Is 7-oh the New Heroin?

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Every day in my clinic, I see the devastating impact of the opioid crisis. If heroin, fentanyl, and other street drugs weren't enough to deal with, there's a new substance that people think is harmless because it's an "herbal" product.  It’s called 7-OH, and it's sold in gas stations, dispensaries, and even online. I’m writing this article because you need to know that it is not the same as the kratom plant and it is far from safe. This isn't just a theoretical danger. A 2024 study of over 30,000 deaths in Florida found that individuals with kratom in their system were 5.6 times more likely to die from drug intoxication than those without. The problem is real, and it is fatal.

The creation of 7-oh products is the same story we've seen before that ends in addiction. It's the story of morphine, alcohol, canabis, cocaine, and to some extent, heroin all over again. Find a naturally occurring substance, chemically concentrate it or modify it, and hijack the brain's reward system with addiction. I don't think the production of products containing 7-oh is happening by accident. In my opinion, the chemists are trying to create more addicts.

If you read Reddit or watch a few YouTube videos, you will encounter so many people promoting the benefits of kratom and 7-oh. As  an addiction specialist, I see the other side; the kratom and 7-oh addicts trying to get away from these products and can't. It's not enough for me to tell you not to try a product you truly believe is safe. Instead, I want to show you how kratom and 7-oh is following the path of opium and heroin so you can protect yourself and your family. 

What Is the Difference Between Kratom and 7-OH?

The kratom you might have heard about is a leaf from a tree in Southeast Asia. For centuries, people chewed it or brewed it  into a tea. The leaf contains dozens of compounds called alkaloids. The main one  is called mitragynine. The typical breakdown of alkaloid composition in the kratom leaf is Mitragyna Speciosa (Kratom) is 66% mitragynine, 8-16% speciociliatine, 9-16% paynantheine, 6-8% speciogynine, and 0.01-0.03% 7-hydroxymitragynine(7-oh). In animal studies, mitragynine has mild effects on the opioid receptor. In fact, animal studies are indicating that mitragynine has almost no noticeable affect. However, animal studies reveal that 7-oh has profound opioid receptor activity that makes it even more potent than morphine.

The 7-oh products being sold today are very different from what is found naturally. They are highly concentrated 7-oh products. Think of it like this: the opium poppy is a plant. For millennia, people used its raw resin. But in the 1800s, a chemist isolated its most powerful ingredient, morphine, and created a concentrated powder that was much more potent and addictive.

That is exactly what is happening with 7-OH. It is being isolated, concentrated, and sometimes synthesized in a lab to create a product that is dangerously potent. When you buy a 7-OH gummy or shot, you are not getting a simple plant extract. You are getting a semi-synthetic opioid.

While the semi-synthetic 7-OH products are a clear and present danger due to their potency, I must be clear, even traditional kratom is not harmless. The 2024 Florida mortality study looked at deaths where mitragynine—the main, less potent alkaloid—was present. They found 36 cases where kratom was the only substance detected, and of those, medical examiners ruled that 20 people died directly from drug toxicity.

Why Are Products Containing 7-OH So Much More Dangerous?

In my field of anesthesiology and addiction medicine, potency, concentration, and delivery methods determine effects and addiction potential. Before morphine was isolated, opium users had no idea how strong their next dose would be. Potency varied wildly, leading to accidental overdoses. Today’s unregulated 7-OH market is the same. The concentration can be wildly different from batch to batch, but the label won’t tell you that. Furthermore, the exact potency of 7-oh is unknown. There is no official Morphine Milligram Equivalent (MME) for 7-hydroxymitragynine. MME is a value used for prescription opioids to standardize dosing, and since 7-OH is not an approved medication, it hasn't been formally assigned one.

However, we can look at animal studies that compare its potency to morphine. The most frequently cited research, based on animal studies measuring pain relief, suggests that 7-hydroxymitragynine is approximately 10 to 15 times more potent than morphine when administered by injection. Some studies looking at how strong it binds to the mu-opioid receptor in the brain have found it to be even more potent. So, based on the animal data, the potency of 7-OH appears to be somewhere in the gap between oxycodone and fentanyl. A simple potency number doesn't tell the whole story. The main issue is the debate over whether 7-OH is a "full agonist" or a "partial agonist" at the mu-opioid receptor.

Full Agonists (like Morphine, Oxycodone, Fentanyl): These drugs activate the opioid receptor to its maximum capacity. The more you take, the stronger the effect (and the more respiratory depression), with no ceiling. 

Partial Agonists (like Buprenorphine): These drugs activate the receptor but have a "ceiling effect." Beyond a certain point, taking more does not increase the effect, which is why they tend to be safer in terms of overdose risk.

Some research suggests 7-OH may be a partial or "biased" agonist, meaning it might have a ceiling effect for respiratory depression while still providing strong pain relief. However, other studies and real-world overdose reports suggest it behaves like a full agonist, especially at high concentrations.

Why Is Kratom So Addictive For Some People But Not Others?

Ever wonder why one person can try a drug and walk away, while another gets hooked? It's not because they have weak minds or "addictive personality." It's because individual humans have unique biology, a combination of different liver genetics and brain chemistry. When you consume kratom, your liver’s cytochrome P450 enzymes get to work. One specific enzyme, CYP3A4, converts the primary alkaloid, mitragynine, into the far more potent and more addictive 7-hydroxymitragynine (7-OH).

Your genetic makeup determines whether your CYP3A4 works "slow," "normal," or "fast".

- Fast metabolizers convert mitragynine into 7-OH very efficiently, leading to a rapid increase in 7-oh, intense opioid-like effect that significantly increases the risk of dependence and addiction.   

- Slow metabolizers do the opposite. They create less 7-oh, experiencing a weaker, less reinforcing effect.

But it doesn’t stop there. The mu-opioid receptors (OPRM1) in your brain, which 7-OH targets, also vary from person to person. If your receptors are genetically more sensitive to opioids, you’ll feel a stronger sense of reward and euphoria, making you more susceptible to opioid addiction. This combination of liver metabolism and brain receptor sensitivity explains why two people can have dramatically different experiences with the exact same substance. The makers 7-oh understand this chemistry and have specifically bypass the CYP3A4 variance the humans and created highly concentrated 7-oh products. This individual biological lottery makes using kratom a gamble, but that gamble becomes exponentially more dangerous when other substances are involved.

The risk skyrockets when these products are mixed with other substances, which is the norm, not the exception. The Florida data revealed that a staggering 93% of decedents with kratom exposure had also used other substances. Most alarmingly, nearly 80% had also used opioids like fentanyl. This combination is a deadly cocktail, with kratom and 7-OH acting as a potent multiplier for overdose risk.

A Case Study in Rapid Addiction To "Hydroxie"

If you think this is just a warning, consider the real-world case of a 35-year-old man recently documented in the Journal of Addiction Medicine. After using kratom, he was introduced to a semi-synthetic 7-OH product called "Hydroxie" in the form of a sublingual film.

He developed tolerance and withdrawal symptoms within days. Within two weeks, he was using one film every one to two hours, spending over $1,500 a month to feed his habit. He was diagnosed with a Severe Substance Use Disorder and required buprenorphine to treat his addiction. The man reported that his cravings for the 7-OH product were "comparable to what he had experienced with heroin." This is not a "safer alternative." It is a fast track to a severe opioid addiction.

The Public Health Emergency is Already Here

My warnings are not theoretical. In the summer of 2025, the Department of Health and Human Services (HHS) and the FDA held a press conference about 7-OH, and the FDA has already sent warning letters to companies marketing these products.

This isn't just bureaucratic caution; it's a response to an growing crisis. According to America's Poison Centers, reported poisonings involving 7-OH tripled in just two months in 2025, jumping from 53 cases by the end of May to 165 by the end of July. Alarmingly, some of these cases involve children. The data also shows the severity: in two-thirds of cases, victims required treatment at a health care facility, and one-third experienced serious health problems. The situation has become so dire that Florida's attorney general has already filed an emergency rule to classify concentrated 7-OH as a schedule I substance.

The DEA is now reviewing the FDA's recommendation for a federal schedule I listing. As an addiction specialist, I fear that this will lead to arrests and incarcerations for substance use, which I think is counterproductive. But the fact that officials are taking these drastic steps proves how dangerous these products truly are.

The Additional Dangers of Kratom and 7-OH

Beyond genetic variations, kratom can cause a pharmacological minefield. A 2025 review in Pharmaceuticals highlighted that mitragynine can inhibit key liver enzymes like CYP3A4 and CYP2D6. This means that if you are taking other medications, from antidepressants to blood pressure pills, kratom can cause their levels in your body to become dangerously high, leading to unexpected toxicity.

Is the FDA Doing Anything About 7-OH?

Federal oversight centers on the Controlled Substances Act. Health officials are conducting a scheduling review to list 7‑OH as a schedule I listing. If finalized, 7‑OH would be a schedule I drug and handled as a schedule I controlled substance with no accepted medical use giving the Drug Enforcement Agency authority to arrest for manufacturing, trafficking, and possession of 7-oh. The FDA and Food and Drug Administration partners continue to issue advisories and develop educational materials for consumers to reduce risk. They need to act fast before this becomes a public health catastrophe. History teaches us a sobering lesson: the first international laws to control morphine didn't appear until 1912, over a century after it was first isolated. By then, the crisis was already global. We are in that same dangerous gap right now with 7-OH. However, as an addiction specialist, I fear that making this a Schedule I drug will lead to arrests and incarcerations for substance use which I think is counterproductive.

How Can I Spot and Avoid These Products?

You won't find these products in a pharmacy. You'll find them in vape shops, gas stations, and online vendors, disguised as "enhanced kratom" or "natural" pain relievers. Often they are sold as dietary supplements, drink mixes, and other kratom products. The packaging is designed to look harmless, like candy or an energy drink.

• Read labels closely. Watch for 7‑OH or 7‑hydroxymitragynine, usually in small print.

• Be cautious with anything marketed as kratom that carries amplified effects or claims of strong euphoria.

• Avoid products associated with 7‑OH products, especially if they appear as gummies or shots from convenience outlets or online sellers.

• If you or a family member experiences symptoms after 7‑OH such as rapid heart rate, high blood pressure, nausea and vomiting, seizure, or breathing trouble,seek immediate care and call the poison help line.

We Don't Have to Repeat the Mistakes of the Past

The story of morphine should have taught us that concentrating a plant's opioid-like effects into a powder, tablet or an injection is a recipe for disaster. We have a choice: we can learn from the past and reject 7-OH, or we can stand by, FAFO, and watch another generation fall into the trap of a "miracle" extract. Don't use kratom and absolutely don't use 7-oh.

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Reif, B., Adkins, A., Boyer, E. W., Kanumuri, S. R. R., Sharma, A., & Smith, K. E. (2025). Substance use disorder following consumption of a novel synthetic 7-hydroxymitragynine product. Journal of Addiction Medicine. Advance online publication. https://doi.org/10.1097/ADM.0000000000001603

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Anderer, S. (2025). What to know about 7-OH, the new vape shop hazard. JAMA, 334(12), 1045–1046. https://doi.org/10.1001/jama.2025.13592

Reif, B., Adkins, A., Boyer, E. W., Kanumuri, S. R. R., Sharma, A., & Smith, K. E. (2025). Substance use disorder following consumption of a novel synthetic 7-hydroxymitragynine product. Journal of Addiction Medicine. Advance online publication. https://doi.org/10.1097/ADM.0000000000001603

About the author:

Harold Pierre, MD, is a board-certified anesthesiologist, board-certified addiction medicine specialist, and a concierge addiction doctor based out of Tulsa, Oklahoma with over 26 years of experience. He is board-certified by the American Board of Anesthesiology and the American Board of Preventive Medicine, and has extension experience managing hormones, pain, addiction, and their intersection. He is licensed in Florida, Texas, Oklahoma, South Carolina, Louisiana, and Arizona. If you are seeking care, you may schedule an appointment with him by calling or texting 918-518-1636. LinkedIn

*Disclaimer: This blog post is for informational purposes only and is not intended as a substitute for professional medical advice, diagnosis, or treatment. Always seek the guidance of your doctor or other qualified health provider with any questions you may have regarding your health or a medical condition before making any changes. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.

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