Kratom-7 OH: Kratom on Steroids

Alkaloid 7-hydroxymitragynine: What is it, and what are the risks?

Keypoint:

• Kratom is an herbal extract that comes from the leaves of a tree in Southeast Asia.

• Kratom-7 OH is a synthetic form of kratom that is highly potent.

• Kratom-7 OH has risks similar to opioids.

Kratom, a Southeast Asian tree in the coffee family, has become widely available in the United States in various forms for several years now. It is often sold at convenience stores, gas stations, and online. As an addiction psychiatrist, I saw use and abuse of kratom explode during the COVID-19 pandemic.

This herbal extract has been used medicinally for centuries in Thailand and other Asian countries. Its leaves have traditionally been chewed or smoked as a remedy for managing pain and fatigue. In the United States, manufacturers have sold it in pill or capsule form to treat mood, pain, and insomnia.

Kratom has a familiar story in the drug world: an exotic herbal with a long history in Eastern culture, once brought to the West, becomes highly touted for its medicinal benefits and as a cure-all for many ailments. As it became more available in the United States during COVID-19, evidence of its addictiveness grew.

Though kratom was promoted as a cure for pain, insomnia, anxiety, and depression, people began using it for opioid withdrawal as well. In low doses, it acts as a stimulant and in higher doses as an opioid. The extract of the plant can be turned into a liquid product, which is marketed as a treatment for muscle pain, cramps, and diarrhea. It is widely available in Florida, where I practice, and is found in local stores, gas stations, and strip mall smoke and vape shops. Many of the benefits don’t generally pan out. Additionally, there are serious side effects, including liver toxicity, seizures, and psychosis. It has a strong addictive potential. Detoxification from kratom looks like detox from opioids and can be very rough. Withdrawal symptoms include:

• Joint and bone pain

• Runny nose

• Diarrhea

• Mood swings

• Depression

• Anxiety

• Irritability

• Tremors

• Chills

• Sweating

• Pin-point pupils

• Gooseflesh

Kratom is not regulated under the Controlled Substances Act, and the Food and Drug Administration (FDA) has not approved kratom for any medical use. The U.S. Drug Enforcement Administration lists it as a Drug and Chemical of Concern. In 2023, the state of Florida banned kratom sales to individuals younger than 21, but legislation to ban sales altogether has not passed.

The risks and addictive potential make kratom a far more complicated and potentially dangerous product than its marketing would have you believe.

Synthetic Kratom

More recently, kratom-7 OH has surged through areas of Florida. It has been available in the form of eye-catching products like gummies, drinks, and powders, and, again, promoted as a safe “health” product that can benefit many ailments.

Kratom-7 OH is an alkaloid found in kratom leaves at low levels. Clever manufacturers have isolated kratom-7 OH from the leaves into a concentrate, making it a highly potent synthetic form of kratom. And very addictive.

Kratom-7 OH has been marketed as 7-hydroxymitragynine, 7-OH-mitragynine, 7-OHMG, 7-Hydroxy, 7-HMG or 7.

Legal Implications

Nationally, the FDA Commissioner, Dr. Marty Makary, took initial steps to place kratom-7 OH on the federal schedule of dangerous drugs in August of this year. The FDA has also labeled kratom-7 OH as an emerging opioid threat, given its action on the body’s opioid receptors, its potency, and its addictive potential. Following the FDA announcement in July 2025, Florida passed an emergency ban on sales of kratom-7 OH in August 2025.

New Research

Older and more recent animal studies have shown that there may be an overdose risk with kratom-7 OH, with respiratory depression shown to be three times greater than morphine. Kratom-7 OH potency in a recent study was 13 times that of morphine.

Many patients I see are seeking treatment for addiction to kratom-7 OH, with signs and symptoms of opioid withdrawal when they stop using it. They have struggled so badly with withdrawal that they have gravitated to other addictive and harder drugs as well to ameliorate their symptoms.

Cautionary Tales

During the thick of COVID-19, I treated a patient who was addicted to kratom. He was in his late 30s and until recently had been a healthy athlete.

He started taking kratom for mood and energy, and was initially happy that it helped him with his physical training. He became addicted and found it difficult to stop using. He had started to drink alcohol excessively to reduce the pain of kratom withdrawal. He fell into depression as well, but after entering treatment and completing detox, his mood improved. He is now doing well in recovery.

More recently, we treated a patient with kratom-7 OH addiction. In her 20s, she came in for detox, having been unable to stop using it, which resulted in her losing her job. Her detox symptoms were identical to what we see with opioid withdrawal, but as intense as what we see with fentanyl, a highly potent opioid. She had started using alcohol and cannabis heavily as well to reduce her symptoms. Instead of the benefits to her mood, she had developed depression. All of this came from some gummies she bought at a vape shop in the panhandle of Florida. Treatment was difficult and challenging. It certainly gave us insight into how dangerous some products marketed as health foods can be.

Note: This article originally appeared on Psychology Today.