California Osteopathic Physicians Issue Clinical Alert: Kratom and 7-OH Carry Overdose and Addiction Risk

Why it matters

Formal guidance from a physician organization helps front-line clinicians respond to increasing patient use of kratom and 7-OH — especially as patients may not volunteer this information and standard drug screens often don't detect it.

The big picture

As kratom and synthetic 7-OH products proliferate in convenience stores and online, clinicians are encountering patients who use them but may not consider them "drugs." The FDA has warned against kratom, and six Los Angeles County deaths were recently linked to 7-OH specifically. The ACOFPCA advisory synthesizes current evidence and provides practical, patient-centered recommendations to help physicians navigate this emerging clinical challenge.

Key findings

• Six recent fatal overdoses in Los Angeles County were linked to 7-OH products
• In natural kratom leaf, 7-OH comprises less than 0.02% of dry weight; in commercial 7-OH products, concentrations can reach 98%
• Whole-leaf kratom also carries risk because mitragynine is metabolized to 7-OH in the liver
• Physicians are advised to use motivational interviewing, screen for kratom use, and discuss naloxone with at-risk patients
• Naloxone can reverse respiratory depression caused by kratom or 7-OH overdose

What they say

According to the advisory, "due to their action on opioid receptors, [kratom and 7-OH] carry their own risks for addiction, withdrawal, and overdose" — and most consumers incorrectly assume these products are safe because they are sold legally.

Bottom line

A physician group is warning that both natural kratom and synthetic 7-OH carry opioid-like overdose risks, and that naloxone should be discussed with any patient who uses them.