The substance use treatment field has seen this pattern before.
A new product starts showing up. At first, it looks niche. Then patients begin mentioning it more often. Staff hear different names for it. Nobody is quite sure how serious it is, and by the time the industry catches up, the problem is already bigger than we realized.
It’s now clear that treatment providers need to start paying much closer attention to 7-hydroxymitragynine, or 7-OH.
Most people hear 7-OH and think kratom. That is not entirely wrong, but it is also not the full story.
7-OH is an alkaloid associated with the kratom plant, but the products causing concern today are not simply traditional kratom leaf. The FDA has focused specifically on products with added or concentrated levels of 7-OH, including tablets, gummies, drink mixes and shots. The FDA has described these products as potent opioid products and has advised consumers to avoid them. That distinction matters.
For treatment providers, the issue is not whether every person who uses kratom has an opioid use disorder. They do not. The issue is that concentrated 7-OH products are being sold in ways that may not look or feel like traditional opioid use to the person taking them. That creates a blind spot.
A Product That Does Not Look Like an Opioid
A recent Daily Wire investigation, The Deadly Drug Hiding in Plain Sight, looked at the growth of the kratom marketplace and, in particular, stronger products containing 7-OH. The piece included interviews with physicians, people in recovery and lawmakers and focused on how easily these products can be purchased and how quickly dependence can develop for some users.
The headline is dramatic, but the underlying question is a fair one: What happens when someone is taking an opioid-active substance but does not think of themselves as using opioids?
That is a real issue for our field.
A patient may say, “I don’t use opioids anymore. I just take kratom.”
Another may say, “I buy something at the gas station for pain.”
Someone else may be using a product specifically because they believe it is safer than going back to fentanyl.
Those statements should lead to more questions, not assumptions.
What product are they using?
- How much?
- How often?
- How long have they been taking it?
- What happens when they stop?
- Do they experience sweating, restlessness, body aches, anxiety, insomnia or other withdrawal symptoms?
That is the level of detail we need.
The FDA Is Not Treating This Like a Minor Supplement Issue
The FDA has been increasingly direct about 7-OH. The agency says there are no FDA-approved uses for 7-OH and has warned about products containing high concentrations of it. It has also reported adverse events involving addiction, withdrawal, anxiety, depression, gastrointestinal symptoms, insomnia and seizures. In July 2025, the FDA issued warning letters to companies marketing concentrated 7-OH products. Those products included gummies, tablets, drink mixes and shots.
For treatment organizations, that should be enough to justify a closer look. We do not need to wait for every scientific question to be settled before updating basic screening and staff education.
Our Intake Questions May Be Behind the Market
This is where I think the industry is most vulnerable. Many treatment programs have very good intake processes, but most of them were built around familiar categories like fentanyl, heroin, benzodiazepines, etc.
Kratom may appear somewhere on the form, but often as a catch-all or “other substance.” That is probably no longer enough. If a patient checks “kratom,” that could mean traditional leaf powder. It could mean an extract. It could mean a concentrated 7-OH tablet purchased at a convenience store. Those are not necessarily the same clinical situation.
Treatment organizations should start asking specifically about:
- 7-OH
- 7-hydroxymitragynine
- 7-Hydroxy
- concentrated or enhanced kratom products
- kratom extracts
- tablets
- shots
- gummies
- drink mixes
If possible, ask patients to identify the brand or show a picture of the package. That may sound overly specific. I do not think it is. The market has become specific. Our assessments need to catch up.
This Also Matters for People in Recovery
There is another reason treatment providers should pay attention.
People in recovery from opioid use disorder are often very clear about what they are trying to avoid. They know not to buy pills on the street. They know the risks of fentanyl. They may have cut ties with dealers and changed their routines. But a product sold at a gas station, smoke shop or online may not carry the same psychological warning. If it is marketed around kratom, energy, wellness or pain relief, it may feel different. That does not mean everyone who uses these products will relapse. It does mean treatment providers should talk about them.
Recovery education has to reflect the drug environment people are actually living in.
What Treatment Organizations Should Do Now
I am not suggesting every provider needs to overhaul its clinical program tomorrow. I do think every provider should be reviewing a few basic things. First, look at your intake questions. If someone is using concentrated 7-OH, would your current assessment identify it? Second, make sure admissions, nursing and clinical staff understand the difference between traditional kratom products and concentrated 7-OH products. Third, review how your organization handles suspected withdrawal from unfamiliar opioid-active substances. Staff should know when to escalate concerns medically. Fourth, talk with your toxicology partner. Know what your current panels detect, what they do not detect and what testing options exist if 7-OH exposure is suspected.
Finally, include 7-OH in relapse-prevention conversations with patients who have a history of opioid use. None of these steps are particularly complicated. The bigger risk is assuming the issue does not apply to your program until you begin seeing more of it.
The Industry Should Learn This Lesson Earlier
The treatment field is often forced to respond after the drug supply has already changed.
We saw it with prescription opioids, heroin and fentanyl. The lesson should be that treatment providers cannot rely only on the substance categories we already know. 7-OH is a good example.
It is available in a retail environment. It may be marketed in ways that feel familiar or harmless. Patients may describe it as kratom rather than an opioid. And the clinical picture may be more serious than the language suggests.
That is enough reason for the SUD field to pay attention. We should also be careful not to overstate the issue. Traditional kratom and concentrated 7-OH products should not simply be treated as the same thing. The FDA itself makes that distinction.
Precision matters. But awareness matters too. The question I would ask every treatment provider is simple: If a patient walked into your program tomorrow dependent on concentrated 7-OH, would your team know what they were looking at?
If the answer is no, this is probably a good time to start the conversation.