Novel semi-synthetic 7-hydroxymitragynine products pose public health risks due to the unknown chemical constituents and the known pharmacology of 7-hydroxymitragynine. Clinicians must screen patients for their use and policymakers must distinguish between kratom and 7-hydroxymitragynine.

The policy implications of semi-synthetic 7-hydroxymitraynine products are unknown, but adverse events or fatalities resulting from 7-hydroxymitragynine products could pose complications to the regulation of a growing kratom industry. Kratom is now used by 10–15 million US adults. Decisions regarding kratom scheduling and regulation are liable to become confused if policymakers can or will not differentiate between kratom and high-potency 7-hydroxymitragynine products synthesized in unregulated or makeshift laboratories. To be clear: equating 7-hdyroxymitragynine products to kratom is analogous to equating synthetic cannabinoids to unaltered cannabis or hemp. Although not all organic kratom products are equal, they have not emerged as a net detriment to public health, and they remain unscheduled at the federal level. Novel semi-synthetic 7-hydroxymitragynine products pose public health risks due to the unknown chemical constituents and the known pharmacology of 7-hydroxymitragynine. Clinicians must screen patients for their use and policymakers must distinguish between kratom and 7-hydroxymitragynine.