Kratom and products containing 7-hydroxymitragynine (7-OH) are popping up in smoke shops and gas stations, sold as safe options for pain relief, easing opioid withdrawal or boosting mood. But the U.S. Food and Drug Administration is urging caution — these products carry real risks of addiction and overdose.
“The biggest misconception is that ‘natural means safe,’” said John Downs, M.D., M.P.H., director of the Virginia Poison Center at VCU Health. “Kratom and 7-OH are not harmless herbal supplements — they act on the same receptors as opioids. People using these substances can have the same detrimental effects seen with opioids.”
What forms do these products take — and are they legal?
Kratom and 7-OH are sold as powders, candies, teas and energy shots. They are not banned or regulated at the federal level in the U.S., though some states have restricted them. In Virginia, for example, kratom cannot legally be sold to anyone under 21. Other states such as Alabama, Arkansas, Indiana, Rhode Island, Vermont, Wisconsin and Louisiana have moved to ban it altogether.
What is kratom and why do people use it?
Kratom comes from the leaves of the Mitragyna speciosa tree, native to parts of Southeast Asia. In low doses, people use it for energy, pain relief, anxiety, or to self-manage opioid withdrawal or opioid use disorder. In the U.S., it is legal but not FDA-approved for any medical purpose; other countries handle its legality and medical use differently.
How does kratom differ from 7-OH — and why does that matter?
“Kratom” generally refers to the herbal supplement, whose leaves contain mitragynine, a psychoactive compound that may ease pain and opioid-withdrawal symptoms. The leaves also contain trace amounts of 7-hydroxymitragynine (7-OH), a far more potent opioid-like chemical.
Products labeled “7-OH” are concentrated versions of that more powerful compound. Because 7-OH more closely mimics the effects of opioids such as heroin and morphine, the FDA has raised particular concern about overdose and dependence with these concentrated products.
What health risks should people know about?
Common side effects of kratom include nausea, confusion, agitation, shallow breathing and seizures. It can also cause severe sedation or coma — symptoms similar to an opioid overdose. With repeated or long-term use, people may develop dependence and experience withdrawal symptoms.
Is this part of the opioid epidemic’s “next wave”?
It’s unclear whether kratom products will mark a distinct new phase of the opioid epidemic. Kratom has been available in various forms for more than a decade, and the dangers remain. Clinicians are still learning how to treat toxicity and dependence from these products, and so far overdose numbers haven’t reached the scale seen with substances like fentanyl.
A notable change, however, is how openly these products are marketed and sold. Seeing them on shelves in vape shops and convenience stores, often without clear warnings, may make them easier for teens and young adults to obtain.
When should you seek medical help?
If someone who has used kratom or 7-OH shows confusion, extreme sleepiness, slowed breathing or seizures, call 911 immediately. Naloxone may reverse some of these opioid-like effects and should be used if available.
For questions about possible exposure or side effects, call the Virginia Poison Center at 1-800-222-1222. Nurses and doctors are available 24/7 to help.
What does recovery look like?
Recovery depends on the amount and duration of use. People who have used kratom or 7-OH for a long time may need treatments similar to those used for opioid use disorder.
How can people avoid these risky products?
Downs recommends avoiding items labeled “extra strength,” “extract,” “enhance,” “Ultra” or “7-OH.” “We don’t know enough about these products yet, but early reports indicate that these products are harmful,” he said. Be wary of bold claims on labels — promises of pain relief or big energy boosts are unlikely to indicate an FDA-approved, safe product. Also avoid mixing these substances with other drugs or alcohol, which can increase the risk of life-threatening breathing problems and sedation.
If you have concerns, contact the poison center.
Fast, free, expert help is available. Learn more about the Virginia Poison Center at VCU Health or call (800) 222-1222.
This article was adapted from an original report published on vcuhealth.org. All rights belong to the original publisher.