape shops across the region.

Hamilton County Coroner Dr. Lakshmi Sammarco, Butler County Coroner Dr. Lisa Mannix and Warren County Coroner Dr. Russell Uptegrove held a joint press conference Nov. 9 to raise the alarm. Across the three counties, there have been 14 suspected overdoses involving kratom or kratom-related alkaloids in the past several months, the Cincinnati Enquirer reported.

Butler County has recorded two confirmed deaths and one suspected death tied to kratom or mitragynine, the primary active compound in the kratom plant, Mannix said, according to WLWT.

The warning comes as overdoses from other drugs are falling. Uptegrove said fentanyl and methamphetamine overdoses have declined, but kratom cases appear to be spiking. Hamilton County's overall overdose deaths dropped for four straight years through 2025, when 195 people died. That was the county's lowest total since at least 2014, the Enquirer reported.

Mannix described the shift at the press conference.

"What's surprising about it at this time is that our overall drug-related deaths due to fentanyl, other opioids or methamphetamine, cocaine, those numbers are down this year," Mannix said, according to Local 12. "And then all of a sudden we see this kind of spike of something that is not necessarily dealt on the street, but dealt right to your home, or that you pick it up at the gas station or the vape shop."

Sammarco said the only form of kratom legal in Ohio is the leaf or powder form. If a product is not in true powdered leaf form, she said, consumers should not trust the label because it may not be accurate.

The coroners said kratom itself is not new, but the way it is being marketed could explain the rise in suspected overdoses, WLWT reported.

The state had already flagged the problem. Gov. Mike DeWine and Attorney General Andy Wilson issued a public bulletin through the Ohio Narcotics Intelligence Center (ONIC) and Ohio Bureau of Criminal Investigation warning that some dietary supplements contain illegal substances, Spectrum News 1 reported Nov. 6. The main concern: products labeled as "cat's claw," a legal herbal supplement, that actually contain synthetic kratom.

At the scene of one fatal overdose, authorities found a package of "Happy Daze Botanical Mango" that claimed to contain 375 mg of cat's claw, according to the Dayton Daily News. A forensic analysis showed the package contained synthetic kratom.

Synthetic kratom compounds produce opioid-like effects, are highly addictive and can cause psychosis, seizures, hallucinations and death, according to the state bulletin. The Ohio Board of Pharmacy issued an emergency ruling in December 2025 classifying mitragynine-related compounds as Schedule I controlled substances, effectively banning most kratom products except raw, unprocessed leaf.

Residents who encounter a questionable product can call the ONIC tip line at 1-833-OHIO-NIC. Officials urged anyone who suspects an overdose to call 911 and administer naloxone if available. Ohio offers free naloxone through its Project DAWN program.