Semi-Synthetic 7-Hydroxymitragynine Products Pose Distinct Public Health Risk

Why it matters

Novel semi-synthetic 7-HMG products with up to 98% potency — sold under brand names alluding to narcotics — are being confused with natural kratom by consumers and policymakers, creating a dangerous and underrecognized public health gap.

The big picture

Equating semi-synthetic 7-hydroxymitragynine to natural kratom is analogous to equating synthetic cannabinoids to cannabis. Policymakers must distinguish between these distinct product categories, or regulation of the legitimate kratom industry could be derailed by harms caused by synthetic analogs.

Key findings

• • Novel semi-synthetic products now marketed with 14–25 mg of 7-HMG per dose and routes including sublingual tablets and nasal sprays — some contain up to 98% 7-HMG
• • 7-HMG has 14–22x greater mu-opioid receptor binding affinity than morphine — far more potent than natural kratom products
• • Some formulations circumvent first-pass metabolism, dramatically increasing bioavailability and opioid-like effects
• • Forensic labs using mitragynine as a kratom marker would misattribute 7-HMG product fatalities to natural kratom
• • Kratom remains unscheduled and used by 10–15 million US adults; novel 7-HMG products endanger that regulatory status

Bottom line

Expert letter to the editor by researchers from Johns Hopkins, Ohio State, and University of Florida; published in Addiction (2024).