Kratom: What You Need to Know About the “Gas Station” Supplement that Can Be Addictive and Turn People Blue!

If you’ve never heard of kratom, you may be surprised to learn that it is a supplement increasingly being sold in gas stations, convenience stores, smoke shops, and online stores—often marketed as a “natural” supplement for energy, relaxation, pain, or mood.

But “natural” does not necessarily mean safe.

Kratom has opioid-like effects, can lead to tolerance, dependence, and withdrawal, and has been associated with serious complications including seizures, liver injury, respiratory depression, and substance use disorder. The FDA has repeatedly warned consumers about kratom and, more recently, about concentrated products containing 7-hydroxymitragynine (7-OH), a particularly potent kratom-derived opioid compound.

And there is now another reason dermatologists are paying attention: chronic kratom use has been associated with striking blue-gray skin discoloration.

What exactly is kratom?

Kratom (Mitragyna speciosa) is a plant native to Southeast Asia. Its leaves contain several biologically active compounds, most notably mitragynine and 7-hydroxymitragynine (7-OH). At lower doses, kratom may produce stimulant-like effects. At higher doses, it can produce opioid-like effects, including sedation and analgesia.

The problem is that products sold to consumers can vary considerably in strength and composition. In particular, concentrated 7-OH products have become increasingly available as tablets, gummies, drink mixes, shots, and other products. The FDA has described concentrated 7-OH products as potent opioid products and recommends that consumers avoid them. They are being sold in places such as gas stations and smoke shops, sometimes with colorful packaging that can make them look more like an ordinary supplement or energy product than an opioid-like drug.

Is kratom addictive?

It can be. Some people who regularly use kratom develop physical dependence and substance use disorder. Symptoms can include cravings, escalating use, tolerance, and withdrawal symptoms when the product is stopped. Reported withdrawal symptoms include restlessness, body aches, fatigue, irritability, sweating, and other flu-like symptoms.

This is one reason the idea that kratom is simply a harmless herbal supplement can be misleading.

The FDA currently states that there are no FDA-approved kratom products and continues to warn consumers about serious adverse effects associated with kratom use.

Why can kratom turn someone “blue”?

There are actually two different skin-related phenomena that are important to distinguish.

1. Blue lips can be a medical emergency

A published case report described a woman who consumed a large amount of kratom purchased from a local gas station. She subsequently developed altered mental status and blue lips associated with hypoxia. Her condition improved after treatment with naloxone.

In this situation, the blue color was not simply a cosmetic skin reaction. Blue lips or skin can indicate cyanosis—insufficient oxygen in the blood. If someone taking kratom becomes difficult to wake, confused, has slow or abnormal breathing, or develops blue lips or skin, this should be treated as a medical emergency.

2. Chronic use may cause blue-gray pigmentation

Dermatologists are also seeing a very different phenomenon: blue-gray or brown-gray skin pigmentation associated with chronic kratom use. Several recent case reports describe patients developing unusual pigmentation involving the face, neck, chest, arms, and hands. In some cases, the pigmentation was initially mistaken for melasma or another common pigmentary disorder. Skin biopsies demonstrated pigment within the dermis and findings consistent with drug-induced hyperpigmentation.

One 2026 case report described progressive blue-gray pigmentation that began on the nose and eventually involved the face, neck, chest, upper back, and arms. The patient had previously used kratom tea for approximately 18 months.

Importantly, this blue-gray pigmentation is different from cyanosis. It is a chronic pigmentary change rather than simply a sign that the body isn't getting enough oxygen.

What does kratom-related pigmentation look like?

The reported cases describe pigmentation that can appear:

• Blue-gray, brown-gray, or slate-colored

• On sun-exposed areas of the face

• On the neck, chest, and arms

• On the backs of the hands

• Sometimes in a distribution that resembles melasma or other pigmentary conditions

Because this is a relatively newly recognized adverse effect, the diagnosis can be challenging.

A dermatologist may need to consider medications, supplements, heavy-metal exposure, melasma, post-inflammatory hyperpigmentation, and other causes of acquired pigmentation.

A complete medication and supplement history is extremely important.

That means telling your dermatologist about products purchased at gas stations, smoke shops, supplement stores, or online—even if you don't consider them to be medications.

Kratom isn't just a skin problem

The skin findings are interesting, but they may be the least concerning aspect of kratom toxicity.

The FDA has identified potential risks including:

• Liver toxicity

• Seizures

• Respiratory depression

• Cardiovascular effects

• Addiction and physical dependence

• Withdrawal symptoms

• Gastrointestinal problems

• Severe toxicity and, in some circumstances, death

  
  

There are also concerns about contamination and variability in commercially available products.

And concentrated 7-OH products are an especially important emerging concern. The FDA has warned that these products are not FDA-approved and can contain potent opioid-like compounds at concentrations substantially greater than those naturally found in kratom leaf.

The bottom line

Kratom is a good example of why “herbal,” “natural,” and “sold over the counter” don't necessarily mean safe. If you or someone you know regularly uses kratom—particularly pills, extracts, shots, or products labeled 7-OH, 7-hydroxymitragynine, or enhanced kratom—it's worth discussing that use honestly with a physician.

And if you develop new, unexplained blue-gray pigmentation, don't assume it is simply melasma or sun damage. Your dermatologist should know about all medications, supplements, and recreational products you are taking.

Most importantly, blue lips or blue skin accompanied by sleepiness, confusion, or difficulty breathing is not a cosmetic issue—it may represent a dangerous lack of oxygen and requires immediate medical attention.

At our dermatology practice, we routinely evaluate unexplained changes in skin pigmentation and can help determine whether a medication, supplement, or other exposure may be contributing to the problem.