The rise of kratom is gaining significant attention across the United States. With its growing popularity, some estimates suggest that as many as 16 million people now use kratom, generating more than $2 billion annually in retail sales. While kratom is often marketed as a natural remedy for pain, anxiety, and even opioid withdrawal, it is also earning attention for potential risks, particularly with the potent compound 7-hydroxymitragynine (7-OH). Advertised as “legal morphine,” 7-OH products are raising alarms among healthcare professionals.

This blog explores what kratom and 7-OH are, why their popularity is soaring, the concerns surrounding their use, and how they are regulated.

What Are Kratom and 7-OH?

Kratom refers to the Mitragyna speciosa tree, native to Southeast Asia, as well as products derived from its leaves. Traditionally, kratom leaves are consumed in teas or chewed to provide mild stimulant effects. Today, kratom products are available in various forms, such as powders, capsules, and extracts. You’ll find them in convenience stores, vape shops, and online.

The Role of Mitragynine and 7-OH

Kratom contains many active compounds, but two key components stand out:

• Mitragynine: The primary alkaloid that makes up 60-65% of dried kratom leaves. It produces mild stimulant effects at low doses.
• 7-hydroxymitragynine (7-OH): A more potent and concentrated metabolite. Although naturally present in very small amounts (less than 0.05%), synthetic versions of 7-OH are now being heavily marketed.

Both compounds interact with opioid receptors in the brain. While mitragynine acts mildly, 7-OH is significantly more powerful, triggering effects such as intense pain relief and euphoria. The problem? 7-OH carries a much higher risk of addiction and side effects, including respiratory depression and withdrawal symptoms.

Why Kratom Is Growing in Popularity

Kratom’s widespread availability and versatility are key factors in its growing popularity. Users are drawn to claims that it can alleviate pain, boost mood, and even combat opioid withdrawal symptoms. However, these claims are not well-supported by scientific evidence.

Some individuals also view kratom as a “natural” alternative to prescription painkillers. Its accessibility in various retail settings has lowered barriers to trying it, further driving its rise in popularity.

The Concerns Over 7-OH and ‘Legal Morphine’

The surge of products marketed as 7-OH or “legal morphine” has raised serious concerns. Unlike traditional kratom, these products contain high levels of 7-hydroxymitragynine, often exceeding 40% purity. This level of concentration amplifies the risks associated with use, including addiction, withdrawal, and overdose.

Healthcare professionals have highlighted several alarming trends:

• Addictive Potential: Research shows that 7-OH is 30-40 times more potent at opioid receptors than traditional kratom. It also has a higher likelihood of causing substance use disorders.
• Adverse Effects: Cases of liver toxicity, seizures, and neonatal withdrawal syndrome have been linked to products containing 7-OH.
• Mislabelling: Some products are deceptively marketed as kratom, despite containing dangerously high levels of 7-OH.

Even advocacy groups like the American Kratom Association (AKA) have issued warnings about 7-OH products, stating that anything with more than 2% 7-OH cannot be considered authentic kratom.

Regulation of Kratom and 7-OH in the US

Federal Oversight

On a federal level, kratom remains unregulated. The rise of kratom has drawn attention to its legal status, as the FDA has not approved any kratom-related products, citing risks of serious adverse events. Despite attempts by the Drug Enforcement Administration (DEA) to classify kratom as a Schedule I substance (a classification for drugs with no medical use and high abuse potential), public and political pushback delayed such action. However, kratom continues to be listed as a “Drug of Concern.”

State Laws

Kratom regulation varies significantly by state:

• Banned States: Six states, including Alabama, Arkansas, Vermont, and Indiana, prohibit the sale and possession of kratom outright.
• Regulated States: Nine states, like Colorado and Georgia, have introduced restrictions to ensure safe consumption, such as potency limits or manufacturing standards.
• Unregulated States: In most remaining states, kratom is legal without specific restrictions, though some local cities or counties have imposed bans.

While steps have been taken in certain states to regulate kratom and prevent abuse, the lack of consistent policies creates challenges in overseeing its safety and use.

The Real Risks of Kratom Dependence

Despite being marketed as a natural remedy, kratom has clear addictive potential, especially when 7-OH is involved. Individuals often underestimate the risks and use kratom to self-medicate conditions like anxiety, pain, or withdrawal from other substances. Over time, this can lead to dependence, with users experiencing cravings, withdrawal, and disrupted daily functioning.

Experts note that the number one reason for ongoing use of kratom is to manage its withdrawal symptoms, perpetuating a cycle of dependency. Common symptoms of kratom withdrawal include:

• Anxiety or irritability
• Muscle aches or spasms
• Insomnia
• Fatigue

Healthcare providers are urged to ask patients specifically about kratom use, as it is often purchased over the counter or online and may not be disclosed initially.

Why Kratom Demands Close Attention

The rise of kratom in the United States is a double-edged sword. While it offers potential benefits for some, particularly in traditional low-dose uses, the risks associated with concentrated 7-OH cannot be overlooked. Mislabelling, inconsistent regulations, and a lack of public awareness compound these dangers, making it essential to approach kratom products with caution.

Remember, just because something is marketed as “natural” doesn’t mean it’s without harm. The rise of kratom highlights the need for informed decision-making and stricter oversight.

Source: Med Scape