ACMT warns of public health risks from 7-OH kratom compounds

The American College of Medical Toxicology says concentrated 7-hydroxymitragynine products linked to kratom can cause opioid-like intoxication, respiratory depression, dependence and withdrawal. The group urges clinical research and tighter controls as commercial products spread in U.S. retail and online markets.

Why it matters: - The American College of Medical Toxicology says 7-hydroxymitragynine and related kratom compounds behave like opioids and can create overdose risk. - ACMT says there are no proven therapeutic benefits for 7-OH and other kratom-associated compounds. - The position statement calls for use only in clinical research with institutional, regulatory and ethical oversight. - ACMT supports measures to stop unrestricted, nonprescription sales of opioid agonists.

What happened: - ACMT released a position statement on public health concerns tied to 7-OH and other kratom compounds. - The group says clinical experience links 7-OH to intoxication, respiratory depression, dependence and withdrawal. - ACMT says concentrated 7-OH products in U.S. retail and online markets have been linked to overdose and death. - The statement says withdrawal and dependence have been treated successfully with medications for opioid use disorder, including buprenorphine and methadone.

The details: - Kratom, or Mitragyna speciosa, is a tree in the coffee family native to Southeast Asia. - Kratom leaves and extracts have long been used for mild stimulant effects and other medicinal purposes. - In the United States, some people use kratom for stimulant or euphoric effects or to manage pain, depression, anxiety or opioid use disorder. - Mitragynine, kratom's main active alkaloid, is a relatively weak mu-opioid receptor agonist that can produce analgesia, sedation and respiratory depression. - Seven-hydroxymitragynine occurs naturally in trace amounts in kratom leaves and is also a metabolite of mitragynine. - ACMT says 7-OH appears substantially more potent than mitragynine. - Other mitragynine-derived compounds named in the statement include dihydro-7-hydroxymitragynine (MGM-15), 9-fluoro-dihydro-7-hydroxymitragynine (MGM-16) and mitragynine pseudoindoxyl (MP). - Beginning in the late 2010s, concentrated 7-OH products became commercially available in U.S. retail and online markets. - Those products have been sold in gas stations, convenience stores and smoke shops. - Many products are labeled as kratom and marketed for pain and anxiety. - Independent analyses found some commercial products had constituent profiles inconsistent with natural leaf material, suggesting adulteration or spiking with 7-OH. - Testing of products labeled to contain 7-OH found concentrations far above levels in natural kratom and above labeled amounts. - Online retailers have also sold MP, MGM-15 and MGM-16. - A rat study found intravenous 7-OH caused opioid-like respiratory depression that reduced breathing frequency, tidal volume and minute ventilation. - Naloxone fully reversed those respiratory effects in the rat study. - Another rodent study found intraperitoneal 7-OH was more potent than mitragynine for analgesia and could substitute for morphine in drug-discrimination assays. - Repeated subcutaneous 7-OH in mice produced tolerance and opioid-like withdrawal signs, including naloxone-precipitated withdrawal. - A rodent pharmacokinetic study found only 2.7% of gavaged 7-OH was orally bioavailable. - ACMT says that limited oral bioavailability still could produce clinically relevant exposure at high doses or with sublingual or buccal absorption. - Human data on MP, MGM-15 and MGM-16 remain limited, but animal studies suggest mu-opioid effects. - ACMT says major gaps remain in understanding pharmacokinetics and safety, including non-opioid off-target effects. - The statement says standardized preclinical testing and carefully monitored clinical trials are needed to identify toxicities, exposure-response relationships and dosing guidance.

Between the lines: - ACMT is drawing a line between traditional kratom leaf use and concentrated, semi-synthetic or adulterated products sold as kratom. - The warning reflects a broader concern that retail availability is outpacing safety data and regulation. - The statement also suggests that some products may be marketed like wellness items while acting like opioid agonists.

What's next: - ACMT says more clinical research is needed to define the pharmacology, safety profile and possible therapeutic uses of 7-OH and related compounds. - The group says future research should happen under appropriate oversight and controlled conditions. - The statement points to controlled dose-escalation studies and monitored trials as the path to better safety data.

The bottom line: - ACMT says concentrated kratom-derived compounds, especially 7-OH, should be treated as potential opioid risks until stronger human safety data exist.