7-OH: Kratom Risks, Addiction, and Treatment

Understanding 7-OH

What Is 7-OH?

According to the U.S. Food and Drug Administration (FDA), 7-OH, also known as 7-hydroxymitragynine, is a naturally occurring substance in the kratom plant, or Mitragyna speciosa.

7-OH is one of the many alkaloids found in the natural kratom leaf, accounting for less than 2% of the total content of kratom alkaloids. Despite its small percentage, 7-hydroxymitragynine is substantially more potent than the kratom plant’s primary alkaloid, mitragynine.

Where Does 7-OH Come From?

7-OH is derived from the kratom plant, or more specifically, from the kratom leaf that grows out of the plant.

The kratom plant is a tropical evergreen tree in the Rubiaceae family that only grows in the wetlands of Southeast Asia across several countries, including Malaysia, Myanmar, Thailand, Indonesia, Papua New Guinea, and Cambodia. Throughout Southeast Asia, the kratom plant has been used for centuries for recreational use and in traditional medicine for a wide variety of ailments.

Since 7-OH makes up 2% or less of the kratom alkaloids in natural kratom, the chemical compound is more often produced semisynthetically. As noted in Pharmaceutical Biology, semisynthetic production of 7-hydroxymitragynine occurs through the chemical oxidation of mitragynine, followed by bulk extraction of 7-OH products. 

How Is 7-OH Related to Kratom and Opioids?

7-OH is one of the psychoactive compounds of the kratom leaf with opioid-like properties.

7-hydroxymitragynine’s opioid-like properties can be seen in shared pharmacological characteristics with classical opioids like morphine and fentanyl. Not only does 7-OH bind to mu-opioid receptors in the brain, which is one of the three types of opioid receptors, but it can also produce similar effects to classical opioid use.

How 7-OH Affects the Body and Brain

What Are the Opioid-Like Effects of 7-OH?

By binding to the opioid receptors in the brain, 7-OH can produce opioid-like effects for pain relief, reduce opioid withdrawal symptoms, reduce other substance use symptoms, and improve mood.

In addition to pain relief, like classical opioids, 7-OH carries a high risk for dependence, opioid withdrawal symptoms, substance abuse, and side effects. 

Can 7-OH Cause Toxicity or Overdose?

Yes, 7-OH carries a high risk of toxicity, overdose, respiratory depression, and death. 

7-OH toxicity can lead to physical and mental health effects, such as:

• Seizures
• Nausea and vomiting
• Insomnia
• Withdrawal symptoms, including restlessness, body aches, fatigue, irritability, and cold sweats
• Anxiety, agitation, confusion, depression, and addiction

Those severe side effects and life-threatening health issues can come solely from 7-OH use, taking it in higher doses, or engaging in comorbid substance use with alcohol or sedatives. 

With naloxone, an overdose may be reversed, but repeated doses may be required. However, fatal overdose is still possible, as noted by the Federal Register, which through toxicology testing saw a significant increase of 7-hydroxymitragynine in fatal overdose cases between 2020 and 2025.

How Does 7-OH Interact With Opioid Receptors?

7-OH works by strongly binding to mu opioid receptors, while also functioning as a partial agonist with a milder effect compared to the full activation of a full agonist like traditional opioids. 

By binding to the mu opioid receptors and activating them, 7-OH can produce potent pain relief, along with typical opioid effects like sedation and euphoria.

The Risks of 7-OH in Supplements and Kratom Products

Are 7-OH Products Regulated by the FDA?

The FDA has taken steps to regulate 7-OH, including a 2025 recommendation for scheduling action to control certain 7-hydroxymitragynine under the Controlled Substances Act (CSA). 

Before the scheduling action recommendation, the FDA started issuing alerts about 7-OH in 2012. 

These early alerts over 7-OH products came due to a lack of regulation, as a variety of 7-OH products, often marketed as kratom products, started popping up in the mid-2000s. All 7-OH products were marketed for human consumption despite lacking FDA-approved medical use or any established safety measures for a dietary supplement or ingredient. 

In the years between the first FDA alert and the scheduling recommendation, numerous states have introduced their own regulations and restrictions on 7-OH and kratom products. Kratom is already illegal in several states, while other states, cities, and counties have strict restrictions on 7-OH use or kratom use.

What Are the Health Risks of Kratom and 7-OH Supplements?

Some of the side effects and other health risks that can arise from kratom and 7-OH supplements include:

• Physical dependence, addiction, comorbid substance use, and overdose
• Agitation, anxiety, depression, confusion, hallucinations, drowsiness, and insomnia 
• Gastrointestinal distress, nausea, vomiting, dizziness, and constipation
• Increased heart rate, irregular heartbeat, and high blood pressure
• Liver toxicity, seizures, respiratory depression, loss of consciousness, and death
• Withdrawal symptoms, including irritability, restlessness, fatigue, body aches, and cold sweats

Which Forms of 7-OH Products Are Most Common?

The most common forms of 7-OH products are sublingual and chewable tablets, capsules, gummies, other chewable candies, powder drink mixes, and liquid health shots.

Despite its high potency and opioid-like effects, 7-hydroxymitragynine can be easily found without a prescription from healthcare professionals. Medicinal kratom is illegal, making it impossible to obtain as an over-the-counter medication or dietary supplement, which means individuals also don’t have access to effective guidance on 7-OH use from a pharmacist.

Kratom products and 7-OH products are commonly found in gas stations, smoke shops, vape shops, convenience stores, and online retailers. 7-OH products come in unassuming yet often bright and colorful forms and packaging that can easily be mistaken for just another group of novelty treats or harmless supplements. 

Although kratom can’t be legally marketed in the U.S., adults, young people, and children can easily access 7-OH from the gas stations and convenience stores in their communities. Coupled with no supervision from pharmacists or other healthcare professionals, this creates a perfect storm for a public health crisis.

Addiction and Withdrawal Concerns

Can 7-OH Cause Opioid Addiction?

Yes, 7-OH can cause opioid addiction – while the kratom plant is not a traditional opioid, it works on the same opioid receptors in the brain as heroin and fentanyl.

7-OH, in particular, is derived from 7-hydroxymitragynine, a naturally occurring alkaloid found in the kratom leaf. However, 7-hydroxymitragynine potency is negligible since it can only be found in trace amounts. 

Semisynthetic 7-OH, which is the majority of 7-OH products, can be produced in higher concentrations. The higher concentration makes it a more potent opioid than in its natural form. 7-OH can be up to 10 times more potent than its parent alkaloid, mitragynine, putting it on par with traditional opioids regarding high potency and risk of dependence and addiction. 

A classic potent opioid like fentanyl is well known as being 50 to 100 times more potent than morphine. 7-OH is estimated to be around 13 times more potent than morphine and can be between 5 and 50 times more potent than kratom powder. 

With its analgesic effects, 7-OH carries a high potency that exceeds that of a potent opioid like morphine, which is known for its ability to provide acute or severe pain relief when other pain relief medicines are not effective or tolerable. This level of potency speaks to the significant risk 7-OH carries for physical dependence, addiction, relapse, and life-threatening health problems. 

You can develop a physical dependence on 7-OH after only a few uses. The risk for rapid onset of physical dependence is especially high for those taking high doses and/or for those engaging in frequent 7-OH use. When 7-OH binds to and activates your brain’s opioid receptors, you can get hooked on the pain relief and/or euphoric effects. 

You may want to use more 7-OH products because you enjoy the pleasure and relief it produces, or you’re trying to avoid physical and psychological distress. However, using more 7-OH to feel or suppress discomfort can lead to cravings that urge you to consume more. 

If you try to stop or cut back on your substance use, you may experience uncomfortable and distressing withdrawal symptoms, impeding your ability to cease kratom use, and creating a cycle of addiction.

What Are Common Withdrawal Symptoms From 7-OH?

Some of the common withdrawal symptoms for 7-OH include:

• Anxiety, panic, restlessness, agitation, depression, mood swings, and emotional instability
• Feeling achy, muscle pain and stiffness, and mild to severe body pain
• Fatigue, insomnia, and other sleep disturbances
• Nausea, vomiting, upset stomach, other digestive issues, and diarrhea
• Headache, sweating, chills, and temperature dysregulation
• Cravings, difficulty concentrating, jerky movements or tremors, watery eyes, and a runny nose

How Does 7-OH Compare to Prescription Opioids?

7-OH is similar or comparable to prescription opioids like morphine and oxycodone in potency, activation, effect, dependence patterns, and withdrawal symptoms.

While kratom alkaloids are generally less potent than prescription opioids, 7-hydroxymitragynine, especially in its concentrated form in 7-OH products, is quite potent. 

Both prescription opioid products and 7-OH work by binding to mu-opioid receptors in the brain to activate their effects. The effects of 7-OH and prescription opioid products are also comparable, as 7-OH shares many of the same opioid-like effects. 

Some of the opioid effects that 7-OH and prescription opioids share include:

• Analgesic effects: Pain relief
• Euphoria: Elevated mood, intense pleasure, or happiness
• Sedation: Calming effect or drowsiness, especially at higher doses or with other substances
• Side effects: Constipation, nausea, respiratory depression, tolerance, and dependence

In addition to similar effects and adverse side effects, prescription opioids and 7-OH share overlapping physical dependency patterns, including:

• Building tolerance from regular 7-OH and prescription opioid use
• Rapid onset of physical dependence that also produces withdrawal symptoms
• Intense cravings that reinforce substance use and abuse
• Trying to quit cold turkey is impaired by uncomfortable and severe opioid withdrawal

7-OH products and prescription opioids also share similar withdrawal symptoms like muscle pain, anxiety, depression, sweating, nausea, runny nose, watery eyes, and insomnia.

Public Health and Safety Considerations

Why Is 7-OH a Concern for Public Health?

7-OH presents a significant public health concern because it’s being sold around the U.S. despite being a highly potent opioid-like substance with no established medical use or FDA approval as a dietary supplement.

7-OH and kratom products marketing present a public health concern because, despite not having federal or state clearance, these products can be easily found in smoke shops, vape shops, gas stations, and online from vendors. 

Whether everyday people find them in a convenience store or online, 7-OH products are incorrectly marketed as supplements or as safe alternatives to traditional opioids. Colorful packaging, candy-like forms, and mislabeling 7-OH as kratom extracts or kratom products appeal to young people and mislead the public about the serious health risks associated with 7-hydroxymitragynine. 

7-OH also presents a public health concern due to regulatory oversight issues. The lack of strong and consistent regulations across federal and state levels for 7-OH and kratom products overall has contributed to inconsistent labeling and dosages, as well as an increased risk of contamination. 

Is 7-OH Considered a Controlled Substance?

Until 2025, 7-OH was not classified as a controlled substance under federal law, but is now being recommended by the FDA for classification as a controlled substance under the Controlled Substances Act (CSA).

Following the FDA scheduling recommendation, the Drug Enforcement Administration (DEA) has filed to temporarily place 7-OH and other kratom products in Schedule I of the CSA.

What Should Healthcare Providers Know About 7-OH?

Healthcare providers should be aware of 7-OH products, their high potency, opioid-like effects, high risk for dependence and addiction, and the serious health risks associated with them. 

With greater awareness, healthcare providers can help educate and advise their patients on the dangers of kratom products and how to avoid them. Providers can also work in collaboration with clinicians to reduce public health risk by educating the public on how to recognize kratom opioid addiction, overdose, and how to use naloxone to reverse an overdose.

Treatment and Support Options

Can 7-OH Addiction Be Treated?

Yes, since 7-OH works similarly to classical opioids, it can be effectively treated with the same behavioral health therapies and FDA-approved medications used for traditional opioid addiction.

Are There Medications to Manage 7-OH Withdrawal?

Yes, there are several medications, including FDA-approved medications for opioid withdrawal, that can be used to help manage 7-OH withdrawal symptoms.

The medications used to help manage withdrawal symptoms can range from supplements to opioid medications like:

• Vitamin B and vitamin C to replace fluids 
• Clonidine for physical symptoms like sweating, chills, insomnia, and anxiety
• Buprenorphine and methadone to alleviate withdrawal symptoms and reduce cravings

At Legacy Outdoor Adventures, our experienced medical staff and clinicians work in collaboration with you to ensure you feel secure and supported throughout treatment, whether during individual therapy or outdoor therapeutic activities. 

Through our tailored treatment planning, we ensure every client’s unique needs are met with ongoing medication monitoring, medication adjustments, support to smoothly transition pre-existing medication regimens into treatment, and the capacity to initiate new medication protocols when appropriate.

What Steps Should a Loved One Take If Someone Misuses 7-OH?

Start a conversation with empathy and concern, discuss your observations without judgment, let them share without interrupting, offer emotional and practical support, and encourage them to talk to a healthcare provider or addiction clinician.  

At Legacy Outdoor Adventures, our care team is driven by compassion and evidence-based, outcome-informed treatment to support our clients in achieving lasting change. Through nature, you can find a safe space with us to self-reflect, gain valuable tools and skills, unlock emotional healing, and be empowered in your personal growth journey.