Kratom and 7-OH: the science and rise of a new opioid agonist

Kratom has been called everything from a natural painkiller to a dangerous drug. But it’s more complicated than most headlines suggest. At the center of that story is a powerful compound called 7-hydroxymitragynine, or 7-OH for short.

You won’t see it listed on most kratom product labels. Yet it plays a major role in how kratom affects the body, and why it’s raising red flags among researchers and medical professionals. While kratom comes from a plant, 7-OH, the compound your body can turn it into, acts like a highly potent opioid agonist.

It works on the same receptors in the brain as drugs like morphine or heroin, even though it comes from a tree leaf native to Southeast Asia.

People come to QuickMD every day seeking help for opioid dependence, kratom withdrawal, and other substance-related challenges. We’ve seen firsthand how kratom can impact the brain, body, and recovery process and want to help you understand its risks, its effects, and how to safely move forward in recovery.

So what exactly is 7-OH? How do kratom alkaloids form inside the body, and why are more kratom products now containing high levels of it, sometimes without consumers even knowing?

This article breaks it all down. We’ll walk through the science of 7-OH, its effects on the brain, and what current research says about its health risks and potential. Whether you’re curious, cautious, or using kratom to cope with something deeper, understanding how this compound works is essential, especially if it’s starting to feel harder to stop than you expected.

Let’s start with the basics: what kratom is, and how 7-OH fits into the picture.

Where does kratom come from, and how does it work

Kratom comes from the leaves of the Mitragyna speciosa tree that grows throughout Southeast Asia. Traditionally, it has been used in the region to relieve fatigue, improve mood, and ease pain.

For generations, people in countries like Thailand, Malaysia, and Indonesia have turned to these leaves as part of their daily lives. Chewing them for energy during long work days, brewing them into tea when dealing with pain, or using them to find calm during stressful times.

Depending on how much someone takes, kratom can act like a stimulant or opioid. 

Many Americans have discovered kratom while searching for alternatives to prescription pain medications or looking for support during the challenging process of reducing dependence on other opioids.

While kratom use isn’t as widespread across the general population, a 2019 national survey found that roughly 1.9 million people used kratom. That’s a significant number when you consider the risks and lack of medical oversight around its use. 

Use rates were much higher among people dealing with prescription opioid dependence and those using substances like cannabis, cocaine, or prescription stimulants. 

This pattern suggests that for many Americans, kratom isn’t a recreational choice but rather an attempt to manage withdrawal symptoms or find relief when conventional treatments feel out of reach or inadequate.

Kratom contains dozens of compounds, but two matter most: mitragynine and 7-hydroxymitragynine. Mitragynine is the main alkaloid in the plant, but 7-OH is the one with real power, and that’s what we’re diving into next.

What is 7-hydroxymitragynine (7-OH), and why does it matter

7-OH, or 7-hydroxymitragynine, is one of the most active compounds found in kratom. It’s part of a group of chemicals called indole alkaloids (a type of naturally occurring compound that interacts with the brain). While kratom contains over 40 alkaloids, 7-OH is by far the most potent.

It doesn’t show up in large amounts, usually just trace levels in raw kratom leaves. But here’s the twist: your body can turn another kratom compound, mitragynine, into 7-OH. 

That conversion happens in the liver, where mitragynine becomes what’s called an active metabolite, a stronger version that actually affects how you feel.

7-OH effects: what this kratom compound does to your brain and body

7-OH binds to mu-opioid receptors in the brain. These are the same receptors activated by drugs like morphine or heroin. When something has a high binding affinity (meaning it attaches strongly), it tends to have a more powerful effect.

In animal studies, 7-OH was up to 13 times more potent than morphine. It produces what researchers call antinociceptive effects, or pain relief, as it dulls the brain’s ability to register pain signals. 

But with that potency comes risks. 7-OH can cause:

• Respiratory depression: slowed or dangerous breathing
• Physical dependence: your body gets used to the drug
• Withdrawal symptoms: like anxiety, muscle aches, or nausea when stopping

And while natural kratom has very low levels of 7-OH, some kratom extracts and enhanced products are designed to increase it, sometimes without warning on the label. That makes the experience less like a tea leaf and more like a pharmaceutical opioid, significantly increasing its misuse potential.

Kratom vs. 7-OH: what’s the difference?

How modern kratom products may contain more 7-OH than you think

If you’re using kratom you bought online or at a store, you might assume it’s the same thing people have used for centuries. A crushed leaf. Maybe a tea. A natural remedy.

But many modern kratom products, mainly concentrates, extracts, and capsules labeled “extra strength,” aren’t just crushed leaves. These products often contain much higher levels of 7-OH than are naturally found in the plant. Mitragynine is sometimes extracted and chemically converted into 7-OH during processing.

Examples of products with kratom in them include:

• Powdered kratom leaf: The most common form, usually sold loose in bags. Users often mix it with water, juice, or make tea.
• Capsules or tablets: Pre-measured doses of kratom powder in pill form, often marketed as “easy to use” or “fast acting.”
• Kratom extracts: Highly concentrated forms, often labeled as “extra strength,” “liquid shots,” or “resin.” These contain much higher levels of compounds like 7-OH.
• Tinctures: Alcohol- or glycerin-based liquid kratom extracts, sold in dropper bottles.
• Kratom teas or drink mixes: Prepackaged tea bags or powder blends intended for brewing, sometimes flavored or combined with other herbs.
• Gummies or edibles: Sweetened products containing kratom, often with vague labeling.

As the market for stronger, more convenient forms has grown, so has the concern about how potent some of these products have become, especially when it comes to 7-OH.

The question many people are now asking is: How risky are these high-strength products really?

Is 7-OH dangerous? Risks of high-potency kratom products

When 7-OH is present in high concentrations, it behaves less like a plant-based supplement and more like a full opioid agonist, meaning it acts strongly on the brain’s opioid receptors, similar to drugs like morphine or heroin, raising its abuse potential.

That shift dramatically raises the chances of:

• Physical dependence
• Intense withdrawal symptoms when stopping
• Overuse or unintentional overdose, especially when mixing with alcohol or other substances
• Respiratory depression, particularly with high doses or in vulnerable users

If you’re struggling with kratom, you didn’t do anything wrong. Many people turn to it, trying to manage real pain or withdrawal. But what starts as something that feels natural can change over time, and that doesn’t mean you failed. 

The way these products are processed today means they may be acting more like an opioid than a supplement, even if they didn’t start out that way.

One reason withdrawal can hit harder than people expect? Many commercial kratom products aren’t just natural leaves. A study found that several popular brands contained unnaturally high levels of 7-OH, which could lead to serious adverse events. These boosted levels may lead to quicker dependence, stronger cravings, and more intense withdrawal symptoms.

If you’re already feeling run-down or foggy, it may not just be withdrawal: some products have tested positive for lead and other heavy metals at unsafe levels.

Looking for advice? Check out our blog for more practical guidance on opioids and kratom, including withdrawal, and how to spot early signs of dependence.

What’s in kratom products?

Many people don’t realize these products can also carry risks that have nothing to do with addiction. In FDA testing, some were found to contain unsafe levels of heavy metals like lead and nickel. That kind of long-term exposure can take a toll, especially if you’re already not feeling well.

The FDA has warned that some products with kratom in them also carry risks of contamination with salmonella, and has even issued mandatory recalls in the past due to unsafe batches.

The FDA continues to warn consumers about these risks, especially in kratom extracts and powders that are marketed as safe or natural alternatives to pain medications. Some of these products may even be spiked with additional alkaloids or synthetics that haven’t been fully studied.

Why 7-OH in kratom deserves more attention

You may think you’re just taking a natural product, but if that kratom capsule or liquid contains boosted levels of 7-OH, it could be working like a strong opioid, with all the risks that come with it. And if you’re struggling between needing it and wanting to stop, you deserve support, not shame.

And because the total alkaloid content isn’t always listed, you might not know how much 7-OH you’re actually consuming. Even regular use of enhanced products can lead to tolerance, dependence, and withdrawal, especially over time.

If you’ve found yourself needing more kratom to feel the same effects, or struggling to stop, 7-OH may be playing a much larger role than you think.

Kratom dependence and withdrawal: How QuickMD can help

We talk to people every day who are navigating kratom use, often trying to manage pain, anxiety, or withdrawal from other opioids. Some started using it as a “natural” alternative. Others turned to it when they didn’t know where else to go. Many had no idea how strong 7-OH really was or how hard it could be to stop.

We’re not here to scare you. We care about helping you stay safe, informed, and supported.

If you’ve found yourself relying on kratom more than you planned, or noticing that stopping brings on withdrawal symptoms, that’s not a sign of failure. It’s a sign that your body’s working hard to adjust. 

And it might be time to explore safer, more stable ways to feel better.

We offer medical support for:

• Kratom-related physical dependence
• Opioid withdrawal
• Substance use disorder, including treatment with Suboxone® (buprenorphine/naloxone)

All of this happens privately, from home, with licensed providers who understand the unique role kratom now plays in many people’s recovery stories.

Some people who’ve made the switch to medically supervised treatment say the difference is night and day.

Suboxone® saved my life. I’m so much happier…on it than I was on kratom.

Key takeaways about kratom, 7-OH, and where to get help

If you’ve been using kratom regularly, especially stronger extracts or capsules, there’s a good chance 7-OH has played a bigger role than you realized. 

It’s not just one of many alkaloids; it’s the one most responsible for kratom’s opioid-like effects, and also the one most closely tied to dependence, withdrawal, and adverse events.

What started as a natural option may now feel like something harder to stop. If that’s true for you, you deserve real support, not judgment.

Whether you’re looking to cut back, stop entirely, or just understand what’s happening, there’s support available, and there’s no shame in asking for it. You don’t have to figure it out alone, and you don’t have to wait until things get worse to reach out.

At QuickMD, we offer real medical care for people navigating kratom use, opioid withdrawal, and substance use disorders on your schedule, from the privacy of your home.

And if you’re not sure whether your kratom use is a concern, that’s okay too. You don’t have to be in crisis to ask questions or get support from QuickMD providers.

Frequently asked questions about kratom and 7-OH

Is kratom federally legal?

Yes, kratom is technically legal, but that doesn’t make it safe.

Kratom and kratom use is not banned at the federal level, and it isn’t classified as a controlled substance by the DEA. But that legal status can be misleading, especially when compared to illicit opioids. The FDA does not approve kratom for any use and has warned of serious health risks, including liver toxicity, seizures, and dependence. There’s no federal regulation of how kratom is made, labeled, or sold. Kratom remains legal and unregulated in most U.S. states.

That means what you’re using might contain far more active compounds like 7-OH than you realize.

Several states, namely Alabama, Indiana, Vermont, Wisconsin, and Arkansas have made kratom illegal to buy, sell, or possess. Others have added restrictions.

Outside the U.S., kratom is banned in countries like Australia, Japan, Malaysia, and several European nations, where it’s classified as a controlled or prohibited substance.

If you’re using it regularly, feeling withdrawal when you stop, or relying on it just to get through the day, you’re not alone, and there’s help available.

Does kratom affect your hormones?

It can, especially with regular or high-dose use.

Some reports suggest it can lower testosterone levels and raise prolactin, leading to low energy, reduced libido, and even sexual dysfunction.

While the research is still early, what we do know is concerning:

• Kratom may suppress the body’s natural hormone systems (including testosterone)
• It may also affect stress hormones like cortisol, though this is less well understood
• The impact seems to vary from person to person, but for many, the effects are negative

If you’re noticing changes in sex drive, mood, or energy since starting kratom, it could be a sign that your hormones are being affected.