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2026.01 – PIB:7-OH

Overdose Response Center

Delaware Partner Information Bulletin

7-OH (7-Hydroxymitragynine)

Bulletin Number: 2026-01

Contact: ORC@delaware.gov
Approved: January 13, 2026
Approved By: Brent Waninger, ORC Director

What Is 7-OH?

  • 7-Hydroxymitragynine (7-OH) is one of the two active alkaloids found in products made from kratom leaves.
  • Although usually present in small amounts, 7-OH is significantly more potent at opioid receptors than mitragynine, the primary compound in kratom.
  • It is responsible for many of kratom’s opioid-like effects, including pain relief (analgesia) and euphoria.
  • The U.S. Food and Drug Administration (FDA) has recommended restricting access to some 7-OH products because of potency concerns. Some products may contain concentrations reported to be more than 10 times as potent as morphine and may be marketed in forms that appeal to children and teens, such as fruit-flavored gummies and ice cream cones.

Risks Associated with 7-OH

According to the bulletin:

  • 7-OH has morphine-like reinforcing effects and is associated with both physical and psychological dependence.
  • Withdrawal symptoms may include:
    • Anxiety
    • Muscle pain (myalgia)
    • Insomnia
  • Toxicity risks include:
    • Respiratory depression
    • Overdose
    • Liver injury
    • Seizures
    • Rarely, death
  • Risks may increase when 7-OH is combined with alcohol, sedatives, or certain medications that inhibit CYP3A enzymes.
  • Product contents are not standardized, making the actual dose unpredictable and increasing the risk of adverse effects.
  • Published case reports have documented physiologic dependence, withdrawal, and Kratom Use Disorder (KUD) associated with chronic daily use.

Treatment Provider Awareness

Because 7-OH is currently sold legally as an herbal supplement, providers are encouraged to specifically ask patients about:

  • Kratom use
  • Herbal supplement use

The bulletin notes:

  • Although 7-OH acts as a potent opioid receptor agonist with analgesic properties, its abuse potential and toxicity risks mean it is not recommended as a treatment for opioid use disorder (OUD).
  • At the time of publication, there were no controlled human trials establishing the safety or effectiveness of 7-OH or kratom for treating OUD.
  • Due to limited evidence, standardized treatment guidelines are not well established.
  • Urine drug screening followed by confirmatory testing can detect kratom alkaloids and may assist with diagnosis and treatment planning.

Withdrawal Management

The bulletin advises that, because withdrawal symptoms may resemble opioid withdrawal:

  • Symptomatic management is generally considered the preferred approach.

For Kratom Use Disorder (KUD), providers may consider medications for opioid use disorder (MOUD), including:

  • Buprenorphine
  • Buprenorphine-naloxone

For patients with co-occurring opioid use disorder, methadone and naltrexone may also be appropriate when clinically indicated.