Cleveland Clinic Journal of Medicine: A Clinical Practice Guide for Physicians on Kratom and 7-OH

Why it matters

A peer-reviewed clinical review in one of the most widely read physician journals in the U.S. signals that kratom has moved from fringe supplement to mainstream clinical concern — and gives practicing physicians actionable guidance for the first time on evaluation, treatment, and what to tell patients.

The big picture

Researchers from Quinnipiac University and Connecticut Valley Hospital reviewed kratom's pharmacology, patterns of use, safety profile, drug interactions, and clinical management in the August 2026 issue of the Cleveland Clinic Journal of Medicine. The review arrives as millions of Americans use kratom for pain, anxiety, and opioid withdrawal — and as concentrated 7-OH products create new toxicity risks. The authors emphasize that newer 7-OH-enriched products differ substantially from traditional leaf preparations and require different clinical assessments.

Key findings

• Kratom's primary alkaloid mitragynine acts as a partial mu-opioid receptor agonist; 7-hydroxymitragynine is far more potent, with greater mu-opioid receptor potency than morphine.
• A 2,700-person survey found 91% of kratom users reported using it for pain, 67% for anxiety, 65% for depression, and 41% to reduce opioid use.
• Clinicians should specifically ask about product formulation because concentrated 7-OH products carry substantially greater toxicity and dependence risk than botanical leaf powder.
• Mitragynine inhibits CYP3A enzymes — a single 2-gram kratom dose increased midazolam exposure by ~40%, suggesting clinically relevant interactions with benzodiazepines, certain opioids, and CNS depressants.
• Naloxone has been used successfully in some kratom toxicity cases but is not universally effective; supportive care and airway management remain primary treatments.

What they say

"Until higher-quality clinical data are available, a stance of cautious neutrality is recommended, neither endorsing nor dismissing use," write the authors. "Patient-centered counseling should acknowledge reported benefits while clearly communicating known risks."

Bottom line

Clinicians now have a peer-reviewed, practical framework for addressing kratom use in their patients — and must treat concentrated 7-OH products as an entirely different clinical risk profile than traditional kratom leaf.