Rosecrance medical director warns of emerging risk of 7-OH and kratom derivatives

Kratom has long occupied a complicated space in conversations about pain, substance use, and opioid addiction.

But addiction physicians are increasingly focused on 7-hydroxymitragynine, or 7-OH, and other highly potent kratom-derived products.

Dr. Puneet Lakhmani, medical director of Rosecrance Therapies and an addiction physician, said the concern is that people who are using kratom derivatives may not realize they are using a highly opioid-active substance until they develop tolerance, dependence, or withdrawal.

“People are buying something that is advertised as giving them a pep in their step or a little bit of pain relief,” Lakhmani says. “And they find themselves in a pattern where they have to take more and more of this substance.”

The distinction between traditional kratom leaf and concentrated 7-OH products has become increasingly important. In 2025, the FDA warned consumers about products containing enhanced or added 7-OH and described concentrated 7-OH as a potent opioid with significant potential for abuse.

Federal regulators have since taken additional steps toward restricting 7-OH above a proposed threshold, along with certain synthetic kratom-related compounds. The FDA has also cited preclinical research showing that 7-OH can have substantially greater opioid-receptor potency than morphine in certain experimental models.

For clinicians, the concern extends beyond potency. Repeated exposure can lead to tolerance and physical dependence, with unpleasant withdrawal symptoms, which have the potential to reinforce continued use of these substances.

“Their brain starts to expect that you’re going to get that opioid stimulation,” Lakhmani said. “And when it doesn’t, it manifests cravings and withdrawal symptoms.”

One challenge is that these products may not look or feel like what consumers traditionally associate with opioids. They can be marketed as supplements or wellness products and sold in conventional retail settings.

“Just because it’s legal doesn’t necessarily mean that these risks aren’t there,” Lakhmani says.

For concentrated 7-OH products, overdose risk is another concern. Because of their activity at opioid receptors, respiratory depression may occur, particularly at high doses or when products are combined with other substances that suppress breathing.

That combination of accessibility, potential for dependence, and opioid-related harms makes 7-OH an emerging issue for clinicians well beyond the addiction treatment field.

For people who have developed dependence on kratom, 7-OH, or other opioids, Lakhmani emphasizes that treatment is available.

Care begins with understanding what a person is taking, how much they are using, and what happens when they try to stop. Depending on the individual, treatment may include medication, therapy, recovery support, and a level of care appropriate to their needs.

“The important thing is that there is an off-ramp,” Lakhmani says. “There are objectively validated approaches that are both medication-based and non-medication-based that are effective in helping people get out of this pattern.”

For someone who started using a product believing it was simply a supplement, recognizing escalating use, cravings, tolerance, or withdrawal can be an important first step.

“You don’t have to go through this alone,” Lakhmani says. “That’s what we do best.”