Explainer: Life-destroying addiction can start at a corner store

When Nathan B. got a free sample pill from his local smoke shop clerk, he never imagined that it would lead him to lose his girlfriend, his job, his house, his cars, his pets and his hard-won years of sobriety.

A former college football player, he never thought that a candy-colored pill would start him down a path leading to months of addiction treatment.

“It tore my life apart,” he said now.

Nathan is one of the untold thousands of Americans whose brains have been hijacked in the last two years by 7-OH, a synthetic opioid that acts on the same parts of the brain as heroin and other opioids.

He’s sharing his story to warn others who might make the same mistake he did at that smoke shop: believing the lie that 7-OH products and others like them are harmless.

Widely available despite dangers

7-OH is a chemical also found in kratom, a plant-derived stimulant from southeast Asia that also acts on the brain’s opioid receptors and carries risks.

Because of legal loopholes, both kratom and 7-OH products are available in smoke shops, vape shops, gas stations and convenience stores nationwide.

Most states, including Michigan, have little or no regulation about their labeling, dosing, purity, who they can be sold to or who can sell them.

A few states, including Ohio, have issued emergency bans or passed restrictions.

The federal government has proposed, but not finalized, regulating 7-OH like it does other opioids.

But right now, the products are everywhere.

Kratom packaging emphasizes its plant-based nature, while 7-OH products often have colorful packaging, a candy-like appearance and fruity flavors.

7-OH, which is made in a lab and not from the kratom plant, is 10 times more potent and addictive than the main active component of kratom, and has been associated with fatal overdoses.

“This isn’t kratom,” said Nathan. “This is totally a different beast altogether.”

Kratom can also cause vomiting at high doses, which Nathan said kept him from overusing it when he was trying to stay off the prescription opioid painkillers he had become addicted to after receiving them for a football injury.

“When 7-OH had just come out, I remember they told me it was an extracted form of kratom – that they had just taken the molecule and made it into its own product,” he remembers. “So I started buying it.”

Unlike street drugs or illegally purchased prescription drugs, anyone can use a credit card to buy both kratom and 7-OH.

Soon, Nathan said, he was spending $300 a day buying hundreds of milligrams in 7-OH doses.

He would wake up in the middle of the night in withdrawal, even though he had taken a dose at 8 p.m.

Withdrawal didn’t only mean physical symptoms such as aches, profuse sweating, nausea and vomiting, but strong cravings for more opioids and suicidal thoughts as it wore off.

Addiction to 7-OH not only derailed his life but drove him deeply into debt as he needed more and more of it to feel the same effect.

Treatment that works for 7-OH and kratom addiction

Fortunately for Nathan, he found his way to the addiction care program at Packard Health run by Eliza Hutchinson, M.D., a University of Michigan family medicine physician with special training in addiction medicine.

Hutchinson prescribed Nathan the same FDA-approved medication that she prescribes to people who have been diagnosed with addiction to heroin, fentanyl, oxycontin and other opioids.

It’s called buprenorphine, with brand names such as Suboxone, Subutex and Sublocade.

Over the past four months, the medication – first as a daily oral dose, then as a monthly injection – has helped Nathan get back to work and life.

Also essential: Keeping up with regular therapy sessions at Packard and daily 12-step program support groups in the community.

Nathan knows he’ll need to go to meetings daily for the rest of his life. They’ll be his ongoing  “medicine” to help him stay away from kratom, 7-OH and other substances, he says.

Recovery is a journey. Medication assisted treatment and the decision to taper off or continue medications is a doctor-patient discussion that weighs the risks and benefits based on scientific data that should be individualized for each patient.

He’s even started refilling his car at a gas station that has a small kiosk instead of a convenience store, to avoid even the chance of seeing 7-OH products.

Nathan is far from alone. But his success and willingness to speak out should inspire others, says Hutchinson, a Clinical Assistant Professor in the U-M Medical School’s Department of Family Medicine and Medical Director of Packard Health’s Medications for Addiction Treatment program.

“Every week, we are seeing a rapidly growing number of patients, many previously in long term recovery from opioid use disorder, who are now struggling with severe consequences of 7-OH addiction. I am grateful that the same medication we’ve used for years during the first three phases of the opioid crisis also work to help them,” she said.

“Still, it is alarming how readily available this substance is in communities across Michigan, often without appropriate labeling to help a consumer understand the severity of the risk to their health and wellbeing,” she added.

Hutchinson also noted that the emergency medication naloxone can reverse an opioid overdose and successfully restore breathing to reverse the effects of opioids, including 7-OH.

A rapidly growing issue

Nathan says that he was the first patient treated for 7-OH addiction at one of the two Michigan-based residential treatment facilities he went to before losing his insurance along with his previous job.

His treatment at Packard Health is covered by Medicaid, while he works to get back to full-time employment with insurance coverage.

One of the therapists who treated him in residential care has since joined Packard Health and told him that now it accounts for nearly a third of the other facility’s patients.

Hutchinson said that people who don’t have access to mental health care or addiction care may self-medicate with kratom, which has some antidepressant-like effects as well as mitigating pain and increasing energy.

Others may even turn to kratom to avoid using more harmful opioids such as fentanyl.

But with kratom products and 7-OH products side-by-side in shops, and 7-OH marketed as a kratom “derivative,” stories like Nathan’s are becoming more common.

Vita McCabe, M.D., the director of the U-M Addiction Treatment Services in the U-M Department of Psychiatry, says that just like Packard Health, her team and their colleagues around the state are seeing more patients with both kratom and 7-OH issues who require medications for addiction treatment.

“This is a wolf in sheep’s clothing,” she said. “Many individuals do not understand the risks of taking kratom and 7-OH products since it is unregulated and is marketed as an energy supplement, among many other things.”

She added, “What most people don’t understand is that they may develop a kratom use disorder, which is a form of an opioid use disorder, that has the same symptoms, side effects, and treatment as all opioid use disorders. We don’t sell oxycodone, heroin or fentanyl in gas stations for people to self-administer.”

A call for regulation

A Michigan state representative has introduced legislation to regulate kratom and 7-OH products, and it has reached the point where it could be voted on by the state House.

Sean Esteban McCabe, Ph.D., who directs the U-M Center for the Study of Drugs, Alcohol, Smoking and Health in the School of Nursing, advised on the bill’s draft.

“Kratom and 7-OH regulation is needed in Michigan if we are serious about protecting our children and fellow Michiganders,” he said.

“While kratom is a natural plant that has been used for hundreds of years, kratom and 7-OH products are widely available throughout Michigan at many outlets to children right now and these products can contain other dangerous substances.”

The arrival of 7-OH products from labs that figured out how to make and sell synthetic forms of the same chemicals that occur in trace amounts in kratom leaves was a game changer, he says.

Officially, 7-OH’s chemical name is 7-hydroxymitragynine. Products also sometimes include another chemical found in trace amounts in the kratom plant, called mitragynine pseudoindoxyl or MP.

But those products don’t contain other compounds found in natural kratom that act against the action of 7-OH and MP.

None of these are regulated, and they can be especially dangerous in children and teens who may think they’re safe because they’re widely available – or worse, may think they’re candy, largely due to marketing directed at younger age demographics.

“Kratom and 7-OH products were involved with more U.S poison center calls in the first six months in 2025 than all of 2024,” he noted. “Kratom has been used by over 5 million people in the U.S. and use is at an all-time high, including in U.S. children.”

The number of deaths involving these substances isn’t yet known, because tests of the blood and tissue of people who died of suspected drug overdoses aren’t usually tested for 7-OH or other synthetic alkaloids.

And because the drug changes rapidly once it’s inside the body, it may not be detectable if the tests aren’t done very soon after death. The risk is therefore much higher.

Growing research on the risks and harms

Sean Esteban McCabe and his team are studying people in the U.S. who used kratom in the past year, and preparing to publish their findings in a peer-reviewed journal.

In general, they find that these individuals were like Nathan: most also used cannabis and met criteria for a substance use disorder under the DSM-5 diagnosis codes used by health professionals. Many reported serious psychological distress.

“It is important to understand why people are using kratom and 7-OH products and provide evidence-based care to help these individuals,” he said. “Kratom and 7-OH use is often used by people to self-treat anxiety, depression, pain, opioid use disorder, and opioid withdrawal. Kratom, 7-OH and other dangerous products such as phenibut remain entirely unregulated in Michigan and available to children despite experts calling for regulation.”

Staying ahead of unscrupulous manufacturers who will undoubtably try to get around legislation by synthesizing slightly different compounds than the ones specifically mentioned in laws or federal drug schedules will be tricky, he adds.

“Regulating these products can feel a bit like Whacka-Mole but it is the right thing to do and we are fortunate to live in a state that makes data-driven public health decisions,” he said.

Information for clinicians

Health care providers of all kinds also need to know more about 7-OH and kratom, to understand the potential effects and how to counsel patients to avoid these substances – including helping parents understand how important it is for children and teens to avoid them.

U-M’s Michigan OPEN opioid education program has updated its kratom guide with 7-OH information. It offers online, on-demand courses for clinicians on kratom, and on kratom, aggression and psychosis, and online clinician education on 7-OH will launch soon.

Providers can also seek training in prescribing medication for opioid use disorder, and seek a consult with a U-M addiction medicine provider, through the Michigan OPEN site.

In early March, Hutchinson and another U-M addiction physician, Chris Frank, M.D., Ph.D., will present a free online training in prescribing buprenorphine for all types of opioid use disorder to Michigan primary care providers.

A warning from one who knows firsthand

Meanwhile, Nathan hopes that everyone, including people with a history of addiction like him, will heed his experience and stay away.

“If you’ve already struggled with addiction, I would never recommend using kratom or 7-OH products,” he said.

“They are marketing it to addicts, and they’re creating addicts from people who don’t know what they’re getting into.”