Kratom and 7-OH dependence

When most people hear the word “opioid,” they think of prescription pain medications, heroin, or fentanyl.

But there is another group of substances that addiction physicians are increasingly encountering: kratom and concentrated kratom derivatives such as 7-hydroxymitragynine, commonly known as 7-OH.

Kratom has been available for years and is often sold in gas stations, convenience stores, and online. It may be marketed for pain relief, increased energy, relaxation, or other purposes. Some people also use kratom to reduce or stop their use of other opioids.

More recently, concentrated kratom derivatives such as 7-OH have raised concerns among addiction and healthcare professionals because of their potent activity at opioid receptors and their potential to contribute to tolerance, physical dependence, withdrawal, and overdose.

For people who use kratom or 7-OH, understanding these substances and recognizing the signs of dependence can be an important first step toward getting help.

What is kratom?

Kratom is a plant-derived substance with leaves that contain naturally occurring compounds called alkaloids, including mitragynine and 7-OH.

Kratom’s effects can vary depending on the amount used. At lower doses, people may experience stimulant-like effects, such as increased energy or alertness. At higher doses, kratom can produce more opioid-like effects, including relaxation and pain relief.

While some people use kratom without developing significant problems, others can develop patterns of use that become difficult to control. The fact that kratom is “naturally occurring” does not mean it is automatically safe or that it cannot lead to dependence.

What is 7-OH?

7-OH is short for 7-hydroxymitragynine, an opioid-active compound associated with kratom. Traditional kratom leaf contains 7-OH in relatively small amounts. However, some products are formulated to contain higher concentrations of 7-OH.

This distinction is important.

Concentrated 7-OH products can have substantially stronger opioid activity than traditional kratom products.

Because 7-OH interacts with opioid receptors, repeated use can potentially result in many of the same broad physiological processes associated with other opioid-active substances, including tolerance and physical dependence.

The opioid connection

Opioid receptors play a role in pain, reward, pleasure, and breathing. Prescription opioids, heroin, and fentanyl also act on opioid receptor systems.

This does not mean that 7-OH, kratom, heroin, fentanyl, and prescription opioids are identical substances. Their chemistry, potency, formulations, and risks can differ significantly. However, the opioid activity of 7-OH is important when considering its potential for dependence, withdrawal, and respiratory depression.

For someone purchasing a product marketed as a supplement or something for pain relief, that distinction may not always be obvious.

Why are people taking kratom and 7-OH?

People use kratom and kratom-derived products for many different reasons.

Some people report using them for:

• Pain relief
• Increased energy or alertness
• Relaxation
• Managing discomfort
• Attempting to reduce their use of prescription opioids
• Attempting to stop using heroin or fentanyl
• Managing opioid withdrawal symptoms

For some people, the substance may initially appear to provide the effect they were looking for. The concern is that repeated use can change the relationship a person has with the substance.

What begins as occasional use can become more frequent. A person may begin taking larger amounts, taking doses closer together, or feeling that they cannot get through the day without the substance.

Can kratom and 7-OH cause addiction?

Regular use of kratom or concentrated 7-OH can lead to tolerance, physical dependence, cravings, and withdrawal. Some people can develop a substance use disorder.

It is important to distinguish physical dependence from addiction.

Physical dependence means that the body has adapted to the presence of a substance and may experience withdrawal when use is reduced or stopped.

Addiction, or a substance use disorder, involves a broader pattern of problematic use. This can include loss of control, cravings, continued use despite negative consequences, and unsuccessful attempts to cut down or stop.

One of the most concerning patterns is when a person begins taking a substance not because they want its original effects, but because they need it to avoid feeling sick.

How does dependence on kratom or 7-OH develop?

The brain and body can adapt to repeated exposure to psychoactive substances. With repeated exposure to an opioid-active substance such as kratom or 7-OH, the brain can become accustomed to receiving opioid stimulation.

Over time, a person may develop tolerance, meaning they need more of the substance to achieve an effect they previously experienced with a smaller amount. They may also develop physical dependence, meaning withdrawal symptoms occur when the substance is reduced or stopped. This can make it increasingly difficult to quit, even when a person recognizes that their use has become excessive.

Tolerance can contribute to a cycle of increasing amounts and more frequent use. For some people using concentrated 7-OH products, this cycle can become particularly disruptive. As the effects wear off and withdrawal symptoms begin to emerge, another dose may temporarily relieve those symptoms. Over time, a person may find themselves taking the substance not to experience its original effects, but simply to feel normal or avoid withdrawal.

Rosecrance addiction physicians who work with clients struggling with dependence on these products report that some individuals spend hundreds of dollars per week or even per day to maintain their supply. That financial burden can affect relationships, employment, housing, and other areas of life.

What does kratom or 7-OH withdrawal feel like?

Withdrawal from kratom or 7-OH can involve physical and psychological symptoms.

Symptoms vary from person to person and depend on factors such as the amount and frequency of use, the specific product, and whether other substances are involved.

Rosecrance addiction physicians say some withdrawal symptoms include:

• Anxiety
• Irritability
• Restlessness
• Strong cravings
• Nausea
• Diarrhea
• Stomach discomfort
• Runny nose
• Goosebumps
• Chills
• Hot and cold sensations
• Body aches
• General discomfort or malaise
• Restless legs
• Difficulty sleeping

Someone may decide they want to stop using only to experience withdrawal and return to the substance to make those symptoms go away.

Can 7-OH cause an overdose?

Concentrated 7-OH products may cause serious toxicity, including respiratory depression, which can be life-threatening and is a major cause of fatal opioid overdoses.

Respiratory depression occurs when breathing becomes dangerously slow or inadequate.

The risk may increase when 7-OH is combined with other substances that can suppress breathing or the central nervous system.

These can include:

• Other opioids
• Alcohol
• Benzodiazepines
• Other sedating medications or substances

Anyone who has difficulty waking, has extremely slow or abnormal breathing, or becomes unresponsive after taking a substance needs emergency medical attention. Call 911 and administer naloxone if it is available.

Can kratom be used to treat opioid withdrawal?

Kratom is not an established or approved treatment for opioid withdrawal or opioid use disorder (OUD). Using kratom to self-manage withdrawal can lead to dependence, unintended effects, and potentially serious toxicity, including overdose.

Some people report that kratom helps relieve certain opioid withdrawal symptoms. However, these anecdotal reports do not establish kratom as a safe or effective treatment. Neither kratom nor 7-OH has been established as a treatment for opioid withdrawal or OUD, and there is not enough reliable evidence to support using either for this purpose.

A person’s opioid use, tolerance, duration of use, medical history, and other individual factors can significantly affect withdrawal and treatment needs. Anecdotal experiences cannot account for these factors or determine what treatment is appropriate or safe for a particular person.

Self-treating with kratom can also lead to unintended or escalating use. Some people may increase the amount they take or switch from traditional kratom products to more concentrated products containing 7-OH, potentially increasing the risk of overdose.

Most importantly, relying on kratom or 7-OH to manage withdrawal may delay appropriate medical care and evidence-based treatment for OUD.  If you are experiencing opioid withdrawal or think you may have OUD, talk with a healthcare professional or addiction medicine physician about evidence-based treatment options and a longer-term plan to support recovery.

What are the signs that kratom or 7-OH use has become a problem?

If substance use is beginning to interfere with daily life or feels difficult to control, that is a good reason to start a conversation with a professional.

A person does not need to wait until these signs are present before seeking help:

• Takes more kratom or 7-OH than intended
• Uses the substance more frequently over time
• Experiences strong cravings
• Needs the substance to feel normal
• Experiences withdrawal when attempting to stop
• Uses the substance to prevent withdrawal
• Has tried to cut down or stop but cannot
• Spends increasing amounts of money maintaining their supply
• Combines the substance with other opioids, alcohol, or sedating substances
• Feels that their use is becoming increasingly difficult to control

It is also important to seek professional guidance if you are using kratom or 7-OH to manage withdrawal from another opioid. An addiction professional can help you understand what you are experiencing and identify appropriate next steps.

Is there help for people struggling with kratom or 7-OH?

Dependence on kratom, 7-OH, and other opioid-active substances is treatable.

At Rosecrance Therapies, addiction and mental health professionals help individuals experiencing substance use disorders identify an appropriate level of care and develop a comprehensive treatment plan for recovery.

Depending on their needs, treatment may include:

• Medical assessment and monitoring
• Medication management when clinically appropriate
• Individual or group counseling
• Recovery support
• Treatment for co-occurring mental health concerns
• Medically supported withdrawal management
• Residential treatment
• Other levels of intensive care when appropriate

While the desire to stop is an important first step, attempting to manage dependence alone can leave a person without support when withdrawal and cravings become difficult.