The Missouri Department of Health and Senior Services has issued a statewide health advisory to warn Missourians about the serious health risks associated with 7-hydroxymitragynine (7-OH), a potent psychoactive product available at gas stations, vape stores, smoke shops and online.
DHSS urges people to avoid products containing 7-OH and cautions anyone experiencing symptoms or suspecting an overdose from 7-OH to call 911 and administer naloxone if available. DHSS said 7-OH, a synthetic derivative of the kratom plant marketed as a natural remedy, is up to 13 times stronger than morphine and has not been tested for safety in humans.
In June, the U.S. Food and Drug Administration issued warning letters to seven companies for illegally distributing products containing 7-OH, including tablets, gummies, drink mixes and shots. In July, the FDA recommended the Drug Enforcement Administration classify the products under the Controlled Substances Act.
Brianne Zwiener, communications manager for the Jefferson County Health Department, said the department’s staff members are aware of the dangers of the drug, thanks to information from the Jefferson County Drug Prevention Coalition.
She said a person will speak about the dangers of 7-OH at the Jefferson County Drug Education Conference in the spring. The Health Department and the coalition are organizing the conference, but the date has not been set.
“(7-OH) is definitely something on the radar,” Zwiener said. “We are looking at ways to provide some education, obviously starting with our drug education conference.
“It’s new. There’s not a lot of data. There’s not a lot of stuff that we really know. It’s very potent. It’s 13 times more potent than morphine, which I thought was very shocking, and it is in some of these products that are easily accessible to individuals.”
In the first nine months of this year, the Missouri Poison Control Center received 47 reports of exposures involving kratom or 7-OH, nearly double the number from 2024.
Eleanor Byrd, the service coordinator for Mercy StepOne for Mercy Hospital South and Mercy Hospital Jefferson, which provides hospital-based stabilization services for opioid and alcohol withdrawal, said she is aware of the problem.
“Since the beginning of 2025, we’re getting more calls in St. Louis from people seeking help with 7-OH addiction,” she said. “We’re still developing evidence-based protocols for the substance because it’s so new, but it’s important to keep up with the trends so we can best support people. In newly released research, medications like suboxone, which we typically use for opioid withdrawal management, are showing promise in helping to alleviate 7-OH withdrawal symptoms.”
Byrd said marketing for the 7-OH products promises pain relief and relaxation for $10 over the counter.
“It’s just kind of a crisis in plain sight,” she said.
A written statement from the FDA said it is “specifically targeting 7-OH, a concentrated byproduct of the kratom plant; it is not focused on natural kratom leaf products. 7-OH is increasingly recognized as having potential for abuse because of its ability to bind to opioid receptors.”
Byrd said a lot of people confuse 7-OH with kratom, but kratom has been around for centuries.
“It’s basically (the difference between) like drinking coffee or taking pure caffeine pills,” she said.
Byrd said there is more of a concern of overdose with 7-OH than kratom, especially when combined with alcohol or other sedatives. Health officials also are concerned that the substance could contribute to liver damage, heart problems, dizziness, confusion “and just a lot of unknowns.”
“The tolerance with 7-OH is very, very rapid,” Byrd said. “So, someone who hasn’t taken opioids might start with 10 milligrams of 7-OH daily, which at a gas station you could typically buy one pill that’s 10 or 20 milligrams, but then build to 600 milligrams daily within just a few months. There are reports that withdrawal is lasting multiple months, which is much longer than traditional opioid withdrawal, from people trying to get off the substances.”