7-OH: What is it? Why do people use it? What medical approaches can help? 

Caleb Banta-Green, PhD, MPH, MSW; Mark Duncan, MD; Chris Buresh, MD, MPH; Maureen Oscadal, RN, MPH; Tom Hutch, MD; Mandy Sladky, MSN, RN

Key points

What is 7-OH? 

7-OH (7-hydroxymitragynine) is an opioid. It acts on the same receptors in the brain as morphine, oxycodone, and fentanyl. 

7-OH is a minor component of the kratom plant, but 7-OH products are synthetic, not natural. They are sold and used in a highly concentrated form. Many 7-OH products are more than 100 times more concentrated than the amounts present in kratom itself. 

Because kratom and 7-OH products are regulated as supplements, and not subject to the same quality control standards as regulated drugs, the contents and potency are unpredictable. Contents vary from product to product, are frequently mislabeled, and are often unknown, so people using them cannot be sure what or how much they are actually taking. 7-OH products have not been tested for safety and can lead to addiction and overdose.  

What is the legal status of 7-OH? 

On July 1, 2026, the United States Drug Enforcement Administration proposed to place 7-OH and other related synthetic compounds into Schedule I for two years, which could be extended up to one additional year while permanent scheduling is considered. This could occur as soon as August 5, 2026. The botanical product kratom would remain unscheduled, meaning its use would continue to be legal federally for all ages, though some municipalities have banned its sale.  

When a drug is banned, people who depend on it often switch to other, sometimes riskier, substances, raising the risk of overdose and other harms.  

Why do people use 7-OH? 

People use 7-OH and other kratom-related products for many reasons including pain, anxiety, sleep, and energy. Some people who are dependent on opioids use it as an opioid alternative. 

The limited research available on why people use the substance is mostly specific to kratom, not 7-OH. There are several reasons for this, including: 7-OH products are relatively new, they may be sold as kratom, labels are often inaccurate, and medical records and overdose records often do not distinguish between 7-OH and kratom.

7-OH acts on the same part of the brain as kratom’s main ingredient, just much more strongly so we can expect similar, and likely greater effects (and risks). 

People report both benefits and problems related to their 7-OH use. Some people report that 7-OH helps them function and others that it negatively impacts their ability to do the things they need and want to.  

People often need to increase their dose of 7-OH to keep getting the effects they want (this is called tolerance). People also report negative side effects when they suddenly stop using 7-OH; many of these effects are similar to stopping other opioids (this is called withdrawal). Some people also report that they quickly start spending much more money than they want to, and often more than they can afford, on 7-OH. 

Health care providers report success in working with people using 7-OH/kratom when they focus on patients’ motivations for use, addressing those concerns, while working to also address their substance use. 

Can people overdose on 7-OH? 

Yes. Because 7-OH acts like other opioids, it can cause heavy sedation and slow or stop breathing. The risk increases when 7-OH is combined with other sedating substances, like alcohol, benzodiazepines, and other opioids. Risk also increases with higher doses of 7-OH, and the amount of 7-OH in a product can often be more than what is on the label.  

Naloxone can help reverse the opioid effects during a 7-OH overdose.  

What to do: If someone can’t wake up or respond, or is breathing too slowly, call 911 and give naloxone and rescue breaths. Stay with the person until help arrives.  

Who uses 7-OH and how common is its use? 

We do not have good information about how commonly 7-OH is used and who is most likely to use it. Recent data on kratom/7-OH show that the substances are not frequently reported among those surveyed at syringe services programs in Washington State. They are also rarely involved in overdose deaths and when they are it is almost always in combination with other drugs. It is also worth noting that death records rarely distinguish kratom from 7-OH. 

What if I want to reduce or stop my 7-OH use? 

Talk to your health care provider. Share with them the reasons you are using 7-OH and what’s going well and what is not. They can recommend ways to improve your health such as counseling, physical therapy, or mental health medications.  

If your use of 7-OH feels out of control, you are having a hard time stopping, or your use is negatively impacting your life, you may have opioid use disorder. Opioid use disorder is treatable with medications, and many also benefit from counseling. 

You can also call the WA Recovery Helpline at 1-866-789-1511 to discuss care options. 

Resources 

Prescribers can call the University of Washington Psychiatry Consult Line for guidance on using medications for opioid use disorder with 7-OH and kratom. Tel: 1-877-927-7924

WA Poison Center | 1-800-222-1222
A team of pharmacists, nurses, and doctors is available 24/7/365 for poisonings, medication mistakes, overdoses, accidental ingestions, and toxic exposures — it’s free and confidential.

WA Recovery Help Line | 1-866-789-1511
The Recovery Help Line is a program for help seekers in Washington State. Reach out 24/7 to get connected with treatment resources and support.  

More information: Kratom & 7-OH: What do we know about use, safety, and overdose risk? From the University of Washington’s Addictions, Drug & Alcohol Institute