Study Finds National Poison Center Database Undercounts 7-OH Exposures by 20% Without Verbatim Text Search

Why it matters

Policymakers and public health officials rely on poison center data to track emerging drug threats — but this study shows that 7-OH exposure cases were being missed, meaning the true scope of the crisis is likely larger than official reports indicate.

The big picture

America's Poison Centers' National Poison Data System is the primary real-time surveillance tool for tracking toxic exposures across the U.S. As 7-OH products flooded the market from 2023 onward, the system had to adapt its coding to capture this new substance. This study reveals a structural gap: poison center calls mentioning 7-OH by product name were being classified under generic kratom codes, masking the specific compound's public health impact.

Key findings

• Researchers queried the National Poison Data System for kratom and 7-OH exposures from January 2023 through July 2025
• A total of 186 exposures to 7-hydroxymitragynine were identified overall
• 149 cases were identified by product code; an additional 37 were found only through reviewing verbatim substance text
• Searching verbatim records identified 7-OH cases two months earlier (November 2024 vs. February 2025 when the product code launched)
• The verbatim search method captured approximately 20% more 7-OH exposures than coding alone

What they say

The study authors concluded that "reviewing uploaded substance verbatim was able to identify 7-hydroxymitragynine exposures earlier and captured an additional 20% of exposures," underscoring the value of enhanced surveillance methods.

Bottom line

Official poison center tallies for 7-OH are likely undercounted by at least 20% — meaning the real-world harm signal is larger and earlier than existing public health data suggest.