The New Opioid: Introducing Kratom-Based 7-OH

Kratom is the name given to the leaves of a tropical evergreen tree that grows plentifully in Southeast Asia. For eons now, the peoples of Southeast Asia have been chewing, smoking, and drinking kratom leaves medicinally, recreationally, and spiritually.

Contained within the kratom leaves are over 50 alkaloids.

Alkaloids are naturally occurring and powerful compounds (particularly common in flowering plants) which have physiological effects on the human body.

One of the 50 alkaloids in the kratom leaf is a compound called 7-Hydroxymitragynine (7-OH-MIT, often simply referred to as 7-OH.) Though not a traditional opiate like heroine, morphine, or codeine, 7-OH binds to the same opioid receptors in the human brain and is considered a partial opioid agonist. “Depending on the source and form, 7-OH can be anywhere from 13 to 46 times more potent than morphine.”

When taken in naturally low dosages, 7-OH acts as a stimulant. In naturally occurring kratom leaves, 7-0H is only present in trace amounts, and the risks of consumption are lower, though not nothing. Addiction is still possible with heavy consumption. This is because when Mitragynine (the main active plant compound and alkaloid found in kratom) is metabolized in the liver, the body converts some of it into additional 7-Hydroxymitragynine.

Then in 1994, chemists extracted 7-OH from the kratom leaf (only 2% of its natural composition) and supercharged it into the opioid-like “drug of concern” that is now being sold for cheap off the shelf at your local convenience store. And when taken in unnaturally high dosages, concentrated 7-OH acts like an opiate with subsequent sedation.

Once obscure and not readily available in North America, kratom and 7-OH products have been rising in popularity since the mid-2000’s as recreational and self-administered medicinal substances used by millions of people across the United States.

Often used to treat pain and anxiety, some users are super fans and super lobbyists, proclaiming kratom products a life-changing and life-saving natural herb. Some former users and parents say that it has destroyed their lives and the lives of their children.

And now kratom and concentrated 7-OH have finally made their way to the rocky shores of rural Montana. Today, kratom-based products are everywhere and cheap; available over the counter at most gas stations and smoke shops in Montana. Sometimes, you have to be 21 to purchase; sometimes there is no age limit.

Kratom products are typically sold as drinks, gummies, capsules, extracts, and powders.

Kratom is not recognized by the Food and Drug Administration as an approved herbal supplement or dietary ingredient. Legally, kratom-based products cannot be added to conventional foods. But the confusion about what it is and its impact on human health has allowed its production and sale to grow in scale and expand across the country.

Unfortunately, as people’s exposure to and use of kratom-related products increases, so too have reports of 7-OH – induced overdoses and deaths, not to mention stints in rehab for heavy users. It is a relatively new and mysterious substance in the US, adding fuel to the fire of an age-old public health crisis – addiction, injury, and overdose.

“All opioids, whether natural or synthetic, prescription or illegal, target areas of the brain involved in the processing of pain and pleasure”, blocking pain and inducing euphoria.

Increasing numbers of kratom-based products are being sold that have unnaturally high levels of 7-OH. And because concentrated 7-OH is neither prescription or illegal, it is slipping through the regulatory cracks and flooding our markets with cheap and easy opioids.

Like the nicotine in cigarettes, 7-OH is promising users a physiological reduction of stress and pain. And it is killing people.

Today, many opioid addicts are self-administering 7-0H to try and wean themselves off harder opioids like fentanyl. It is the Wild West of addiction right now and 7-OH is often part of a larger concoction of drugs that is killing people on our streets and in our homes.

According to the Montana Department of Health and Human Services, between January 1, 2019 and December 31, 2025, 45 Montanans overdosed and died with kratom-based products later found in their systems.

“In over 75% of cases where kratom was detected during toxicology, at least one other drug was identified as contributing to cause of death. This most often included opioids. This makes it difficult to understand the role kratom played in these fatalities,” reads the Montana DPHHS report.

Yellowstone County in Southern Montana has been hit especially hard by this growing crisis and is currently spearheading public health efforts to shut down the sale of kratom-based products in and around Billings, especially to minors.

Because 7-OH is a partial opioid agonist that binds to the same opioid receptors in the human brain as fentanyl and other opioids, the same over-the-counter medication that can reverse opioid overdoses work for 7-OH overdoses as well. That’s great news!

  However. Effective doses of naloxone may vary and may require more than one administration. According to toxicologists, “7-OH has a longer half-life than naloxone, so repeat dosing or a continuous naloxone infusion may be required.”

When overdosing from opioids, the human body loses consciousness and forgets how to breathe, the lips turn blue, the skin turns pale and clammy, and both heartbeat and blood pressure drop.

Because of our current drug crisis, it is important for concerned citizens to learn the signs of an overdose and be given the tools to save a life. Narcan is often free and readily available at most health departments and health clinics across the state.

Narcan, the brand name for the drug naloxone, an opioid antagonist, is easily administered via a nasal spray and works by blocking opioid receptors in the brain. (Meaning, it tells the body to start breathing again.)

Narcan training is also becoming more common across the state. For information about Narcan training, please contact Jakob Miles, LCPH Opioid Prevention Coordinator, at 406-457-8875 or email him at jmiles@lccountymt.gov.

To date, the legal status of kratom and 7-OH products vary from region to region and remains largely unregulated by the federal government, often leaving local governments and health departments to make their own decisions and conduct their own enforcement.

Lewis and Clark Public Health is currently evaluating the regulation of these substances under the FDA Food Code and state regulations. Currently, other Montana counties are beginning enforcement to remove this product from commerce in their licensed establishments.

In Lewis and Clark County, education will be provided to local operators to understand the legal ramifications of selling the product before any enforcement is taken.

For further information about regulations and enforcement, please contact Licensed Establishment Supervisor Nina Heinzinger at 406-447-8361 or email her at nheinzinger@lccountymt.gov.