Kratom Addiction

Understanding Kratom Use

If kratom has become part of managing pain, getting through the day, or avoiding withdrawal, changing it can feel complicated. Start with the product you use and what happens between doses. Leaf powder, extracts, and concentrated 7-OH can involve very different concerns.^[1][2][6]

Kratom refers to psychoactive products made from the leaves of Mitragyna speciosa, a Southeast Asian tree. People use it for pain, energy, mood symptoms, or opioid withdrawal. The formulation, concentration, and pattern of use matter when assessing its effects and risks.^[1][2]

When Does Kratom Use Require Emergency Help?

Call 911 if someone cannot be awakened, has slow or stopped breathing, makes choking or gurgling sounds while unresponsive, or has discolored lips or nails. Do not wait to identify the product. If an opioid overdose is possible, give naloxone if available, place the person on their side, and stay until help arrives.^[7]

How Do Kratom Leaf, Extracts, and 7-OH Differ?

“Kratom” does not describe one standardized product. It may mean chewed leaves, brewed tea, dried leaf powder, capsules, tablets, gummies, liquid extract shots, or products enhanced with specific alkaloids. These products can differ in chemical content, concentration, serving size, contaminants, and labeling accuracy.^[2][9]

That variability matters because research on one formulation cannot automatically be applied to another. Traditional tea, dried leaf powder, extract shots, and concentrated 7-hydroxymitragynine tablets can involve different exposures.

Kratom Leaf, Powder, and Tea

Natural leaf products use whole or ground kratom leaves. In traditional Southeast Asian settings, fresh leaves may be chewed or brewed into tea for fatigue, pain, or diarrhea. Dried kratom leaf powder is more common in Western countries, and US products also include capsules.^[10][2]

Kratom leaf contains more than 50 alkaloids, meaning naturally occurring plant chemicals that can affect the body. Mitragynine is the most abundant and is responsible for many effects. The body can also convert some mitragynine into 7-hydroxymitragynine, often shortened to 7-OH.^[3][1]

Even “natural leaf” is not chemically uniform. Plant diversity, processing, preparation, and serving size may change exposure. A tea is technically a water extraction, but it generally differs from products marketed as concentrated extracts.^[5]

Concentrated Kratom Extracts

An extract concentrates some of the plant’s chemicals. Kratom is sold as powders, capsules, tablets, gummies, energy drinks, and extract shots; only some of these are concentrated extracts.^[2][5]

Extract discussions describe mixtures of plant chemicals, sometimes labeled “full-spectrum” or “broad-spectrum,” as well as isolated-mitragynine products that separate out that alkaloid. Check the ingredients and concentration rather than relying on those labels.^[5]

The word “extract” does not reveal what is actually concentrated. In a study of Reddit posts from 2020 through 2022, researchers usually could not determine the type, concentration, or serving size of extracts being discussed. Extract use was associated with posts describing dependence, perceived addiction, and difficulty quitting, but the study could not establish that extracts caused those experiences.^[5]

That analysis reported an absence of human laboratory studies of concentrated kratom extracts. Therefore, findings from controlled dried-leaf studies cannot be used to calculate a comparable or safe extract amount.^[5]

Concentrated or Enhanced 7-OH Products

7-hydroxymitragynine is a kratom-related alkaloid with strong activity at the mu-opioid receptor, a cell target involved in opioid effects. FDA states that 7-OH makes up less than 2% of the total alkaloid content of natural kratom leaves but has substantially greater mu-opioid receptor potency than mitragynine.^[1]

Products containing concentrated, enhanced, isolated, or partly synthetic 7-OH are not equivalent to natural leaf. Marketplace reviews have described products with compositions that differ markedly from native leaf, including some marketed under the broader “kratom” name. This labeling may lead people to assume that concentrated 7-OH has the same history and risk profile as tea or leaf powder.^[2]

Human evidence specifically evaluating concentrated 7-OH remains limited. Animal studies show opioid-like tolerance and physical dependence after repeated 7-OH exposure, but animal findings cannot determine a safe human amount or predict exactly how people will respond.^[2]

A published case described severe escalating use and opioid-like withdrawal in one man who used concentrated 7-OH tablets. That case demonstrates what can happen, not how often it happens or what every user will experience.^[2]

Can Kratom Cause Dependence or Addiction?

Using kratom, being physically dependent on it, experiencing withdrawal, and having a diagnosable substance use disorder are related but different. Keeping these distinctions clear reduces stigma and helps match care to the actual problem.

Kratom Use Without a Diagnosis

Ordinary use means that a person has consumed a product. It is different from physical dependence or a use disorder.

Frequency still matters for risk assessment. A person who tried leaf tea once presents a different clinical question from someone taking an extract repeatedly to prevent withdrawal.

Kratom Tolerance

Tolerance means needing more of a substance to produce a similar effect or noticing less effect from the same amount. It can develop with psychoactive substances and some appropriately used prescription medicines. Tolerance is one possible sign of physical adaptation, not proof by itself that a person has lost control.^[6]

Physical Dependence on Kratom

Physical dependence means the body has adapted to repeated exposure. It is usually recognized through tolerance, withdrawal after reducing or stopping, or continued use to avoid withdrawal.^[6]

Physical dependence is not identical to addiction. Someone may experience withdrawal without major disruption in responsibilities or relationships. Conversely, a person can have a substance use disorder even if withdrawal is not the central problem.^[5]

Kratom Withdrawal Symptoms

Withdrawal is a group of symptoms that appears after a physically dependent person stops, reduces, or changes a substance. A period without kratom or a sudden reduction is relevant specifically to someone whose body has become dependent, not merely anyone with recent kratom exposure.

Reported kratom withdrawal includes sleep difficulty, flu-like discomfort, anxiety, restlessness, and other opioid-like symptoms. A concentrated 7-OH case included anxiety, insomnia, runny nose, abdominal pain, restlessness, sweating, and chills.^[5][2]

Studies in traditional Southeast Asian users often described withdrawal as mild and associated with higher amounts or more frequent use, and many participants reported managing symptoms themselves. These findings may not apply to concentrated extracts or 7-OH products in the United States.^[4]

One study observed no withdrawal during a 20-hour monitoring period. A brief observation with no symptoms does not establish that withdrawal cannot occur later or after different patterns of use.^[4]

Signs of Kratom Use Disorder

A substance use disorder is a clinical pattern in which substance use leads to impaired control, distress, risky use, or harmful consequences. Because kratom does not have its own named class in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition or DSM-5, clinicians may diagnose it under the category for another or unspecified substance and identify kratom specifically.^[5]

Possible features include using more or longer than intended, craving, unsuccessful efforts to cut down, continuing despite physical or personal harm, and interference with activities or obligations. Tolerance and withdrawal may contribute to diagnosis but are neither required nor always sufficient.^[1][5]

This distinction is important because some kratom studies counted many daily users as meeting criteria mainly through tolerance, withdrawal, craving, and using more than intended. Functional or social disruption was much less commonly reported in some samples.^[6]

A 2024 study followed 357 U.S. adults who used kratom at least three days a week for at least four weeks. Of these participants, 238 (66.7%) met the researchers’ symptom-count criteria for kratom use disorder.^[11] This convenience sample cannot estimate the prevalence among all U.S. kratom users.^[11]

The authors also concluded that most participants described use that appeared nonproblematic. When use did become problematic, avoiding withdrawal was usually a key immediate reason for using. Common symptoms centered on tolerance, withdrawal, craving, and using more than intended; reported social impairment or hazardous use was uncommon.^[11]

Assessment is appropriate when use is escalating, withdrawal drives repeated use, attempts to change have not worked, health or mood is worsening, or use is interfering with life. These signs justify a professional conversation; they are not a self-diagnosis checklist.

What Happens When Kratom Use Changes or Stops?

A person without physical dependence may experience no withdrawal after stopping. Someone using daily, using multiple times a day, taking extracts, or using concentrated 7-OH may have a different experience, particularly if they already use kratom to prevent discomfort.^[5]

Withdrawal severity cannot be predicted from a product name alone. The actual alkaloid content may be unknown, and co-occurring opioid, alcohol, stimulant, sedative, pain, sleep, or mental health problems may affect what happens next.

If a person has withdrawal between uses, has previously had a difficult stop, or uses concentrated products frequently, it is reasonable to seek medical assessment before making a major change. Discuss any opioid use disorder, serious medical illness, severe depression, or use of multiple substances as part of that assessment.^[6][5]

Products differ in concentration, so grams, capsules, or package “servings” alone are not a reliable basis for a taper schedule. Treatment decisions should consider the person’s symptoms, product, other substances, health conditions, and goals.^[6][5]

Treatment for Kratom-Related Problems

FDA has not approved kratom or its known alkaloids to treat any medical condition. Published treatment evidence for kratom-related problems consists largely of case reports and small case series rather than controlled trials.^[1][6]

Treatment can still be useful. The appropriate approach depends on whether the main issue is poisoning, physical dependence, an isolated kratom use disorder, an underlying opioid use disorder, chronic pain, mental health symptoms, or a combination.

What Happens During a Kratom Assessment?

A useful assessment identifies the exact product and asks about leaf, extract, or concentrated 7-OH; frequency and duration; withdrawal between uses; unsuccessful efforts to change; other substances; medications; pain; sleep; mood; and effects on daily life.

A clinician should assess kratom addiction using established substance use disorder criteria systematically rather than assuming that any daily use is addiction. Researchers reviewing kratom diagnosis recommend documenting individual criteria and distinguishing physical dependence from broader impairment.^[6]

Medical Care for Kratom Withdrawal

Care depends on the withdrawal symptoms, the product, and whether opioid use disorder is also present. Clinicians have used buprenorphine in published kratom cases. However, controlled studies have not established its safety and effectiveness for an isolated kratom use disorder. Discuss that distinction when considering medication.^[6]

Care When Opioid Use Disorder Is Also Present

The situation is different when a person has an underlying opioid use disorder in addition to kratom use. Treatment should address the opioid use disorder directly rather than focusing only on kratom withdrawal.

A clinical review recommends medication for opioid use disorder rather than relying on behavioral therapy alone for people with both conditions, because untreated opioid use disorder carries substantial relapse risk. Behavioral care may be added when the person wants it.^[6]

One published case reported improvement after buprenorphine-naloxone treatment in a man with opioid use disorder, kratom dependence, chronic pain, anxiety, and depression. This supports clinical consideration, not a guarantee of the same outcome for another person.^[12]

Behavioral Support and Ongoing Recovery

In general substance-use care, cognitive behavioral therapy helps people recognize triggers and practice coping skills. The kratom clinical review discusses counseling as a possible part of care, but direct evidence for isolated kratom use disorder is sparse. Agree on what counseling would address, such as cravings, stress, or another condition.^[13][6]

A first goal can be arranging an assessment, identifying the product, discussing other sedating substances, or explaining what made a previous change difficult. You can ask for help before deciding on a long-term goal.

Why Do People Use Kratom?

People commonly report using kratom for pain relief, energy, relaxation, stress, fatigue, mental health symptoms, or problems related to alcohol or opioids. These reasons help identify what care a person may need, but they do not prove that kratom effectively treats the underlying condition.^[5][2]

For national context, the 2022 NSDUH estimated that 1.9 million U.S. people age 12 or older, or 0.7%, had used kratom in the past year.^[20] This is a dated estimate of use, not a count of people with kratom use disorder.^[20]

Kratom Use for Pain

Some people describe pain relief from kratom. A systematic review (a study that collects and evaluates multiple studies using a planned method) found two interventional human studies reporting reduced pain sensitivity. In interventional studies, researchers test an exposure or treatment in people rather than only observing existing use.^[4]

Reduced sensitivity during a laboratory pain test, however, is not the same as demonstrating lasting improvement in chronic pain, physical function, sleep, or quality of life.^[4]

The studies reviewed before 2021 were small and largely involved chronic male users in Southeast Asia. Results may differ for other people and products.^[4]

Kratom Use for Energy and Fatigue

People commonly describe stimulatory effects, including increased energy or productivity. Kratom can also produce sedating or opioid-like effects, with the pattern influenced by the product, alkaloid exposure, and conditions of use.^[14]

Participants’ reports describe how they felt after use, not a tested treatment for persistent fatigue.^[5][1]

Kratom Use for Anxiety, Depression, and Stress

Some consumers report using kratom for anxiety, depression, relaxation, or stress. Available surveys and social-media studies describe perceived benefit for some people and worsening or life disruption for others. They cannot determine whether kratom caused improvement or deterioration.^[5]

Kratom Use for Opioid Withdrawal

People may use kratom to reduce opioid use or manage opioid withdrawal. Some observational reports describe perceived benefit, and a systematic review called the evidence preliminary. Important portions of the supporting evidence came from self-report or animal research rather than large controlled human treatment trials.^[4]

Kratom is not an FDA-approved treatment for opioid withdrawal or opioid use disorder. Substituting it for opioids can also result in continued physical dependence or a new pattern of problematic use.^[1][6]

People using kratom to avoid opioid withdrawal should be assessed for opioid use disorder rather than expected to manage alone. Established medications for opioid use disorder have a different evidence base from kratom, particularly for reducing relapse risk.^[6]

Kratom Effects and Short-Term Safety

Kratom can produce stimulant-like, pain-relieving, sedating, or opioid-like effects. A person’s experience may depend on formulation, alkaloid concentration, amount, frequency, health conditions, metabolism, and other substances used at the same time.^[14]

FDA identifies possible opioid-related effects including sedation, nausea, vomiting, constipation, physical dependence, withdrawal, and respiratory depression. Respiratory depression means breathing becomes too slow or shallow to supply the body adequately with oxygen.^[1]

The absence of severe symptoms during previous use does not guarantee that a new product or combination will act the same way. Product inconsistency and uncertain alkaloid content are recurring problems in consumer reports and case analyses.^[5][9]

How the Body Processes Kratom

A 2024 study measured kratom alkaloids in healthy adults after single doses and 15 daily doses of characterized leaf powder. With repeated exposure, blood concentrations reached steady levels in about seven to nine days. That finding concerns how the body processes and clears kratom. This describes drug clearance, not how much a person should take.^[3]

The study examined absorption and clearance, rather than treatment success. Its carefully measured leaf powder and selected healthy participants differ from unknown extracts, concentrated 7-OH products, and people with significant health problems.^[3]

What Poisoning Can Look Like

Kratom poisoning can combine sedation or unconsciousness with seizures, blood-pressure changes, and a fast or slow heart rate. In a Czech series of ten poisonings, nine people had altered consciousness. Naloxone helped two of the three people who received it. A response cannot be assumed, and emergency care remains necessary.^[8]

A precise lethal amount or blood concentration is unknown. Fatal reports often involve other substances and incomplete product or medical information. That uncertainty does not show that kratom alone cannot be fatal.^[9]

Interactions and Polysubstance Use

Polysubstance use means taking more than one psychoactive substance within the same period. Published case reports frequently involve kratom with other drugs, making it difficult to identify each substance’s contribution. The case-report review nevertheless concluded that coadministration may increase the risk of serious outcomes compared with kratom alone.^[9]

Particular concern is reasonable when kratom or concentrated 7-OH is combined with opioids, alcohol, benzodiazepines, sleep medicines, or other sedating substances because their effects may overlap. Evidence is not sufficient to calculate a safe combination or interaction threshold.^[14][9]

Mitragynine is processed partly through cytochrome P450 enzymes, a family of liver and intestinal enzymes that also processes many medications. Laboratory findings support the possibility of medication interactions, but clinical research has not mapped every meaningful combination.^[3][14]

A manageable precaution is to tell a clinician or pharmacist the exact product being used, including leaf, extract, or 7-OH, before starting or changing prescription medicines. If available, bring the package or a photograph of its label.

Contamination and Mislabeling

Some harms may arise from contaminants rather than the expected kratom alkaloids. A case-report review cited an elemental analysis that raised concern about exposure to lead, nickel, and arsenic exceeding regulatory limits at kratom amounts of 25 grams or more a day.^[9]

The finding concerns the tested products. A familiar brand name or “natural” label cannot substitute for reliable manufacturing and independent testing.

Mislabeling is especially consequential when concentrated 7-OH is sold as ordinary kratom. A person may use expectations developed from leaf powder or tea even though the product has a markedly different chemical profile.^[2]

Longer-Term Physical and Mental Health Findings

Longer-term evidence is much less certain than many product claims suggest. The available literature raises concerns about dependence, withdrawal, liver injury, seizures, learning, cholesterol, and mental health, but the strength and applicability of evidence differ by outcome.^[4][1]

Kratom Dependence and Daily Function

Daily or frequent use is associated with tolerance and withdrawal in observational research. Observational research also links severe dependence with poorer physical well-being, without separating kratom’s effects from other influences.^[4]

Liver, Neurologic, and Metabolic Concerns

FDA warns about liver toxicity and seizures associated with kratom.^[1] An evaluation of acute case reports documented seizures among reasons surviving patients sought care. Such reports cannot reliably show how often seizures occur among kratom users or determine causation in every report.^[9]

Observational studies in chronic Southeast Asian users reported associations involving learning impairment and higher cholesterol. The cross-sectional designs cannot determine whether kratom caused these findings, and the results may not apply to different products or populations.^[4]

Product contamination can also contribute to longer-term risk. Repeated heavy-metal exposure is a separate issue from mitragynine’s direct effects and may vary by manufacturer or batch.^[9]

Kratom and Mental Health

People report using kratom for anxiety, depression, and stress, yet mental health problems also appear in adverse-event reports and dependence cases. These observations may reflect kratom effects, withdrawal, the underlying condition, other substances, or several factors together.^[9][12]

Sleep disturbance, anxiety, restlessness, and flu-like discomfort have been reported during withdrawal.^[5][2] When mental health symptoms continue, become severe, or impair safety and daily function, ask for assessment of both substance-related and independent mental health concerns rather than assuming one explanation.

Practical Choices for People Who Use Kratom

FDA advises against using kratom for medical treatment, and no use pattern has been established as risk-free. People who are not ready or able to stop can still take steps that reduce uncertainty and make future care easier.^[1]

Risk-reduction steps are not a guarantee of safety or an endorsement of use.

They include:

• Identify whether the product is leaf, ordinary extract, or concentrated or enhanced 7-OH.
• Do not assume a product called “kratom” has a natural-leaf chemical profile.^[2]
• Avoid combining it with opioids, alcohol, benzodiazepines, sleep medicines, or other sedating substances because serious case reports often involve multiple substances.^[9]
• Tell a clinician or pharmacist about kratom when reviewing medicines because clinically important interactions remain incompletely studied.^[14]
• Keep the original packaging or a photograph of the label in case medical care is needed.
• Notice whether use is becoming more frequent, amounts are rising, or doses are being taken mainly to avoid withdrawal.
• Seek assessment rather than attempting an improvised change when concentrated 7-OH, opioid use disorder, severe withdrawal, or major medical or psychiatric illness is involved.^[6][2]

Someone using kratom for pain deserves a pain assessment even if stopping is not the immediate goal. Someone using it for anxiety, depression, fatigue, sleep, or opioid withdrawal similarly deserves care for that underlying concern rather than being told only to discontinue the product.

How Can Families Support Someone Using Kratom?

Instead of arguing over whether kratom is “natural” or “an opioid,” ask what product is being used, what it helps with, what has changed, and whether withdrawal occurs between uses.

For assessment, focus on observable concerns, such as escalating extract use, missed responsibilities, seizures, loss of consciousness, worsening mood, mixing with alcohol or sedatives, or repeated unsuccessful attempts to cut down. Describe those concerns without labels such as “addict.”^[9][6][5]

If physical dependence may be present, avoid assuming that abrupt stopping is simple. Encourage an assessment that considers withdrawal, pain, mental health, and other substance use together.

Families can also learn overdose signs, keep naloxone available when opioid exposure is possible, and call 911 for unresponsiveness or abnormal breathing. Naloxone can be carried and administered by bystanders and is available over the counter in all 50 states.^[7] Seizures are also among the serious adverse events reported with kratom.^[1]

Support does not require taking full responsibility for another adult’s recovery. Family members may set boundaries, seek their own counseling or support, and offer specific help such as making a call, providing transportation when possible, or writing down product information for an appointment.

Is Kratom Legal in the United States?

The US regulatory picture has two separate parts: federal controlled-substance scheduling and Food and Drug Administration rules for marketing drugs, supplements, and foods. A product can be unscheduled under the Controlled Substances Act while still being unlawfully marketed under food or drug law.

FDA Rules for Kratom Leaf Products

FDA’s kratom guidance states that kratom is not lawfully marketed in the United States as a drug product, dietary supplement, or food additive in conventional food. FDA considers kratom-containing supplements “adulterated,” meaning they fail applicable legal safety requirements because there is inadequate information to reasonably assure that the ingredient does not present a significant or unreasonable risk of illness or injury.^[1]

FDA also classifies kratom added to conventional food as an “unsafe food additive,” meaning it cannot lawfully be added to those foods. These are legal determinations governing product marketing, not federal controlled-substance possession rules. “Adulterated” in this context does not necessarily mean that a particular product has been found to contain a contaminant.^[1]

These statements do not mean that every possession of leaf kratom violates federal controlled-substance law. They concern how products are marketed and sold under laws administered by FDA.

No prescription or over-the-counter drug containing kratom or its known alkaloids is legally on the US market. FDA has not approved kratom to treat pain, opioid withdrawal, opioid use disorder, anxiety, depression, or another condition.^[1]

FDA also warns consumers about liver toxicity, seizures, substance use disorder, and reported deaths, while acknowledging that kratom’s contribution to many deaths involving other drugs is unclear.^[1]

Concentrated 7-OH Products

FDA distinguishes concentrated 7-OH products from the small amount naturally present in leaf and identifies 7-OH as having substantially greater mu-opioid receptor potency than mitragynine.^[1]

A warning letter, product seizure, or proposal is not the same as FDA approval or federal controlled-substance scheduling. FDA states that no drug containing kratom or its known alkaloids is legally on the US market and that kratom cannot lawfully be marketed as a dietary supplement.^[1]

Federal Actions in 2026

The 2026 federal actions distinguish ordinary leaf from concentrated 7-OH and certain related substances. The Drug Enforcement Administration (DEA) proposed a specified 7-OH threshold rather than a blanket action against all kratom leaf. Schedule I is a federal controlled-substance category. The proposed threshold and the separate order for three related substances should not be treated as the same action.^[15][16]

The following federal records, checked September 25, 2026, describe different actions affecting kratom-related products:

• July 6: proposed 7-OH action. DEA published a notice of intent to temporarily place 7-OH above a specified threshold in Schedule I. The notice says the scheduling order will impose controls when issued; the notice itself is not that effective order.^[15]
• August 26: more time for comments on the threshold. The Department of Health and Human Services (HHS) extended comments on the proposed 7-OH threshold through September 10, 2026. This is a request for information about the threshold, not a permanent scheduling decision or a general assessment of kratom’s safety.^[17]
• August 26: an effective order for three related substances. DEA temporarily placed mitragynine pseudoindoxyl, MGM-15, and MGM-16 in Schedule I, effective August 26, 2026, until August 26, 2028. These are three named substances related to 7-OH; this order should not be described as the final order for 7-OH itself or a blanket ban on kratom leaf.^[16]

The distinction matters: a proposed rule, a comment period, and an effective scheduling order have different legal consequences. ^{[15][17][16][1]}

Because state rules can differ and change, FDA directs readers to state health or law-enforcement agencies for applicable state law. Do not rely on retail availability to determine your state’s law.^[1]

Where Can You Find Help for Kratom Use?

If you are learning about kratom and have not started using it, distinguish natural leaf from extracts and concentrated 7-OH before evaluating any claim.

If you use kratom without current problems, identify the formulation, avoid mixing it with other substances, and include it when discussing medicines or health symptoms with a clinician. Watch for rising use, tolerance, withdrawal, or changes in mood and function.

If you want to reduce or stop, write down the product type, frequency, duration, reasons for use, withdrawal experiences, other substances, and medications. Bring that information to a primary care, addiction, pain, or mental health clinician to discuss treatment options. You do not need to diagnose yourself before asking for help.

If you use kratom to manage opioid withdrawal or replace opioids, request an assessment for opioid use disorder and discuss established treatment options. Kratom is not an FDA-approved substitute for medication treatment.^[1][6]

If concentrated 7-OH or extracts have escalated, withdrawal is driving repeated use, or previous attempts to stop have been difficult, seek professional support before another major change. Bring the packaging or a photograph and explain what happens when a dose is delayed.^[6][5][2]

If severe depression, anxiety, chronic pain, fatigue, or sleep problems are involved, ask for those concerns to be assessed alongside substance use. They are relevant to the conversation because people report using kratom for pain, mental health symptoms, fatigue or energy, and opioid withdrawal, and withdrawal can include sleep difficulty.^[1][5]

For US treatment referrals, the Substance Abuse and Mental Health Services Administration National Helpline is free, confidential, and available in English and Spanish 24 hours a day at 1-800-662-HELP (4357). It provides referrals rather than counseling. People can also text their ZIP code to 435748 for the English-language HELP4U referral service; message and data rates may apply.^[18]

For unresponsiveness or slow, shallow, difficult, or stopped breathing, call 911, give naloxone if available, place the person on their side, and stay until help arrives.^[7]

If you have thoughts of suicide or urges to hurt yourself, call or text 988 or chat at 988lifeline.org in the United States. Call 911 for a life-threatening situation.^[19]