Supply ends on a single day
A temporary scheduling order takes effect the day it publishes in the Federal Register — no grace period, no phase-out, no statutory sell-through window, and no clinical transition plan attached.E03
Physician-led · Evidence-graded · Reviewed 8 Aug 2026
Build the bridge
Build the bridge
before you
close the road.
Concentrated 7-hydroxymitragynine should be controlled. But a scheduling order changes the legal status of retail inventory overnight, and a patient's opioid dependence does not change on the same timetable. This resource exists so that clinicians, institutions, patients, and families are ready for the transition rather than surprised by it.
01 — The central point
Concentrated 7-OH is not ordinary kratom leaf.
It is an opioid-active drug sold through an ordinary retail channel, in rapidly usable dosage forms, sometimes with unreliable labelling. Dependence and medically significant withdrawal are real. Respiratory depression and overdose are possible. Regulation is accelerating. Treatment capacity has not been scaled for the people who may abruptly lose access.
The dependent population is uncounted
A patient may deny opioid use while taking a 7-OH tablet every few hours, because neither the package nor the shop taught them to think of it as an opioid. They are in no registry, and a routine opiate immunoassay will not find them.E24
The substitution risk is fentanyl
A person whose tolerance was built on an inconsistently labelled retail product may dose an illicit opioid badly. The illicit market is not a dependable taper — it is a dose calculation with unknown units and lethal error bars.
The position of this resource
This project supports decisive regulation of concentrated and semisynthetic 7-OH products. It also holds that removing a widely available opioid product without a treatment bridge creates avoidable harm. Those positions are not contradictory. Read the full argument →
02 — Start where you are
Six ways into this material
The clinical modules are written for prescribers. The crisis briefing is written for administrators, journalists, and policymakers. The patient guide is written for people who are frightened. Every claim carries a citation that resolves to a graded record in the evidence library.
If it is you
For patients & families
What to expect if your supply disappears, how to get naloxone today, why substituting street opioids is the thing that kills people, the signs that mean you should be seen soon, and what treatment actually looks like.
Read the guide → BriefingThe crisis — who, what, when, where
The regulatory record in plain language: the two notices of intent, the compounds and the 0.050% and 1.00 mg thresholds, the statutory clock, the state patchwork, the surveillance signal, and why a scheduling action becomes a clinical event.
Read the briefing → For prescribersClinical guide — five modules
Receptor pharmacology and why the partial-agonist framing misleads; metabolites, kinetics and testing; a full chemistry and detection reference; the withdrawal course and a buprenorphine-forward treatment framework; comorbidity, toxicity and interactions — plus a printable bedside assessment worksheet.
Open the guide → Most usedWithdrawal course & MAT
The provisional timeline and why it is only provisional, the COWS problem, five-step intake and triage, standard versus low-dose buprenorphine initiation, adjuncts, what not to do, and the argument for the least intensive setting that is safe.
Go to treatment → Audit itEvidence library — 57 records
Every source, graded A to D, with its key finding and its stated limitations. A citation that hides its own weaknesses is a rhetorical device, not a reference. Filter by regulation, surveillance, pharmacology, kinetics, toxicity, or treatment.
Check the sources → Call to armsTake action
What prescribers, health systems, policymakers, and the industry should do in the next thirty days — plus two letters, short and long, that you are free to adapt and post under your own name.
See what to do →
03 — How to read this site
Certainty is labelled, not implied.
The evidence base here is genuinely uneven: solid analytical chemistry and regulatory documents, a small but useful human treatment literature, and almost no controlled data on high-dose human exposure. Rather than dressing every inference in a lab coat, each claim carries a plain label.
Established
Emerging
Mechanistically plausible
Practice-based synthesis
Data insufficient
The most important thing this site does not know
There is no controlled human pharmacokinetic study of the repeated, high-dose, directly ingested commercial 7-OH exposures seen in heavily dependent patients. A precise universal withdrawal clock does not exist, and neither does a fixed “safe hour” for starting buprenorphine. Any source that gives you one is guessing. Patients should not self-start buprenorphine by counting hours from the last dose. How to make the decision instead →
Waiting for a large prospective trial would be scientifically comfortable and clinically useless to patients losing access now. — Why this exists
If you are the patient
Do not stop abruptly and alone. This is treatable.
Do not panic, stockpile, or substitute illicit opioids. Write down the exact product, the labelled milligrams per unit, how many units a day, the dosing interval, and the time of your last dose — then take that to a clinician. Keep naloxone available and make sure someone close to you knows how to use it.
Disclaimer
The clinician pages are educational resources for licensed professionals. They do not replace examination, local protocols, toxicology consultation, or individualised medical judgement. The patient pages do not diagnose substance use disorder and do not provide a self-directed detoxification protocol. The legal tracker is informational and is not legal advice. Nothing here creates a physician–patient relationship. Anyone experiencing withdrawal or toxicity should be evaluated by an addiction medicine professional. In an emergency, call 911.