APA Psychiatrists Sound Alarm on 7-OH as New "Gas Station Opioid," Urge Treatment Protocols

Why it matters

Concentrated 7-hydroxymitragynine (7-OH) products—derived from kratom and sold legally at vape shops and gas stations—are causing opioid addiction in patients with no prior drug history. The American Psychiatric Association is urgently calling for formal treatment guidelines, clinical awareness, and sweeping regulatory reform before the crisis deepens.

The big picture

7-OH is semi-synthesized by chemically converting kratom's abundant mitragynine into concentrated 7-hydroxymitragynine, which acts as a full mu-opioid receptor agonist comparable to morphine. The resulting products—gummies, shots, drink mixes, tablets—can contain 500% more 7-OH than natural kratom leaves. The FDA issued a physician warning in July 2025 and announced plans to schedule 7-OH as a controlled substance, but addiction psychiatrists say the regulatory response is too slow and too narrow.

Key findings

• 7-OH is a full agonist at the mu-opioid receptor; in animal models, rodents cannot distinguish between 7-OH and morphine
• Concentrated 7-OH products may contain 500% higher 7-OH levels than natural kratom leaves, according to the FDA
• In the first 7 months of 2025, there were 1,690 kratom-related Poison Control calls—more than the entire previous year; 40% specifically involved 7-OH
• About half of addicted patients presenting to clinics have no prior opioid use history; the other half have histories of opioid use disorder
• Buprenorphine/naloxone is proving effective for kratom addiction but requires indefinite treatment; APA is developing formal clinical guidelines with ASAM and AAAP

What they say

"Kratom is marketed as if it's a cool, hip, fun, trendy thing, and it's legal, so it's readily accessible," said Elie G. Aoun, M.D., assistant professor of clinical psychiatry at Columbia University. "This gives people the impression that it's safe, when in fact it's causing people to develop an addictive disorder."

Bottom line

Addiction psychiatrists warn that 7-OH is creating a new wave of opioid dependence—including in patients with no prior drug history—and the U.S. healthcare system must prepare clinical protocols and regulatory guardrails before the crisis mirrors the prescription opioid epidemic.