University of Michigan Doctors Warn: 7-OH Addiction Now Making Up a Third of Some Treatment Caseloads

Why it matters

Clinicians at one of the nation's top research universities are sounding the alarm: 7-OH addiction has gone from a rare curiosity to a rapidly growing share of addiction treatment caseloads, and standard buprenorphine does work — if patients can access it.

The big picture

7-hydroxymitragynine (7-OH) is a synthetic opioid chemically derived from mitragynine, the main alkaloid in kratom, but is roughly 10 times more potent and addictive. Since appearing on the market in 2023, 7-OH products have spread rapidly through gas stations, smoke shops, and vape stores under the kratom brand umbrella, often without clear labeling disclosing opioid risks. Kratom and 7-OH poison center calls in the first six months of 2025 already exceeded all of 2024.

Key findings

• 7-OH is approximately 10 times more potent and addictive than kratom's main compound, mitragynine
• One Michigan residential treatment facility went from zero to nearly one-third of caseload being 7-OH patients
• Poison center calls for kratom and 7-OH in the first 6 months of 2025 exceeded all of 2024
• Over 5 million people in the U.S. have used kratom, use is at an all-time high including in children
• Standard buprenorphine (Suboxone/Sublocade) is effective for treating 7-OH opioid use disorder
• Michigan legislation to regulate kratom and 7-OH has reached a potential House vote

What they say

Every week, we are seeing a rapidly growing number of patients, many previously in long-term recovery from opioid use disorder, who are now struggling with severe consequences of 7-OH addiction. — Dr. Eliza Hutchinson, U-M addiction medicine physician

Bottom line

Michigan addiction doctors are treating a surging wave of 7-OH opioid addiction — a substance freely sold at corner stores that is now filling treatment programs at a pace that has overtaken more established opioid addictions at some facilities.