Some call this stuff “gas station heroin” or “legal morphine.”
It’s trumpeted as a relaxation drug and workout enhancer, sold as powders, teas, pills, edibles and liquid extracts, marketed as a “natural remedy” easing pain, anxiety, even opioid withdrawal.
But the “natural” products can be synthetic, behave like stimulants and produce opioid-esque euphoria that devolves into rapid, wracking withdrawal, doctors say.
“It’s highly addictive even for people who aren’t addicts,” said Dr. Joe Desanto, who works with several Orange County addiction treatment centers. “I’m seeing cross-trainers and athletes coming in saying, ‘What the hell is going on?’
The story starts with kratom, a tropical tree native to Southeast Asia. The culprit here is a potent derivative of kratom — 7-OH — stocked at vape shops and gas stations until California’s very recent crackdown. Now, it’s a few clicks away on the internet.
This 7-OH is not a traditional opiate, but it fits the brain’s opiate receptors just like an opiate, Desanto said. “Sometimes people in recovery try it to relax, and then they are hooked. The detox management we use for opioids doesn’t touch it. Fentanyl detox is easier and more manageable.
“It’s an evil drug,” Desanto added. “I’m scared for the general public.”
Deadly?
He’s not alone.
“According to public health officials, kratom and 7-OH are associated with addiction, serious harm, overdose and death,” the governor’s office said in March. “These products have not been tested for safety, consistency, effectiveness or accurate labeling and have not been approved for sale by the FDA. When combined with alcohol, prescription medications, or other substances, they can cause severe respiratory depression and fatal outcomes.”
Tracking is in its infancy, and statistics aren’t yet uniform or up-to-date. But the U.S. Centers for Disease Control and Prevention has found that kratom was implicated — at least in part — in at least 846 fatal overdoses in 30 states and D.C.
In California, kratom was implicated in 242 deaths over a three-year period, with 27 blamed solely on “the illegal substance,” the California Department of Public Health said.
By October, the Los Angeles County Department of Public Health had tied six local deaths to kratom. The victims were otherwise healthy “with no other substances identified as substantively contributing to their deaths,” officials said.
The California Department of Public Health issued a statewide consumer warning declaring that foods, dietary supplements and medical drugs containing kratom or 7-OH are dangerous and illegal to sell or manufacture in California in October as well.
But bad outcomes have increased exponentially, according to data from the California Poison Control System. It logged 67 kratom-related cases in 2022; 104 in 2024; and 215 in 2025.
Nationwide, America’s Poison Centers received 1,690 reports of kratom-related cases in the first seven months of 2025 alone, surpassing the total in 2024. There were at least 165 reports related to 7-OH — more than a third had serious health problems, and two-thirds were treated at a healthcare facility.
The U.S. Food and Drug Administration has warned people not to use kratom “because of the risk of serious adverse events, including liver toxicity, seizures and substance use disorder (SUD).” Signs of addiction included “using kratom for longer than intended, using more kratom than intended, having cravings for kratom, continuing to use kratom despite adverse consequences (either physically or in their personal life), increasing the amount of kratom used to produce the same effect (tolerance), and experiencing withdrawal symptoms when kratom use was stopped (physical dependence).”
Newborns have also experienced withdrawal, the FDA said. “Kratom and 7-OH do not have FDA-approved medical use, and products containing 7-OH have not been proven to be safe or effective,” it said.
Earlier this year, the California Department of Public Health cracked down on these products in concert with state Alcoholic Beverage Control and Tax and Fee Administration officials. Over three weeks, more than 3,300 kratom and 7-OH products left shelves at licensed businesses, and officials announced a 95% compliance rate. They seized more than $5 million of kratom and 7-OH products, officials said.
‘Psychoactive’
Researchers spent hours dissecting kratom and 7-OH under the umbrella of “novel psychoactive substances” at the American Society of Addiction Medicine Conference in San Diego last weekend.
In kratom’s indigenous setting in Southeast Asia, people chew kratom leaves or brew them into “decoctions” that are consumed throughout the day, much as coffee is consumed here, Katherine Hill, who’s working on her doctorate at the Yale School of Public Health, said on an ASAM podcast.
But for export, the leaves must be picked, dried and pulverized into a powder. Early products were extracted from the whole leaf and “came to contain all the parts of the plant or were like a little shot or a chocolate bar or some easy product,” Hill said.
Those were refined to feature a chemical called mitragynine. That has morphed into 7-OH products. All of them could be sold under the name “kratom,” though, so it can get confusing, Hill said.
Their research shows that people typically first purchased 7-OH products from brick-and-mortar stores like gas stations and vape shops, then switched to internet sales because it was cheaper, said researcher Kirsten Smith, a leading clinical expert on kratom and recent assistant professor at the Johns Hopkins University School of Medicine.
“I think there’s a newer consumer demographic that might be younger,” she said on the ASAM podcast. “It could be a little bit more like carefree, spur-of-the-moment use.”
People felt a bit like guinea pigs, the researchers found, noting inconsistencies in the nature and potency of 7-OH products that suggest quality control issues. Folks were also frustrated with the products’ marketing, often adopting street drug slang with names like “Perks” and “Blues” and “Roxys.”
But — are kratom et al opioids? That’s harder to answer than you might think.
Kratom leaf extracts typically contain several dozen alkaloids, “and some of these alkaloids absolutely have opioidergic activity,” said Smith.
Some bind to the brain’s opioid receptors weakly. Others more strongly. Others not at all. But isolate 7-OH and the pharmacology is very different; studies have shown it’s extremely potent in its pure form. That’s not what seems to be in commercial products, however; who knows what’s actually in there?
“There’s two things to remember with kratom, and again, I’m just talking about kratom leaf and extract,” Smith said. “A. Yes, there’s opioid activity. B. Is this acting like a typical opioid? No. And part of the reason for that is we have not seen respiratory depression, but it is not behaving like a typical opioid in any way, shape or form. And when I say ‘it,’ I mean any of the alkaloids within kratom.”
Hill agreed. “When people are asking, ‘Is it an opioid?’ It’s not our classical opioid,” she said.
‘Gray zone’
Enter now the FDA.
While 7-OH, a naturally occurring alkaloid in the kratom plant, comprises less than 2% of the total alkaloid content in natural kratom leaves, the FDA said 7-OH demonstrates “substantially greater” opioid-receptor potency than kratom’s primary alkaloid (mitragynine), as well as other classical opioids such as morphine.
Some 1.7 million Americans aged 12 and older have used kratom, according to federal surveys, and last July the FDA launched a national efffort to put 7-OH on the controlled substances list.
In California, the Department of Alcoholic Beverage Control began enforcing its crackdown at more than 4,600 licensed locations in February. As of late April compliance hit 97.26%, and just 126 violations were found, said ABC spokesperson Devin Blankenship.
A simple internet search for “7-OH” suggests that won’t be enough, however.
“The demand for these products will not go away with the prohibition of kratom or 7-OH,” said researcher Smith at ASAM. “This is a very unique gray zone.”
So much is unknown. She and Hill beseeched clinicians to document their kratom and 7-OH cases to help map a way forward.
State and federal officials ask for help as well. Anyone experiencing adverse effects after consuming these products should contact Poison Control at 800-222-1222 or visit poisonhelp.org. To report the unlawful sale of these products, call the CDPH Complaint Hotline at 800-495-3232 or submit an electronic report at https://apps.cdph.ca.gov/AutoForm2/Page/AutoForm2.aspx.
“We are in a new world in which the supplement industry and the internet and dark web have permitted folks who are inclined to just have access to a wide variety of substances that are ever dynamic and changing,” said Smith.
“The drug supply,” said Dr. Timothy J. Wiegand at the ASAM session, “has never been more dangerous and unpredictable.”