Washington State Health District Issues Clinical Advisory: Screen All Patients for Kratom and 7-OH — Standard Drug Tests Won't Detect Them

Why it matters

Clinicians in Washington State are being warned that standard urine opioid drug tests will not detect kratom or synthetic 7-OH products, creating a dangerous diagnostic blind spot as opioid-like overdoses and withdrawal cases surge statewide.

The big picture

As kratom and 7-OH products proliferate in convenience stores and gas stations, emergency departments are increasingly seeing patients with opioid-like presentations — including respiratory depression, seizures, and altered mental status — that test negative on standard drug panels. With local ordinances restricting access in some Washington communities, healthcare providers are also seeing more withdrawal presentations as dependent users lose legal access to products. The Spokane Regional Health District advisory is one of several local government actions responding to the national wave of kratom-related hospitalizations.

Key findings

• Standard urine drug screens do not detect kratom or 7-OH mitragynine — clinicians should ask directly about use when opioid-like symptoms appear without a positive tox screen
• Clinical adverse effects include nausea, agitation, tachycardia, seizures, hepatotoxicity, respiratory depression, and opioid-like withdrawal
• Chronic use of kratom and 7-OH can cause dependence; patients may not realize how potent or risky their products are
• As local bans take effect, Washington health districts anticipate a wave of withdrawal presentations in emergency departments
• Naloxone should be provided to suspected users; Washington Poison Center and addiction providers are listed as resources

What they say

"Ask your patients about the use of kratom and 7-hydroxymitragynine (7-OH) for unexplained opioid-like symptoms, seizures, vomiting, or withdrawal despite a negative opioid screen," the Spokane Regional Health District advisory states.

Bottom line

**Kratom and 7-OH are invisible to standard drug tests — clinicians must ask patients directly to avoid missing a potentially serious diagnosis.**