Kratom and 7-OH: Public Health Risks Amidst Regulatory Gaps

Short Wave · December 29, 2025 · Listen to Original Episode →

Original Title:

TL;DR

The widespread availability of kratom and 7-OH products in unregulated retail environments creates a public health risk due to inconsistent potency and potential contamination, circumventing standard pharmaceutical safety protocols.
7-OH, a potent opioid compound found in kratom, is estimated to be 13 times more powerful than morphine, necessitating careful consideration for regulation due to its high addiction potential.
Kratom's dual nature as a stimulant in small doses and an opioid-like substance in larger doses complicates its classification, leading to a public health debate on its risks versus potential benefits for pain management and opioid weaning.
The lack of FDA regulation for kratom and 7-OH products means consumers may unknowingly ingest products with unsafe levels of heavy metals or contaminants like salmonella, posing direct health threats.
Past public outcry successfully prevented the DEA from scheduling kratom's active ingredients, indicating that future regulatory decisions for 7-OH will likely involve significant public input and advocacy.
Products marketed as "kratom" can contain significantly higher concentrations of 7-OH without clear labeling, creating a dangerous situation akin to misrepresenting alcohol content, where consumers receive a much stronger substance than anticipated.

Deep Dive

Kratom and its potent derivative, 7-OH, are at the center of a complex public health debate, with regulatory bodies like the FDA recommending scheduling 7-OH alongside opioids due to its extreme potency, while millions of users rely on these substances for pain management and to wean off other opioids. This situation highlights a significant gap where the drug market has outpaced scientific understanding and regulatory frameworks, creating a public health challenge with potential implications for addiction, safety, and access to alternative treatments.

The availability of kratom and 7-OH products, ranging from teas and pills to more potent extracts and synthetic goods, is widespread across various retail outlets, making them easily accessible. Traditionally, kratom, derived from tree leaves, has been used in Southeast Asia for centuries to boost energy and alleviate pain. In smaller doses, it can act as a mood enhancer, providing focus and energy akin to coffee, and is even used by some to manage mental health conditions like depression, anxiety, PTSD, and ADHD. However, in larger doses, its effects can mimic those of opioids, leading to pain relief, calmness, and euphoria. The compound 7-OH, a specific alkaloid found in the kratom plant, is of particular concern. While present in tiny quantities in natural kratom leaf, synthetic or extracted 7-OH products can be significantly more potent--reportedly 13 times more so than morphine. This higher concentration means 7-OH binds more exclusively to opioid receptors, raising serious concerns about its addictive potential and safety.

The implications of this regulatory and scientific limbo are substantial. While some researchers and users highlight kratom's benefits for opioid withdrawal and chronic pain management, others point to concerning addiction rates, with over a quarter of surveyed users meeting criteria for kratom use disorder, exhibiting increased tolerance, cravings, and withdrawal symptoms. Anecdotal reports and early data suggest 7-OH may be even more addictive, particularly in formulations designed for rapid absorption, such as nasal sprays or sublingual tablets. Furthermore, the lack of FDA regulation has led to safety scares, including recalls for salmonella contamination and the presence of heavy metals like lead and nickel. A critical issue is product mislabeling, where potent 7-OH extracts are often simply marked as "kratom," akin to mistaking beer for high-proof alcohol. This lack of transparency means users may unknowingly consume much higher doses of psychoactive compounds, increasing risks of adverse events, including overdose deaths, though numbers are often complicated by co-occurring substance use.

The debate over scheduling 7-OH products echoes a similar near-miss a decade ago when the DEA considered controlling key kratom compounds. Public outcry led the DEA to reconsider, illustrating the strong advocacy from user communities. Currently, regulatory authority is fragmented, with some states implementing bans or restrictions, while federal action, specifically scheduling by the DEA, remains a possibility that will determine the future availability and legal status of these substances. This leaves the public and affected communities in an ethical and legal gray area, balancing potential therapeutic benefits against significant public health risks.

Action Items

Audit 7-OH product formulations: Assess 3-5 product types (e.g., nasal spray, sublingual tablet) for mechanisms that bypass absorption barriers, potentially increasing addiction risk.
Track 5-10 kratom/7-OH user reports: Monitor anecdotal evidence for kratom use disorder symptoms and compare to documented opioid withdrawal severity.
Measure 7-OH potency variance: Analyze 3-5 product batches to quantify the difference between labeled "kratom" and actual 7-OH concentration, comparing to opioid potency benchmarks.
Draft regulatory proposal: Outline 3-5 key considerations for DEA scheduling of 7-OH, addressing potential impacts on current users and public health risks.

Key Quotes

"Kratom's derived from tree leaves. It's been used for centuries in Southeast Asia, mostly Indonesia, Malaysia, and Thailand, for energy and to treat pain. But in the US, it's sort of an umbrella term that includes a bunch of different products like teas, pills, extracts, synthetic goods that all vary in strength depending on how they're made."

Rachel Carlson explains that "kratom" is a broad term encompassing various products derived from a Southeast Asian tree. Carlson highlights that these products, used traditionally for energy and pain relief, now exist in diverse forms in the U.S., with varying potencies.

"7-OH is not just like an opioid. It is an opioid. That was FDA Commissioner Marty McCarry during a press conference in July. And that's when the FDA said they were recommending certain 7-OH products be scheduled alongside opioids. Our focus is not on kratom. Our focus is on 7-OH, which according to the Journal of Medical Chemistry is 13 times more potent than morphine."

Emily Kwong relays FDA Commissioner Marty McCarry's statement identifying 7-OH as an opioid, distinct from kratom itself. McCarry's emphasis on 7-OH's potency, noted as 13 times that of morphine, underscores the FDA's concern and recommendation for scheduling.

"The kratom plant contains different compounds called alkaloids. Mitragynine and 7-hydroxy-mitragynine (7-OH) are two of the major psychoactive ingredients. Mitragynine binds to opioid receptors, but also things like serotonin receptors in the brain. And in the kratom plant and in natural kratom leaf products, 7-OH shows up in tiny quantities."

Rachel Carlson clarifies the chemical components of kratom, distinguishing between mitragynine and 7-OH. Carlson explains that while mitragynine affects multiple receptor types, 7-OH is present in very small amounts in natural kratom leaf products.

"So I would see 7-hydroxy-mitragynine more as an opioid than kratom. That's Oliver Grundmann, he's a professor at the University of Florida College of Pharmacy."

Emily Kwong presents Oliver Grundmann's perspective, a professor at the University of Florida College of Pharmacy. Grundmann categorizes 7-hydroxy-mitragynine as more akin to an opioid than kratom itself.

"The real problem too is that even some of these products that are extracts that have higher levels of 7-OH are not labeled as such. They often just say kratom. So it would be like picking up a bottle of beer that should have 5% alcohol in it and actually getting a bottle of Everclear that has, you know, very high content of alcohol. That doesn't sound good."

Emily Kwong shares a quote from Albert Garcia Romeo, an associate professor at Johns Hopkins School of Medicine. Garcia Romeo points out that high-concentration 7-OH products are often mislabeled as "kratom," creating a dangerous disparity in potency, likened to receiving Everclear instead of beer.

"So it's possible 7-OH could follow a similar path. But for now, it's up to states. There are some like Ohio, Florida, Rhode Island, Vermont, Indiana. They have either bans, limitations, or age restrictions on either kratom or 7-OH."

Emily Kwong discusses the regulatory landscape for 7-OH products, noting that while federal scheduling is uncertain, several U.S. states have already implemented restrictions. Kwong lists specific states that have enacted bans, limitations, or age requirements for kratom or 7-OH.

Resources

External Resources

Research & Studies

Journal of Medical Chemistry - Mentioned as the source for the claim that 7-OH is 13 times more potent than morphine.
Study surveying 2,000 people who used kratom - Referenced for data indicating that over a quarter met criteria for kratom use disorder.
Animal studies and early data on 7-OH - Mentioned as suggesting 7-OH could be more addictive.

People

Rachel Carlson - Producer of the episode, discussed kratom and 7-OH.
Emily Kwong - Host of the episode, discussed kratom and 7-OH.
Marty McCreary - FDA Commissioner, quoted on 7-OH being an opioid.
David Epstein - Senior investigator at the National Institute on Drug Abuse (NIDA), discussed kratom's effects and symptoms of kratom use disorder.
Oliver Grundmann - Professor at the University of Florida College of Pharmacy, discussed 7-OH as an opioid.
Ed Boyer - Medical toxicologist at Ohio State University, discussed addiction potential of kratom and 7-OH.
Albert Garcia Romeo - Associate professor of psychiatry and behavioral sciences at Johns Hopkins School of Medicine, discussed the mislabeling of 7-OH products.
Jessie Diggins - US Olympic cross country skiing athlete and Sothfa brand ambassador, discussed the importance of sleep for athletic performance.

Organizations & Institutions

FDA (Food and Drug Administration) - Mentioned for its statements and recommendations regarding 7-OH products and for recalling kratom products due to contamination.
DEA (Drug Enforcement Administration) - Mentioned for its past consideration of scheduling kratom's active ingredients as controlled substances.
NIDA (National Institute on Drug Abuse) - Mentioned in relation to David Epstein's affiliation.
NPR - The public media organization producing the podcast.
Memorial Sloan Kettering Cancer Center - Mentioned in a sponsorship message regarding clinical trials.
Charles Schwab - Mentioned in a sponsorship message regarding wealth management.
Freshworks - Mentioned in a sponsorship message regarding IT and customer support software.
Sothfa - Mentioned in a sponsorship message as the official mattress and restorative sleep provider for the US Olympic and Paralympic teams.
BetterHelp - Mentioned in a sponsorship message regarding therapy services.
Mint Mobile - Mentioned in a sponsorship message regarding mobile phone plans.

Websites & Online Resources

plus.npr.org/shortwave - Mentioned for signing up for Short Wave+ to listen sponsor-free and support NPR.
podcastchoices.com/adchoices - Mentioned for learning more about sponsor message choices.
npr.org/about-npr/179878450/privacy-policy - Mentioned as the NPR Privacy Policy.
schwab.com - Mentioned for learning more about Charles Schwab's services.
freshworks.com - Mentioned for learning more about Freshworks products.
sothfa.com/npr - Mentioned for saving on Sothfa products.
betterhelp.com/npr - Mentioned for a discount on therapy services.
mintmobile.com/switch - Mentioned for switching to Mint Mobile.

Other Resources

Kratom - Discussed as a plant-derived substance used for energy and pain, with varying products and effects.
7-OH (7-hydroxy mitragynine) - Discussed as a potent compound found in kratom, with opioid-like effects and concerns about addiction.
Opioids - Referenced as a class of drugs with which 7-OH is compared and contrasted, and from which some users attempt to wean using kratom.
First Amendment - Mentioned in the context of editorial independence for public media.