Kratom and 7-OH: What They Are, Why 7-OH Acts Like an Opioid, and When Treatment Is Needed

Just because something is marketed as natural or sold in stores doesn’t mean it’s safe.

Kratom and 7-OH are prime examples of this. Legal, readily available, and labeled as herbal supplements, these compounds can be insidious, even resulting in addiction — since they act similarly to opioids.

Kratom product use is on the rise. The National Poison Data System reports a 1,200% increase in kratom-related exposure reports from 2015 to 2025.

It’s important to understand exactly what kratom and 7-OH are, what the difference between them is, and the dangers of taking them. Read on to learn more.

What is kratom?

Kratom refers to leaves (or products derived from the leaves) of a Southeast Asian tree called Mitragyna speciosa. People take it by brewing the leaves into tea, swallowing capsules, or using it as a powder mixed into another drink or food.

People may take kratom for different reasons. Some take a smaller dose for a stimulant effect — increased energy and alertness, while others take a higher dose to experience sedative or opioid-like effects, like increased relaxation.

However, just because kratom is natural and readily available doesn’t mean it’s safe. It can cause adverse effects, especially when taken in high doses, and can be increasingly dangerous alongside other drugs or prescription medications.

Is kratom an opioid?

No, kratom is not officially an opioid. However, it can act like an opioid. This is because its active component, mitragynine, converts to 7-hydroxymitragynine (7-OH), which binds to opioid receptors in the brain. These are the same receptors that traditional opioids bind to, which is why it may produce opioid-like effects.

What is 7-OH?

When someone takes kratom, their body ultimately converts some of it to 7-OH. However, 7-OH is also available for purchase as a much more potent and concentrated form than one can get from kratom itself. It’s often sold as tablets, gummies, or drinks.

Just like kratom, 7-OH is readily available to buy in places such as gas stations, smoke shops, or online. Additionally, some products marketed as kratom may actually contain dangerously high concentrations of 7-OH.

Why 7-OH acts pharmacologically like an opioid

7-OH acts like an opioid because it binds to opioid receptors in the brain.

“7-OH has potent activity at the mu-opioid receptor, the same receptor system involved in the effects of traditional opioids,” says Dr. Tara Fuller, DNP, Manager of Advanced Practice Psychiatry at Charlie Health. “Your opioid receptors do not care whether something came from a prescription bottle, a poppy plant, or a smoke shop.”

When a compound such as 7-OH binds to mu-opioid receptors, it leads to opioid-like effects, such as relaxation and pain relief.

Because it binds to these receptors and results in these effects, that means someone can experience dependence and withdrawal from it — especially if they use it long-term.

What is the difference between kratom and 7-OH?

The main difference is that kratom generally refers to the plant, which contains multiple naturally occurring compounds, while 7-OH is a specific compound found in kratom in very small amounts. Concentrated 7-OH products sold at gas stations and smoke shops can contain much higher amounts of the compound and produce stronger opioid-like effects.

“One of the biggest misconceptions right now is that 7-OH is simply ‘stronger kratom.’ That dramatically understates what we’re dealing with,” says Dr. Fuller. “Traditional kratom leaf naturally contains only trace amounts of 7-OH. Concentrated 7-OH products can deliver amounts that someone would never realistically encounter from traditional leaf alone.”

Kratom side effects

Kratom and 7-OH can result in many adverse effects, including (but not limited to) the following:

• Dizziness
• Drowsiness
• Trouble breathing
• Confusion
• Dry mouth
• Hallucinations or delusions
• Depression
• Nausea/vomiting
• Constipation
• Tremors
• Seizures

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Is kratom addictive?

Kratom and 7-OH can cause physical dependence, and some people develop an addiction from using them.

If someone continuously uses kratom or 7-OH, they’re at risk for dependence. Especially if someone is using it consistently for over two weeks, there’s a risk of withdrawal symptoms.

Here are some questions to ask that could be red flags that someone has an addiction, according to Dr. Fuller.

• Are they taking more than they intended?
• Are doses getting closer together?
• Are they waking up needing it?
• Have they tried unsuccessfully to stop?
• Are they using to prevent withdrawal rather than to get the original effect?
• Is the substance fitting into their life, or is their life starting to organize itself around the substance?
• Are they using because they feel like they need this to feel “normal”?

Additionally, there’s an important distinction between addiction and physical dependence. “Physical dependence means the body has adapted to the substance. A substance use disorder involves the larger behavioral picture — impaired control, craving, continued use despite harm, and disruption in functioning,” Dr. Fuller says. However, both physical dependence and addiction require addressing.

Kratom and 7-OH withdrawal symptoms

“Kratom, and particularly concentrated 7-OH, withdrawal can look very opioid-like,” Dr. Fuller says. She lists the following as some potential withdrawal symptoms:

• Intense cravings
• Irritability
• Restlessness
• Anxiety
• Sweating
• Chills
• Insomnia
• Muscle aches
• Abdominal cramping
• Nausea
• Diarrhea
• Runny nose
• Watery eyes

However, more research is needed to understand kratom and 7-OH withdrawal symptoms fully. There are some case studies of people needing medically assisted treatment for 7-OH withdrawal.

Can you overdose on kratom?

Yes, you can overdose from kratom-related products, although it is rare. However, the vast majority of deaths related to kratom happen when it’s combined with another drug — commonly fentanyl, heroin, benzodiazepines, prescription opioids, and cocaine.

Since kratom and 7-OH products are “herbal supplements,” they are not regulated, which means these products could really contain anything, including dangerous additives and doses much higher than advertised, making them even more risky to take. There are also newer kratom-derived compounds such as MGM-15, Dr. Fuller says, which are also dangerous.

“The larger concern is that the market is evolving faster than our ability to study these compounds, meaning consumers may essentially be encountering increasingly potent opioid-active products before we fully understand their risks,” Dr. Fuller adds.

When these products are becoming more and more potent, risk for overdose rises.

When treatment is needed

For any substance use disorder or addiction, including kratom or 7-OH addiction, treatment is needed when:

• A person cannot control their use of the substance
• They keep using the substance despite the problems it’s causing in their life
• It impairs their ability to function day-to-day
• There’s a tolerance (needing more to get the same effect) and withdrawal when one stops using the substance

There are different types of treatment for substance use disorders, including traditional outpatient therapy, intensive outpatient programs (IOPs), partial hospitalization programs (PHPs), or residential treatments.

The appropriate level of care depends on the severity of the addiction and any other co-occurring or underlying mental health conditions which also need to be addressed.

What is the treatment for kratom and 7-OH addiction?

As for treating any addiction or substance use disorder, treatment is two-pronged: getting sober from the substance and addressing the underlying causes that led to someone using (and continuing to use) the substance.

“The goal is not simply to tell someone to stop using kratom or 7-OH,” Dr. Fuller says. “We have to understand why they were using it in the first place. Was it helping with pain? Anxiety? Depression? Trauma symptoms? Energy? Sleep? Opioid withdrawal?”

Once the provider has helped someone identify their underlying motive (or motives) for using the substance in the first place, addressing that is key. “If we take away the substance but never address the job it was doing for that person, we have only removed their coping mechanism. We have not treated the problem,” Dr. Fuller says.

Some types of therapy that may benefit people with a substance use disorder include:

• Cognitive behavioral therapy (CBT): Helps people learn how thoughts, feelings, and behaviors are connected. CBT therapists help clients identify unhealthy, unhelpful thought patterns and create healthier thoughts, which can in turn lead to healthier behaviors.
• Dialectical behavior therapy (DBT): Gives people practical skills to cope with distress and heightened emotions. DBT therapists will teach clients skills they can use in the moment when they’re feeling triggered, and healthily manage intense emotions rather than turning to a substance.
• Motivational interviewing: Teaches people that motivation comes from within themselves, and they have the power to create change — including overcoming SUD. Motivational interviewing helps people explore their feelings and identify their own reasons to stay motivated toward sobriety.

Depending on the underlying circumstances that led to substance use, more specialized types of therapy may be needed. For example, if someone was turning to 7-OH to numb the pain related to trauma, they could benefit from trauma-informed therapies.

“The goal is not just abstinence. The goal is helping someone get to a place where they no longer need a substance to make their day feel survivable,” Dr. Fuller says. “A lot of these patients did not think, ‘I’m going to start using an opioid today.’ They thought, ‘I’m going to try something legal that might help me feel better.’”

When is medical stabilization needed?

For someone to participate safely in an outpatient treatment, such as an IOP, they must be medically and psychiatrically stable enough to do so, Dr. Fuller says.

“For significant 7-OH dependence, the presentation can become remarkably opioid-like, and psychiatric providers can evaluate whether medication-assisted treatment for an opioid-type use disorder is clinically appropriate,” Dr. Fuller says.

She lists the following as signs that someone may need a higher level of care, such as medical stabilization, before pursuing outpatient treatment:

• Severe withdrawal
• Dehydration
• Altered mental status
• Seizures
• Significant sedation
• Respiratory concerns
• Unstable vital signs
• Complicated polysubstance use
• Acute suicidality
• Psychosis
• An inability to safely care for oneself

Once someone is medically stabilized, they can pursue longer-term outpatient treatment to address the addiction and underlying contributing factors.

Kratom and 7-OH addiction treatment at Charlie Health

Charlie Health is a virtual behavioral health provider delivering high-acuity treatment for kids, teens, and adults facing serious mental health conditions and addiction. We incorporate a variety of evidence-based treatment modalities into individual therapy, supported groups, and family sessions.

Our intensive outpatient program for addiction consists of 10+ hours of treatment each week. This includes processing groups, experiential groups, skills-building groups, individual therapy, and optional family therapy and psychiatric care. In addition, clients in the IOP can work with a recovery coach for an extra layer of support.

If you’re a provider and you have a client who might be a good fit, refer them today.

If you think you might benefit from Charlie Health’s IOP, fill out this form.