This year, Workit Labs published an article in the peer-reviewed journal, Annals of Internal Medicine Clinical Cases. Their article, “What Clinicians Should Know About Kratom and 7-OH Mitragynine” is aimed at doctors and researchers. But what does it say to regular people like us?
What are kratom and 7-OH?
Kratom (Mitragyna speciosa) is a recreational substance that is increasingly being used in the United States. It comes from trees native to Southeast Asia. At low doses, it acts like a stimulant. At high doses, it acts like an opioid. One of kratom’s active compounds, 7-hydroxymitragynine (called 7-OH), has also recently become more widely available. 7-OH is extremely good at bonding to the opioid receptors in the brain (up to 22 times more than morphine), which means it has a greater opioid-like effect than leaf kratom, as well as a greater risk for dependence and addiction. Kratom and 7-OH products may be found in smoke shops, vape shops, cafes, gas stations, and on the internet.
Are kratom and 7-OH legitimate treatments?
There is no evidence-based indication for medical use of either kratom or 7-OH.
Are kratom and 7-OH dangerous?
The first concern is that people don’t really know what they’re consuming when they take kratom and 7-OH products. There is no regulation by the U.S. Food and Drug Administration requiring that products use standardized formulation or clear labeling of dose-strength. So the potency and purity can vary greatly. There are also concerns that products can be contaminated with other substances (like lead).
The second risk is the effects kratom and 7-OH can have on the body and mind. Some people who use kratom and 7-OH regularly have been shown to develop damage to the liver and kidneys, seizures, difficulty speaking, heart attack, overdose, and death.
Why would people use kratom or 7-OH?
These products are often marketed for overall wellness, energy, managing pain or mood, or as a way to get a natural, safe high. Newer products, such as 7-OH–infused gummies, ice creams, and sweet drinks, make it easy to consume high levels of the substance without really knowing what they’re taking.
We’ve known people to start using kratom products as a private and inexpensive attempt to self-manage their opioid use disorder. Note that the recommended treatment for opioid use disorder is buprenorphine, which has years of testing and evidence supporting its use.
How is kratom or 7-OH dependence treated?
Given the similarities of kratom or 7-OH dependence to opioid use disorder, buprenorphine treatment is generally considered a best practice. Guidelines for treatment have not yet received wide consensus. Like with opioid use disorder, treatment is probably better long-term, rather than using buprenorphine for a quick detox or rapid taper. In our experience, many members who come to us with kratom or 7-OH dependence also have anxiety symptoms; We believe it’s important to treat the anxiety alongside the kratom or 7-Oh dependence.
Where do the people setting regulations and making laws go from here?
It may be tempting for lawmakers to just ban kratom and 7-OH products. However, regulations should recognize that many of the people who are using kratom can develop withdrawal symptoms. Cutting off access can cause physical and mental health crises. (This article was published before the DEA announced its plan to list 7-OH temporarily as a Schedule I controlled substance.)
We would suggest regulations that limit consumption and access without a straight-out, sudden ban. We also think the vendors who sell these products should offer education so consumers can make informed decisions, and so they know treatment is an option.
Click here to read “What Clinicians Should Know About Kratom and 7-OH Mitragynine” in the Annals of Internal Medicine Clinical Cases.