On September 12, the Los Angeles County Department of Public Health (LACDPH) announced that 7-Hydroxymitragynine had been linked to three overdose deaths. Better known as 7-OH, the synthetically concentrated version of a compound found in the plant kratom has rapidly gained attention since the Food and Drug Administration recommended in July that it be placed under Schedule I of the Controlled Substances Act.
Various media outlets are reporting that 7-OH was directly responsible for the deaths, which is also the conclusion most people would probably draw from the LACDPH press release, where 7-OH was the only substance singled out in the headline.
“The Los Angeles County Department of Public Health is making residents and health care providers aware of the risks of the synthetic kratom compound known as 7-Hydroxymitragynine (7-OH) after the County of Los Angeles Medical Examiner recently identified three fatal overdoses in LA County residents between the ages of 18 to 40 years old,” LACDPH stated. “Alcohol was present in all cases. The decedents were otherwise healthy, with no other substances identified as substantively contributing to their deaths.”
In medical examiner case records that LACDPH confirmed to Filter correspond to the three deaths in question, none determined 7-OH to be the primary cause of death. One that lists cause of death as acute alcohol toxicity cites 7-OH as an underlying cause alongside kratom and two antidepressants, and notes that other significant conditions included “pulmonary congestion and edema, psychiatric history with prescribed antidepressant therapy.”
LACDPH told Filter that reconciling this with description in the press release would be best addressed by the medical examiner, who had not responded as of publication time.
FDA slide warning of 7-OH as an emerging public health threat
In August, just after the FDA recommended banning 7-OH under Schedule I of the CSA, Louisiana passed a bill that banned both 7-OH and kratom explicitly. Florida became the first state to ban 7-OH on its own. America’s Poison Centers—the organization that oversees the National Poison Data System—reported that so far in 2025 there had been 165 reports of 7-OH exposure. Of the unspecified number of patients who reported exposure to 7-OH and no other substances, more than one-third had “serious health problems” and more than two-thirds “were treated at a health care facility.”
7-OH isn’t readily detectable on standard urinalysis tests. So the data that US poison centers are going off of is primarily self-reported, and isn’t confirmed at a lab. The same is true of calls about kratom exposure.
“At low doses, 7-OH can have stimulant-like effects and at higher doses it has opioid-like effects,” LACDPH continued in its press release. “High doses of 7-OH and/or co-used with alcohol or other sedatives can cause severe respiratory depression and death. Again, they are unregulated and may contain unknown concentrations of 7-OH, increasing the risk of unintentional overdose.”
We tend to think of stimulants as uppers and opioids as downers, and there is obviously a lot of truth to that. But a more complete description would explain that all kinds of drugs have a stimulating effect at lower doses, and a sedating effect at higher doses. Alcohol is a good example of this, because it’s so commonly used; most of us are probably familiar with the concept of someone getting chatty after the first couple of drinks, and passing out by the end of the night. But it’s not clear what basis there is for saying that “high doses” are linked to respiratory depression and death. 7-OH is unregulated. What constitutes a high dose, and how does someone know that’s what they’re taking?
Prohibition and regulation are legal constructs that have very little to do with a drug’s actual benefits or harms.
Advocates for 7-OH say the sudden attention to 7-OH is being manufactured by, essentially, Big Kratom.
“Unfortunately, there are current efforts in a number of state legislatures to ban 7-OH, which are largely driven by a kratom organization that views 7-OH as a threat to its market share,” states Holistic Alternative Recovery Trust, a nonprofit supportive of 7-OH and other opioid alternatives. “7-OH can be an invaluable harm reduction tool that should remain an option for the hundreds of thousands of consumers that rely on it. This was a key factor in HHS’ decision to reject efforts to ban kratom and 7-OH.”
Groups like the American Kratom Association, meanwhile, are quick to draw a distinction.
“The AKA is committed to protect consumers from deliberately deceptive marketing by 7-OH product manufacturers who are materially misleading and confusing consumers seeking traditional kratom products,” AKA Senior Fellow on Public Policy Mac Haddow stated in January. “Any product containing a level of 7-OH that exceeds the 2 percent of the overall alkaloid content are not kratom products, and consumers looking to purchase traditional kratom products should avoid these mislabeled products.”
Beginning with Indiana and Wisconsin in 2014, seven states have now banned kratom. This includes Rhode Island, which in July passed legislation to reverse its ban and plans to flip to a legal regulation model in 2026. The FDA’s recent call to ban 7-OH didn’t extend to kratom. (The agency attempted to ban kratom nearly a decade ago, but was overwhelmed by public pushback.)
This gets confusing because many kratom stakeholders are also pushing for legal regulation of the plant, which contains the chemical compound they’re are hoping to ban (in its concentrated form). 7-OH stakeholders, meanwhile, are also arguing for regulation, and suggesting that the compound has untapped medical benefits while posing no more risk than kratom.
The important thing to remember in all this is that prohibition and regulation are legal constructs that have very little to do with a drug’s actual benefits or harms. That’s why the CSA tells us that marijuana has no medical benefits and alcohol has no potential for addiction, and the designation reserved for the most dangerous drugs of all—Schedule I—is a list of 300 synthetic cannabinoids and unpronounceable research chemicals.
Images (cropped) via United Stated Food and Drug Administration
