Lawmakers keep trying to ban 7-OH. What do we know about this novel substance?

Lawmakers and regulators across the United States have a new substance in their sights: 7-hydroxymitragynine, commonly known as 7-OH. As of April 19, 2026, at least five states have banned 7-OH, and several more have recently enacted (or are actively considering) similar prohibitions. At the federal level, Congress is considering a bill that would place the substance on Schedule I, the most restrictive level of the Controlled Substances Act, which is reserved for drugs deemed to have a high potential for abuse and no medical application.

These efforts represent a well-intentioned response to the recent increase in deaths involving—though not necessarily attributable to—7-OH. However, prohibition itself comes with a range of potential harms, including hindering research and driving people to the unregulated and more dangerous illicit market. Furthermore, once drugs are banned, de- or rescheduling them is a lengthy and uncommon process, even if scientists uncover strong evidence for medical potential.

Drug scheduling is serious business that best serves individuals and communities when it follows the research rather than precedes it. Research-based knowledge on 7-OH is currently limited; however, here is what we do know.

What is 7-OH?

The kratom plant is a tropical evergreen tree native to Southeast Asia. For centuries, people have consumed the leaves for energy or pain relief, to treat opioid withdrawal, or as an intoxicant. Today, kratom and its potent derivative, 7-OH, can be found in smoke shops and convenience stores across the country, sold in a variety of consumer-friendly forms including teas, shots, candies, pills, and more.

While kratom use has increased in the United States in recent years, lawmakers and regulators are currently focused on a specific compound. A metabolite of the plant’s primary active compound, mitragynine, 7-OH occurs in trace amounts (typically 0.1 percent concentration or less) in whole-leaf kratom. Both mitragynine and 7-OH are partial mu-receptor agonists, meaning they bind to the same opioid receptors as drugs like heroin, morphine, and fentanyl but—unlike those full agonists—do not fully activate them.

Although 7-OH only occurs in minuscule amounts in the kratom plant, some manufacturers are isolating it to generate commercial products that contain much higher concentrations. Many 7-OH opponents focus on concerns about potency and concentration; indeed, the substance is five to 50 times more potent than mitragynine. Therefore, while its trace presence in kratom is not necessarily problematic, higher concentrations do bring greater potential for effect. This does not inherently make 7-OH a dangerous substance. However, it does mean that the extant research on kratom’s effects has limited utility for understanding the potential benefits and risks of 7-OH or for guiding regulatory decision-making.

How do people use 7-OH?

Millions of people throughout the United States regularly use kratom and 7-OH products, and these individuals report similar motivations as seen in Southeast Asia’s much longer history with the plant. In low doses, kratom acts as a stimulant, with some individuals reporting improved energy, mood, and daily functioning. Because it acts more like a typical opioid at higher doses, many people consume it for pain relief, euphoria, and to treat opioid withdrawal symptoms. Approximately two-thirds of those who use kratom report doing so to reduce their dependence on heroin or other opioids or as a substitute for these drugs. Early evidence suggests that using kratom may also help some people reduce use of other substances like stimulants or alcohol.

What are the risks of 7-OH use?

Kratom has been used for centuries in Southeast Asia with few negative effects reported. Recent U.S. data also suggest that whole-leaf kratom is safe to use although not risk free: About one in five kratom users experience adverse consequences, and roughly 1 percent experience effects that drive them to seek medical treatment.

Although 7-OH is derived from kratom, products that center this compound are more potent than those based on the whole-leaf plant. Therefore, despite kratom’s lengthy history of use with minimal negative effects, the risks associated with 7-OH warrant a closer look.

Common side effects associated with kratom and 7-OH include increased heart rate, nausea, dizziness, agitation, and constipation. Rare but more serious side effects include seizures, liver toxicity, and arrhythmias.

Like many other drugs and medications—from coffee and nicotine to oxycontin and fentanyl—kratom and its derivatives can lead to tolerance and physical dependence. This means that over time people may need to use more of the drug to achieve the desired effects and that suddenly stopping use may result in withdrawal symptoms. While experts do not consider most kratom use to constitute a substance use disorder, some individuals do develop an addiction characterized by compulsive use despite negative consequences. It is noteworthy that very little research related to kratom dependence and addiction specifically examines 7-OH, which makes this relatively novel compound an obvious target for future studies.

Perhaps the most significant factor driving lawmakers’ and regulators’ recent attention to 7-OH has been a number of high-profile overdose deaths. As a compound that binds to and activates the brain’s mu opioid receptors, 7-OH can cause respiratory depression. However, because 7-OH is a partial agonist, there is a “ceiling effect” on that respiratory depression, which makes it less likely to cause an overdose than full opioid agonists like morphine, heroin, or fentanyl. This distinction is currently supported by the fact that in the vast majority of overdoses involving kratom or 7-OH, other drugs have been present— most often fentanyl.

While these risks are important to consider, they also must be understood within the context of kratom and 7-OH use more broadly. In particular, individuals who use kratom products are more likely than non-users to report using other substances, both legal and illegal. Furthermore, as many as one in 10 people with an opioid use disorder use kratom. Thus, polysubstance use—whether for self-medication or recreational purposes—is a complicating factor in all of these issues.

Conclusion

Lawmakers across the United States are increasingly considering legislation, emergency orders, and regulatory efforts to prohibit the kratom plant and especially its potent derivative, 7-OH. While these proposed policies are often well-intended, they represent a reactive approach that oversimplifies a complex issue. Across substances, prohibition and even excessive restriction come with dangers of their own, driving people away from regulated options to illicit markets and unregulated products.

In addition, criminalization can increase stigma, which discourages individuals from seeking treatment or other help when they need it. Bans also hinder research, preventing scientists from gaining a more accurate and nuanced understanding of a substance. This information is essential to developing a regulatory approach that aligns with 7-OH’s risks and benefits to individuals and society.