Kratom Derivative 7-OH Withdrawal Caused Opioid Symptoms in a Case Study

Kratom products are marketed in the United States much like energy drinks and dietary supplements, yet there is increasing concern that this drug demands far greater caution.

As the DEA’s temporary scheduling of the substance is awaited, a new case report on one man’s withdrawal from 7-OH, a kratom derivative, illustrates the consequences when people abruptly stop using it.

Often dubbed the notorious ‘petrol station opioid’, products may be described and sold in the United States as ‘kratom’, named after the plant Mitragyna speciosa. Increasingly, however, consumers are more likely to be sold the synthetic derivative 7-OH (7-hydroxymitragynine).

That makes for a markedly different situation.

"You drive down the street and see a vape shop – you'll probably see a sign in the window that says 'Kratom sold here' in fluorescent letters," said medical doctor Michael Moss, director of the Utah Poison Control Center.

Although it is frequently marketed as a ‘natural’ product, 7-OH is exceptionally powerful compared with the plant from which it was derived. Pharmacologists have found that 7-OH products can even be more potent than morphine.

An estimated 2 million people in the US used kratom in 2024, and its popularity has continued to rise.

"Commercial 7-OH products are chemically enriched or semi-synthetic, generated by oxidation of mitragynine isolates, and deliver amounts that far exceed natural abundance," a University of Arkansas for Medical Sciences team wrote in a 2025 review.

"Such preparations bear little resemblance to traditional kratom leaf or tea, despite frequent marketing under the 'kratom' label."

7-OH products are becoming more and more potent. (US FDA)

7-OH potency, poisoning and opioid dependence

While governments rush to develop policy, poison centres throughout the United States are reporting a steep rise in symptoms of 7-OH or kratom poisoning. The increase appears to be 67.8 percent in the past year alone.

Conversely, some patients are arriving with acute withdrawal after using the drug. This stems from its strong affinity for μ-opioid receptors, the same receptors implicated in addiction to morphine, fentanyl and opium.

For that reason, 7-OH and related drugs have become easily accessible alternatives for opioid users seeking to manage their addiction, despite the absence so far of clinical evidence that they are effective.

The 7-OH withdrawal case study

This is the context for the case study: a 43-year-old man with a history of substance-use disorders who was withdrawing after long-term, high-dose 7-OH use.

He had used cocaine during his 20s and developed opioid use disorder in his 30s, for which he did not seek treatment.

"The patient reported that he transitioned from kratom to concentrated 7-OH products because he perceived stronger, faster opioid-like effects and required smaller quantities to avoid withdrawal," explained the Chicago doctors behind the case report.

While these products are often marketed as an 'extract' of the kratom plant, they're usually at least partially synthetic. (US FDA)

He had used 7-OH for roughly 18 months and said he was taking around 360 mg each day.

When he attended hospital, it had been approximately 48 hours since his last 7-OH use, a 30 mg dose.

He showed the typical symptoms of mild opioid withdrawal: nausea, diarrhoea, abdominal cramps, restlessness, chills, clamminess and anxiety.

Yet his urine test showed none of the usual opioids or stimulants that doctors might have anticipated. Viral gastroenteritis, alcohol withdrawal and clonidine withdrawal were also excluded.

Withdrawal from 7-OH was therefore the likeliest cause.

As 7-OH closely resembles opioids, clinicians can manage its withdrawal in much the same way.

The man received buprenorphine and naloxone (4-1 mg), then left hospital with a 14-day supply at the same daily dose. He was also given clonidine, antiemetics, antidiarrhoeals, muscle relaxants and over-the-counter painkillers for symptom management.

He was additionally referred to counselling services.

"Distinguishing traditional kratom preparations from concentrated/isolated 7-OH products is critical for risk assessment, counseling, and regulatory compliance," the doctors noted.

"Although buprenorphine remains appropriate for both, clinicians should anticipate potentially more rapid dependence and symptom escalation with concentrated 7-OH."

DEA scheduling of 7-OH remains uncertain

In July, the DEA declared its intention to place 7-OH above a specified threshold temporarily in Schedule I, alongside three other substances connected to 7-OH.

The announcement has prompted considerable concern among 7-OH users, the drug’s producers and retailers, and healthcare workers who fear their departments may soon face a ‘s***-storm’.

However, until the temporary scheduling order is formally published in the Federal Register - something the notice of intent says could occur at any point after August 5, 2026 - all involved remain in limbo.

Even after that, the practical consequences of banning 7-OH are uncertain. State regulations differ substantially, while whether criminalising drugs reduces harm at all is a separate question.

Related: There’s a Scientific Reason Regular Cannabis Users Wake Up More Stressed

Still, as the doctors state in their case report, healthcare professionals and people using kratom products need to understand the rising potency, the distinction between kratom leaf and 7-OH, and the suitable treatments.

"Pharmacists should screen for these products, time buprenorphine initiation to moderate withdrawal, provide harm-reduction counseling, and incorporate evolving state regulations into patient education," they concluded.

The research appeared in the Journal of the American Pharmacists Association.

This article was fact-checked and edited by Fiona MacDonald. Although we take pride in our process, we are only human. If you find an error, please tell us.