The compound 7-hydroxymitragynine, or 7-OH, occurs naturally in trace amounts in kratom leaves, but products containing concentrated 7-OH — sometimes called “gas station heroin” — are now sold as tablets, gummies and liquid shots at gas stations, smoke shops and online. Clinicians said the products carry far more opioid danger than kratom, even though they are often marketed as a natural kratom derivative.
The compound is a growing concern for behavioral health leaders. Mo Sarhan, MD, medical director at Caron Treatment Centers in Delray Beach, Fla., told Becker’s that 7-OH is the drug he is watching most closely, and he expects its use to keep growing. The Drug Enforcement Administration has temporarily placed three related compounds in Schedule I, and action on 7-OH itself is pending. States are also moving to restrict it.
Here are seven things to know:
1. It occurs naturally in trace amounts but is sold in concentrated form. Sarah Kawasaki, MD, director of the Advancement in Recovery Program at Hershey, Pa.-based Penn State Health Psychiatry and Behavioral Health, said 7-OH, a psychoactive compound found naturally in kratom, has been synthetically isolated and manufactured for these products. Michigan Medicine experts said lab-made 7-OH is 10 times more potent and addictive than the main active component of kratom and has been associated with fatal overdoses.
2. It is marketed as a natural product. Ann Arbor-based University of Michigan experts said 7-OH products often come in colorful packaging with a candy-like appearance and fruity flavors. Missouri health officials warned that products containing 7-OH are marketed as natural remedies but carry serious risks, including addiction, overdose and death. Dr. Sarhan said patients who would never use heroin buy 7-OH because the label calls it a plant alkaloid. “Functionally, it is an opioid marketed as a botanical supplement,” he said.
3. Dependence can develop within weeks. Dr. Kawasaki said physical dependence can set in within two to three weeks of regular use. Withdrawal from concentrated 7-OH is especially severe, Penn State Health reported. At Michigan Medicine, clinicians said they are seeing a rapidly growing number of patients each week with severe consequences of 7-OH addiction, many of whom had been in long-term recovery from opioid use disorder.
4. Poison center exposures are climbing. America’s Poison Centers documented 14,449 kratom exposures from 2015 to 2025, an increase of about 1,200% over the decade, according to the DEA. Dr. Sarhan said America’s Poison Centers projects a nearly 68% increase this year. He also said about 1 in 4 people exposed to kratom or 7-OH alone were hospitalized. An FDA assessment found that 7-OH is a potent opioid that produces respiratory depression.
Northbrook, Ill.-based Brightside Recovery reported a threefold increase in patients seeking treatment for 7-OH in recent months. The provider, which operates clinics in Northbrook, North Aurora, Olympia Fields, Rockford and Peoria, said 9 in 10 patients seeking treatment in the last month were using 7-OH. The clinic is now treating more patients for 7-OH use than fentanyl use, said David Kushner, MD, medical director at Brightside Recovery.
5. Standard opioid use disorder treatment works. Dr. Kawasaki said 7-OH and kratom use disorder responds well to the same medications used for other opioid use disorders, particularly buprenorphine. Eliza Hutchinson, MD, a University of Michigan family medicine physician with training in addiction medicine, said naloxone can help reverse overdoses caused by the opioid effects of kratom and 7-OH. Dr. Sarhan said repeated naloxone doses may be needed. He urged clinicians to ask every patient directly about kratom and 7-OH, since most will not volunteer it.
6. The DEA has scheduled three related compounds; 7-OH is pending. On July 1, 2026, the DEA filed notices of intent to temporarily place 7-OH above a specified threshold in Schedule I, along with three related substances: mitragynine pseudoindoxyl, MGM-15 and MGM-16. The agency placed the three related substances in Schedule I effective Aug. 26, 2026, and that order runs until Aug. 26, 2028. The DEA said the move was necessary to avoid an imminent hazard to public safety. Action on 7-OH remains pending. The FDA had already sent warning letters to seven 7-OH companies in July 2025, and the U.S. Marshals Service seized about $1 million in 7-OH products from three Missouri firms in December 2025.
7. HHS has proposed limits to separate natural kratom from enhanced products. On Oct. 9, HHS recommended Schedule I control for products in which 7-OH and mitragynine pseudoindoxyl, alone or combined, exceed 1 milligram per gram in solids or 1 milligram per milliliter in liquids. A product would also be covered if it contains less than 100 times as much mitragynine, kratom’s dominant alkaloid, as those compounds. An FDA review found 7-OH to be roughly two to nine times as potent as morphine. The DEA is issuing new notices of intent adopting the limits. It temporarily scheduled the three related substances Aug. 26, but no temporary scheduling order has been issued yet for 7-OH.
8. States are acting on their own. Several states have moved against 7-OH without waiting for federal action. Connecticut placed kratom and its derivatives, including 7-OH, in Schedule I effective March 25, 2026, the state Department of Consumer Protection said. Kansas and Tennessee bans on kratom and 7-OH took effect July 1, 2026, according to the Kansas Hospital Association and Tennessee House Republicans’ news release. Massachusetts placed all kratom products in Schedule I under an emergency regulation effective Aug. 28, 2026, which retailers have sued to block, The Boston Globe reported. Ohio made its emergency ban on synthetic kratom permanent in May 2026, WOSU reported, and Virginia enacted a law banning 7-OH products, Virginia Mercury reported.
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