Background: Kratom is a plant widely consumed for the stimulant and opioid properties of its primary psychoactive component, mitragynine. A related compound, 7-hydroxymitragynine (7-HMG), also known colloquially as “7-OH,” “7-Hydroxy,” “7-OHMG,” or “7,” is present in kratom in smaller amounts but is much more potent at the µ-opioid receptor. Increasingly, concentrated 7-HMG is being marketed at gas stations, smoke shops, and online, exposing people to this higher potency opioid in larger quantities. Little has been published about the management of withdrawal from and addiction to 7-HMG. Case Summary: This case concerns a man in his 30s hospitalized for intensive treatment of 7-HMG use disorder. Opioid withdrawal symptoms emerged within 8 hours and were stabilized with methadone 50 mg over 36 hours. Methadone was then tapered, and buprenorphine 16 mg per day was initiated via low-dose induction, with resolution of craving and improvement in co-occurring depression by discharge from residential aftercare. Conclusions: 7-HMG is a widely available, largely unregulated, underrecognized substance with potency at the µ-opioid receptor that may increasingly concern clinicians and policymakers. Patients with 7-HMG use disorder may benefit from medication for opioid use disorder. More research is needed to characterize the effects of 7-HMG in humans and guide management.
Hendler et al. (Tue,) studied this question.