Doctor’s Note: What is 7-OH? Featuring Dr. Gerges

Medically Sound takes on recovery’s most complex questions

Over the past few years, kratom has gone from a niche herbal supplement to something you can find in smoke shops, convenience stores, and online retailers across the country. Alongside that rise in popularity, one of kratom’s naturally occurring compounds, 7-hydroxymitragynine or 7-OH, has been getting more attention from researchers, regulators, and people who use kratom alike.

While 7-OH exists only in tiny amounts in natural kratom leaves, some newer products concentrate it to much higher levels. That’s where questions about safety, dependence, and potency start to grow.

Dr. Mark Gerges, MD, has been watching this trend closely. As both a physician and someone following the evolving science on kratom, he’s been tracking the research on 7-OH and listening to what’s happening on the ground. Here, he shares what he’s learned — from how 7-OH works in the body to why certain products carry greater risks — and what people should know before they try it.

Dr. Gerges, what exactly is 7-hydroxymitragynine, or 7-OH, and how is it different from mitragynine?

Dr. Gerges: 7-OH is one of many alkaloids in the kratom plant, but it’s present naturally in very small amounts. Mitragynine is the primary active component of kratom. The key difference is potency, 7-OH binds to opioid receptors in the brain more strongly than mitragynine, which means its effects are more comparable to traditional opioids.

Does 7-OH occur naturally, or does the body make it?
Dr. Gerges: Both. You’ll find trace amounts in raw kratom leaves. But when you ingest kratom, your liver can also convert some of the mitragynine into 7-OH. That metabolic process is one reason the intensity of effects can differ from person to person.

Can you explain the liver’s role in that process?
Dr. Gerges: The CYP3A4 enzyme in the liver transforms part of the mitragynine you consume into 7-OH. How much gets converted depends on your liver health, your genetic makeup, and even other medications or substances you’re taking.

How potent is 7-OH compared to mitragynine or morphine?
Dr. Gerges: It’s substantially more potent than mitragynine at the mu-opioid receptor, the same receptor targeted by drugs like morphine. That means even small amounts of 7-OH can produce strong opioid-like effects.

How do the effects of 7-OH compare to whole-leaf kratom in terms of onset and duration?
Dr. Gerges: 7-OH typically has a faster onset and shorter duration than whole-leaf kratom. Whole-leaf kratom produces a slower build-up of effects because it contains mostly mitragynine along with other alkaloids.

What risks are associated with using 7-OH?
Dr. Gerges: The risks are similar to those of other opioids but can be amplified because dosing is harder to control in unregulated products. There’s a higher risk of dependence, more severe withdrawal, and potentially dangerous respiratory depression, especially in high doses or when combined with alcohol, benzodiazepines, or other depressants.

Why are synthetic or enhanced 7-OH products more dangerous than natural kratom leaves?
Dr. Gerges: It comes down to concentration. Natural kratom has very little 7-OH. Some manufactured products contain much higher levels, making the effects stronger and more unpredictable. That unpredictability increases the risk of overdose.

Are the withdrawal symptoms from 7-OH different from those of mitragynine?
Dr. Gerges: Yes. Withdrawal from 7-OH can start sooner after stopping and often feels more like withdrawal from prescription opioids with stronger cravings, muscle aches, sweating, diarrhea, anxiety, and trouble sleeping.

In what types of products is 7-OH usually found?
Dr. Gerges: You’ll most often see it in concentrated kratom extracts, gummies, shots, and some liquid energy or wellness drinks.

Why is the FDA looking to classify 7-OH as a Schedule I substance? How does that differ from kratom regulation?

Dr. Gerges: The FDA views 7-OH as a high-risk opioid with no accepted medical use, which is the Schedule I standard. Natural kratom isn’t federally scheduled, though it is restricted in some states.

If that scheduling happens, what would it mean for medical use or harm reduction?
Dr. Gerges: It would make possession and sale illegal, even for harm-reduction purposes, and could limit legitimate research into any potential medical uses.

*Since this Q&A was recorded, Florida Attorney General James Uthmeier has issued an emergency rule classifying isolated or concentrated 7-OH as a Schedule I controlled substance under state law—effective immediately. Retailers must remove these products from shelves, and enforcement is already underway. Leaders described 7-OH as a powerful painkiller with high abuse potential and overdose risk.

Is there any evidence that kratom or 7-OH can help with pain or opioid withdrawal?
Dr. Gerges: Some research and anecdotal reports suggest kratom may help with pain and withdrawal symptoms. But safety concerns, especially with high 7-OH products, complicate any potential benefits.

If someone wants to stop using 7-OH, what medical oversight or treatment options do you recommend?
Dr. Gerges: The safest route is to do it under medical supervision. In some cases, we manage symptoms as they arise. In others, we treat 7-OH dependence like other opioid use disorders, using medications like buprenorphine to reduce withdrawal symptoms and cravings. Counseling, peer support, and harm-reduction services can also be important parts of recovery.

What’s your bottom-line advice for people considering or currently using 7-OH products?
Dr. Gerges: Understand that 7-OH is far more potent than natural kratom, and that potency brings greater risks. If you’re going to use it, avoid mixing it with other depressants, keep doses low, and take breaks. And if you’re thinking about stopping, don’t do it alone. Medical guidance can make it safer and more successful.

Doctor’s Note is a monthly blog series where we ask clinicians to unpack complex topics in addiction and mental health. Our thanks to Dr. Gerges for sharing his perspective and expertise—and for his ongoing commitment to evolving how we care for people. Stay tuned for next month’s Doctor’s Note, where we’ll continue the conversation with another expert voice from the field: Dr. Carlos Tirado, on the role of ketamine therapy in treatment.