CDPH Health Advisory: Kratom and 7-OH May Lead to Addiction, Serious Harm, Overdose or Death - January 16, 2026

​Background

Kratom is the common name for the leaf of a tropical tree, Mitragyna speciosa. Kratom has a complex pharmacological profile with the potential for sedative, stimulant, and opioid effects due principally to the presence of mitragynine, which is metabolized to 7-hydroxymitragynine, (commonly known as 7-OH), a potent opioid. 7-OH and other kratom derivatives may lead to addiction, serious harm, overdose, and/or death. The use of 7-OH was linked to six recent fatal overdoses in Los Angeles County.

Kratom is sold in many forms, primarily in food and dietary supplements (bulk powders, capsules, tablets, extracts, gummies, and beverages). Kratom is often advertised as an herbal supplement as a solution for pain management, anxiety and mood enhancement, energy, and focus.

An estimated 1.7 million Americans aged 12 and older used kratom in 2021, according to the Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health (PDF, 3MB); use is highest among adults aged 26 or older, estimated at 1.4 million. Many of these people seek out kratom or 7-OH to treat symptoms of anxiety, ​pain, and opioid withdrawal. However, these substances have not been clinically proven to be effective or safe for treatment of these or other complaints, and due to their action on the opioid receptors, they carry their own risks for addiction, withdrawal, and overdose. Harmful side effects of kratom and 7-OH can include withdrawal symptoms, insomnia, anxiety, seizures, and potentially fatal respiratory depression. The U.S. Food and Drug Administration (FDA) has warned people not to use kratom because of the possible harm it can cause.

Because kratom and 7-OH products are widely available and advertised, most consumers incorrectly assume that such products are legal to sell and manufacture for consumption and safe to consume.​

Recommendations for Health Care Providers

• Use motivational interviewing and person-first language to elicit honest information about substance use and develop a trusting, collaborative relationship with patients who use drugs.
• Understand the reasons people use kratom and 7-OH, and know how to communicate compassionately and effectively about the risks related to these drugs.
  
• Educate patients that products claiming to contain kratom or 7-OH have not been tested for safety, consistency, or accurate labeling, nor have they been approved for sale by the FDA.
• Educate parents and guardians about kratom and 7-OH use and strategies for o​pen communication with youth (PDF).​
• Know the differences between whole-leaf kratom and highly concentrated, synthetic products derived from the kratom plant (such as 7-OH).
• • In the natural plant, 7-OH is typically less than 0.02% of the plant's dry weight, whereas 7-OH products typically have concentrations of up to 98% 7-OH. As such, these synthetic products may be more concerning than the natural plant material.​
  • However, whole-leaf kratom is not completely without risks: studies demonstrate that mitragynine, the primary alkaloid in the kratom plant, is metabolized to 7-OH in the liver, resulting in an intoxicating effect that can mimic that of opioids.​
• ​Continue to refer people with opioid use disorders to medication-assisted treatment (MAT), such as buprenorphine and methadone, as well as additional supports for people with substance use disorders.
• ​Inform patients that to reduce risk of overdose, anyone who may use kratom or 7-OH is advised to never mix with alcohol or other drugs, know the signs of overdose, and carry naloxone. Naloxone is a life-saving medication used to reverse an opioid overdose, including overdose related to heroin, fentanyl, prescription opioid medications, kratom, or 7-OH. If possible, provide take-home naloxone and overdose response training before the patient leaves the facility. ​