Status As of August 8, 2026, no DEA temporary scheduling order for 7-OH has been published in the Federal Register. The earliest lawful effective date was August 5, 2026 — an order may publish any day. Track the docket →
Eusomnia 7-OH Resource

Evidence library

Every source behind this resource, with its evidence grade, its key finding, and — the part that usually goes missing — its stated limitations. Inline [E##] markers throughout the site link directly to the record here.

57 records 6 categories Graded A–D
How grades are assigned
Evidence grades in this library
GradeMeaningRecords
ADirect, authoritative, or controlled evidence within its stated scope.32
BDirect human evidence of limited size or design — case series, small cohorts, validated analytical work.20
CPreclinical, in-vitro, ex-vivo, or indirect human evidence requiring extrapolation.4
DWeak, anecdotal, or contested evidence. Cited for completeness, not relied upon.1
How certainty is labelled in the text

Claims across the clinical modules carry a plain-language certainty label rather than being dressed uniformly in a lab coat. The five labels are used consistently:

Established Emerging Mechanistically plausible Practice-based synthesis Data insufficient
Why limitations are printed

A citation that hides its own weaknesses is a rhetorical device, not a reference. Every record below states what its source cannot support, so a sceptical reader can audit the reasoning rather than take it on trust.

  1. E01 A Surveillance 2026

    America’s Poison Centers. Health Advisory: Serious Illnesses Associated with Kratom and 7-OH Products. Open source

    Evidence typeNational poison-center surveillance
    Key finding593 7-OH reports in 2025 and 901 from Jan 1 through Jun 30, 2026; among 7-OH-only reports, 38.8% serious, 63.8% treated in a healthcare facility, and 20.5% hospitalized.
    LimitationsVoluntary exposure reports; undercounting, reporting bias, incomplete product verification, and coexposures limit incidence and causality estimates.
  2. E02 A Federal regulation 2026

    U.S. Drug Enforcement Administration. DEA to Temporarily Schedule 7-OH and Related Substances to Protect Public Safety. Open source

    Evidence typeOfficial agency announcement
    Key findingDEA filed notices of intent for concentrated 7-OH and for MP, MGM-15, and MGM-16. The announcement states controls apply once temporary orders take effect.
    LimitationsAnnouncement is not itself the scheduling order; status must be checked against the Federal Register.
  3. E03 A Federal regulation 2026

    DEA. Schedules of Controlled Substances: Temporary Placement of 7-Hydroxymitragynine Above a Specified Threshold in Schedule I - Notice of Intent. Open source

    Evidence typeOfficial Federal Register notice
    Key findingProposes temporary Schedule I control above specified thresholds; excludes botanical material below threshold; an order may issue on or after Aug 5, 2026 and becomes effective when published.
    LimitationsNotice of intent is not a final temporary order.
  4. E04 A Federal regulation 2026

    DEA. Temporary Placement of Mitragynine Pseudoindoxyl, MGM-15, and MGM-16 in Schedule I - Notice of Intent. Open source

    Evidence typeOfficial Federal Register notice
    Key findingProposes temporary Schedule I control of MP, MGM-15, and MGM-16.
    LimitationsNotice of intent is not a final temporary order.
  5. E05 A Federal public health 2025-2026

    U.S. Food and Drug Administration. Hiding in Plain Sight: 7-OH Products. Open source

    Evidence typeOfficial agency public-health page
    Key findingDistinguishes concentrated/enhanced 7-OH products from botanical kratom and describes opioid-related risks and regulatory concerns.
    LimitationsAgency synthesis; not a controlled clinical study.
  6. E06 A California regulation 2025

    California Department of Public Health. Foods, Dietary Supplements and Medical Drugs containing Kratom and 7-OH are Dangerous and Illegal to Sell or Manufacture for Consumption. Open source

    Evidence typeOfficial state notice
    Key findingStates products containing kratom or 7-OH are illegal to sell/manufacture for consumption under California food/drug law; reports six LA County deaths linked to 7-OH and recommends naloxone.
    LimitationsThis is food/drug enforcement, not a statement that California scheduled every kratom alkaloid under the controlled-substances schedules.
  7. E07 A California regulation 2026

    California Department of Public Health. CDPH Warns Retailers and Public About the Dangers of Kratom-derived Products and 7-OH. Open source

    Evidence typeOfficial state notice
    Key findingReiterates enforcement, product-quality concerns, overdose risk, naloxone, and more than $5 million in seized products.
    LimitationsAgency notice; linked-death attribution may include complex toxicology.
  8. E08 A California clinical guidance 2026

    California Department of Public Health. Kratom addiction - healthcare provider advisory. Open source

    Evidence typeOfficial state clinician advisory
    Key findingAdvises clinicians that kratom and 7-OH may cause addiction, withdrawal, overdose, and death; recommends MOUD referral and naloxone.
    LimitationsBroadly combines botanical kratom and concentrated 7-OH; individual risks differ by product.
  9. E09 A Product chemistry 2026

    Brown PN, Chan M, Zhang X, Brendler T. Elevated 7-Hydroxymitragynine Levels Found in Products Misbranded as Kratom. J AOAC Int. Open source

    Evidence typeAnalytical product study
    Key findingVery high 7-OH concentrations and alkaloid profiles inconsistent with authentic leaf; concentrations were considered achievable only through synthetic processing.
    LimitationsProduct sample may not represent the entire market; clinical outcomes were not studied.
  10. E10 A Product chemistry 2026

    Avula B, et al. Quantitative analysis of 7-hydroxymitragynine in commercial kratom products and its stability under chemical and physiological conditions. Phytochemistry. Open source

    Evidence typeAnalytical product and stability study
    Key findingFound label-content disagreement, oxidation byproducts, evidence of semisynthetic origin in over 98% of tested 7-OH-labeled products, and 7-OH degradation to 3-dehydromitragynine in simulated gastric conditions.
    LimitationsIn-vitro/simulated conditions do not establish human in-vivo conversion or toxicity.
  11. E11 A Market emergence 2025

    Hill K, et al. De facto opioids: Characterization of novel 7-hydroxymitragynine and mitragynine pseudoindoxyl product marketing. Drug Alcohol Depend. Open source

    Evidence typeSystematic online market survey
    Key findingIdentified 304 semisynthetic 7-OH/MP products in six months, mostly 7-OH-only tablets, shots, or gummies.
    LimitationsOnline market snapshot; does not estimate sales, users, or clinical incidence.
  12. E12 A Pharmacodynamics 2026

    Hemby SE, et al. Multifaceted modulation of human opioid receptors by kratom alkaloids. Front Pharmacol. Open source

    Evidence typeHuman-receptor in-vitro pharmacology
    Key findingCharacterizes MOR, KOR, and DOR binding/function, signaling bias, assay-dependent efficacy, minor alkaloids, and speciophylline as a MOR positive allosteric modulator.
    LimitationsIn-vitro potency and efficacy do not directly establish clinical effect size or exposure.
  13. E13 B Pharmacodynamics 2021

    León F, et al. Activity of Mitragyna speciosa alkaloids at serotonin receptors. J Med Chem. Open source

    Evidence typeIn-vitro receptor pharmacology plus animal behavioral work
    Key findingPaynantheine/speciogynine bind 5-HT1A/5-HT2B; O-desmethyl metabolites activate 5-HT1A; none activated 5-HT2B.
    LimitationsHuman concentrations and clinical contribution remain unknown; does not prove isolated 7-OH is serotonergic.
  14. E14 A Pharmacodynamics 2025

    Chen Y, et al. In Vitro Pharmacology of Mitragynine at alpha-Adrenoceptors. ACS Chem Neurosci. Open source

    Evidence typeRecombinant human/rat receptor pharmacology
    Key findingMitragynine was a low-potency alpha1A partial agonist and alpha2A antagonist; MG, 7-OH and 9-OH did not activate tested alpha2 receptor pathways.
    LimitationsLow-micromolar in-vitro effects; clinical relevance and tissue exposure uncertain.
  15. E15 B Pharmacodynamics 2021

    Chakraborty S, et al. Kratom Alkaloids as Probes for Opioid Receptor Function. ACS Chem Neurosci. Open source

    Evidence typeIn-vitro and preclinical pharmacology
    Key findingCharacterizes multiple minor indole/oxindole alkaloids at opioid receptors.
    LimitationsPreclinical/in-vitro evidence; many compounds lack human exposure data.
  16. E16 A Metabolism 2019

    Kruegel AC, et al. 7-Hydroxymitragynine Is an Active Metabolite of Mitragynine and a Key Mediator of Its Analgesic Effects. ACS Cent Sci. Open source

    Evidence typeHuman liver preparations plus mouse pharmacology
    Key findingCYP3A converts mitragynine to 7-OH; in mice, formed 7-OH explained much of opioid-mediated analgesia.
    LimitationsAnimal exposure-response; does not define high-dose direct 7-OH human kinetics.
  17. E17 A Metabolism/detection 2020

    Basiliere S, Kerrigan S. CYP450-Mediated Metabolism of Mitragynine and Investigation of Metabolites in Human Urine. J Anal Toxicol. Open source

    Evidence typeRecombinant CYP and authentic human urine analysis
    Key findingMaps O-demethylated, carboxylated, and conjugated metabolites and CYP contributions; 9-O-demethylmitragynine is an important urinary metabolite.
    LimitationsCase urine data and in-vitro CYP systems do not define controlled human PK.
  18. E18 A Metabolism 2020

    Kamble SH, et al. Metabolism of a Kratom Alkaloid Metabolite in Human Plasma Increases Its Opioid Potency and Efficacy. ACS Pharmacol Transl Sci. Open source

    Evidence typeEx-vivo human plasma and receptor pharmacology
    Key findingDemonstrates conversion of 7-OH to mitragynine pseudoindoxyl in pooled human plasma and greater opioid potency/efficacy of the product.
    LimitationsEx-vivo conversion is not a systemic human conversion fraction or clinical half-life.
  19. E19 A Clinical metabolism/DDI 2024

    Jaisi A, et al. Effects of Itraconazole on Pharmacokinetics of Mitragynine and 7-Hydroxymitragynine in Healthy Volunteers. ACS Pharmacol Transl Sci. Open source

    Evidence typeControlled human drug-interaction study
    Key findingCYP3A inhibition reduced 7-OH formation and increased mitragynine exposure, supporting CYP3A-mediated formation in humans.
    LimitationsLow controlled botanical exposure; direct high-dose 7-OH was not administered.
  20. E20 A Human pharmacokinetics 2022

    Tanna RS, et al. Clinical Pharmacokinetic Assessment of Kratom in Healthy Adult Participants. Pharmaceutics. Open source

    Evidence typeControlled human single-dose botanical tea study
    Key findingMeasured multiple alkaloids in plasma and urine through extended collection; botanical-context 7-OH terminal half-life was several hours and targeted urine remained informative through 120 hours.
    LimitationsSmall study using 2 g botanical tea; formation-limited kinetics and assay sensitivity prevent a universal detection window.
  21. E21 B Human pharmacokinetics 2026

    Huestis MA, et al. Mitragynine and 7-hydroxy-mitragynine plasma pharmacokinetics after single and 15 multiple oral kratom extract doses. J Anal Toxicol. Open source

    Evidence typeControlled human extract study
    Key findingShows dose/regimen-dependent exposure and accumulation patterns after a mitragynine-rich extract.
    LimitationsNot direct purified 7-OH; industry relationships disclosed; generalizability to commercial 7-OH products is limited.
  22. E22 C Preclinical pharmacokinetics 2025

    In Vitro and In Vivo Pharmacokinetic Characterization of 7-Hydroxymitragynine in Sprague-Dawley Rats. Open source

    Evidence typeRat PK study
    Key findingOral 7-OH was rapidly absorbed with low oral bioavailability in rats; systemic MP exposure was limited in that model.
    LimitationsRat kinetics cannot define human purified 7-OH half-life, bioavailability, or induction timing.
  23. E23 B Respiratory toxicity 2025-2026

    Mitragynine and 7-hydroxymitragynine: Bidirectional effects on breathing in rats. Open source

    Evidence typeControlled rat respiratory study
    Key findingIV 7-OH reduced respiratory frequency, tidal volume, and minute ventilation; naloxone reversed depression; potency for 50% minute-volume reduction was 4.5-fold morphine in this model.
    LimitationsSpecies, IV route, and endpoint prohibit conversion to a human dose-potency ratio.
  24. E24 B Human overdose 2026

    Pullman MK, et al. Cardio-pulmonary arrest in a patient revived with naloxone following reported use of 7-hydroxymitragynine. Clin Toxicol. Open source

    Evidence typeHuman case report
    Key findingDocuments cardiopulmonary arrest after reported 7-OH use with naloxone-associated revival.
    LimitationsSingle report; product composition, coexposures, and causality cannot be fully resolved.
  25. E25 B Withdrawal/treatment 2026

    Lybik N, et al. Management of acute withdrawal from 7-hydroxymitragynine after high-dose chronic use. J Am Pharm Assoc. Open source

    Evidence typeHuman case report
    Key findingHigh-dose use around 360 mg/day; prominent GI/autonomic/affective symptoms about 48 hours after last dose despite COWS 5; treated with buprenorphine/naloxone and adjuncts.
    LimitationsOne patient; no validated timeline or dose-response.
  26. E26 B Treatment 2026

    Fenske E, et al. Buprenorphine for the Management of 7-Hydroxymitragynine Use: A Retrospective Case Series. J Addict Med. Open source

    Evidence typeNine-patient retrospective case series
    Key findingSix low-dose and three standard initiations; 8/9 initiated and stabilized, no precipitated withdrawal/adverse events reported, and most reported improvement at follow-up.
    LimitationsSmall, retrospective, low-barrier telehealth cohort without comparator.
  27. E27 B Treatment 2026

    Hendler R, et al. A Case of 7-Hydroxymitragynine Use Disorder Treated With Buprenorphine. J Addict Med. Open source

    Evidence typeHuman case report
    Key findingDescribes severe 7-OH use disorder and transition to buprenorphine using a staged clinical approach.
    LimitationsSingle case; cannot establish universal induction timing.
  28. E28 C Withdrawal complexity 2025

    7-Hydroxymitragynine and Nicotine Pouch Withdrawal Syndrome: A Case Report. Open source

    Evidence typeHuman case report
    Key findingSevere overlapping 7-OH/nicotine withdrawal with precipitated withdrawal after buprenorphine, agitation, psychosis, and respiratory compromise.
    LimitationsMajor nicotine and polysubstance confounding; should not define a typical 7-OH course.
  29. E29 B Dependence phenotype 2025

    Substance Use Disorder Following Consumption of a Novel Synthetic 7-Hydroxymitragynine Product. J Addict Med. Open source

    Evidence typeHuman case report with product/blood confirmation
    Key findingRapid tolerance and one sublingual film every 1-2 hours; severe SUD, supraventricular tachycardia, urinary retention; buprenorphine induction.
    LimitationsSingle patient with prior opioid history and other substance use.
  30. E30 B Botanical dependence 2014

    Singh D, et al. Kratom dependence, withdrawal symptoms and craving in regular users. Drug Alcohol Depend. Open source

    Evidence typeCross-sectional study of regular traditional kratom users
    Key findingDocuments dependence, physical and psychological withdrawal, and dose/frequency associations in regular users.
    LimitationsTraditional brewed kratom population; does not establish purified 7-OH withdrawal kinetics.
  31. E31 B Hepatotoxicity 2021

    Ahmad J, et al. Liver injury associated with kratom: U.S. Drug-Induced Liver Injury Network. Drug Alcohol Depend. Open source

    Evidence typeProspective DILIN case series and review
    Key findingEleven cases attributed to kratom, commonly jaundiced and hospitalized, all recovered.
    LimitationsPredominantly kratom products/mixtures; isolated 7-OH-specific causality not established.
  32. E32 C Cardiac pharmacology 2020

    Lu J, et al. Mitragynine inhibits hERG1a/1b channel current. Open source

    Evidence typeIn-vitro cardiac ion-channel study
    Key findingMitragynine inhibited hERG current with IC50 about 333 nM and affected channel complexation.
    LimitationsMitragynine, not purified 7-OH; in-vitro concentration-response does not establish clinical arrhythmia incidence.
  33. E33 B Cardiac clinical data 2021

    Leong Bin Abdullah MFI, Singh D. ECG comparisons between regular kratom users and controls. Open source

    Evidence typeCross-sectional human ECG study
    Key findingHigher odds of sinus tachycardia and borderline QTc, but no difference in prolonged QTc.
    LimitationsTraditional kratom users; observational design; not purified 7-OH.
  34. E34 B Pregnancy 2021

    Wright ME, et al. Outcomes of mothers and newborns to prenatal exposure to kratom: a systematic review. Open source

    Evidence typeSystematic review of six case reports
    Key findingMaternal and neonatal withdrawal occurred in the included reports and often required pharmacologic treatment.
    LimitationsExtremely small case-report literature; no direct concentrated 7-OH data.
  35. E35 A Drug interactions 2023

    Tanna RS, et al. Clinical Assessment of the Drug Interaction Potential of Kratom. Clin Pharmacol Ther. Open source

    Evidence typeControlled human probe-drug study
    Key findingA 2 g kratom tea modestly increased oral midazolam AUC/Cmax without changing half-life, suggesting intestinal CYP3A inhibition; no meaningful dextromethorphan change.
    LimitationsLow botanical dose; may not predict high-dose extract or purified 7-OH interactions.
  36. E36 C Drug interactions 2022

    Brogdon HD, et al. Potential pharmacokinetic kratom-drug interactions resulting in toxicity. Open source

    Evidence typeHuman case report
    Key findingHigh-dose kratom with venlafaxine/quetiapine was associated with serotonin toxicity and ECG abnormalities, plausibly through CYP inhibition.
    LimitationsSingle case, very high botanical exposure, and multiple drugs; mechanism inferred.
  37. E37 A Analytical testing 2024

    Quantification of 11 kratom alkaloids including mitragynine and main metabolites in human plasma using LC-MS/MS. Open source

    Evidence typeValidated analytical method applied to controlled human samples
    Key findingDemonstrates compound-specific targeted plasma testing and accumulation of several alkaloids with repeated extract dosing.
    LimitationsAnalytical validity does not provide universal clinical detection windows.
  38. E38 A Analytical testing 2026

    Sheehan D, et al. Avoiding False Identification of 7-Hydroxymitragynine in Kratom Products Using Multicriteria LC-MS Confirmation. Open source

    Evidence typeAnalytical method paper
    Key findingShows the need for orthogonal/multicriteria confirmation to avoid false 7-OH identification in complex matrices.
    LimitationsProduct analysis rather than clinical toxicology outcome data.
  39. E39 B Emerging analogues 2025

    Gour A, et al. From Kratom to Semi-Synthetic Opioids: The Rise and Risks of MGM-15. Drug Test Anal. Open source

    Evidence typeCommercial product analysis and receptor binding
    Key findingCommercial tablets averaged about 10.9 mg MGM-15; MGM-15 had greater hMOR/hDOR binding affinity than 7-OH.
    LimitationsNo controlled human pharmacokinetics, metabolism, safety, or withdrawal data.
  40. E40 B Forensic review 2026

    Papsun DM, et al. 7-Hydroxymitragynine: Not Your Garden Variety Kratom. Am J Forensic Med Pathol. Open source

    Evidence typeForensic review/brief report
    Key findingEmphasizes the forensic distinction between concentrated 7-OH products and botanical kratom.
    LimitationsForensic perspective; not a prospective clinical study.
  41. E41 A Medical education 2025

    California Society of Addiction Medicine. 2025 Addiction Medicine Board Exam Preparation Course. Open source

    Evidence typeOfficial course/faculty listing
    Key findingLists Brian Harris, MD as faculty for Basic Science (Neurobiology) and Legal Aspects of Addiction Medicine; bio lists board certifications and no relevant financial relationships for the activity.
    LimitationsPublic program does not independently document every slide or a specific 7-OH segment.
  42. E42 A State regulation 2026

    Connecticut Department of Consumer Protection. Information About Kratom: Schedule I controlled-substance update. Open source

    Evidence typeOfficial state regulatory guidance
    Key findingConnecticut designated Mitragyna speciosa and 7-hydroxymitragynine as Schedule I controlled substances, effective March 25, 2026; final regulatory approval was reported April 2, 2026.
    LimitationsState guidance summarizes the rule; verify the current regulation and statutory penalties before legal reliance.
  43. E43 A State regulation 2026

    Florida Department of Legal Affairs (Office of the Attorney General). Emergency Rule 2ER26-1: Addition of 7-OH and Related Compounds to Schedule I. Open source

    Evidence typeOfficial state emergency-rule announcement
    Key findingAnnounced June 22, 2026 and designated Emergency Rule 2ER26-1, effective July 1, 2026. Names 7-OH, mitragynine pseudoindoxyl, 7-acetoxymitragynine, 9- and 10-hydroxycorynantheidine, MGM-15, and MGM-16; announced limits are 1 mg/g or mL and a 100:1 mitragynine-to-7-OH ratio, subject to the rule's own terms.
    LimitationsEmergency rules are time-limited. Duration, any replacement or permanent rule, and current effective status must be rechecked before legal reliance.
  44. E44 A State legislation 2026

    New York Senate Bill S8925A, 2025-2026 session. Open source

    Evidence typeOfficial state legislative record
    Key findingPassed both chambers; would prohibit sale above 2% of total alkaloids or 1 mg per serving, effective 90 days after becoming law.
    LimitationsOfficial tracker reviewed Aug. 8 did not show delivery or signature; verify enactment and effective date.
  45. E45 A State advisory 2025

    Texas Department of State Health Services. Serious Illnesses Associated with 7-OH Use. Open source

    Evidence typeOfficial state health advisory and poison-center summary
    Key findingTexas warned against concentrated 7-OH; as of Aug. 27, 2025, state poison centers had 192 kratom/7-OH reports, including 19 concentrated 7-OH reports, 11 treated at a healthcare facility; clinicians were advised to use naloxone for respiratory depression.
    LimitationsAdvisory and exposure reports do not themselves schedule 7-OH or establish population incidence.
  46. E46 A FDA enforcement 2025

    U.S. Food and Drug Administration. FDA Seizes 7-OH Opioids to Protect American Consumers. Open source

    Evidence typeOfficial federal enforcement announcement
    Key findingFDA and DOJ announced seizure of approximately 73,000 units of concentrated 7-OH products valued at roughly $1 million from three Missouri firms.
    LimitationsAn enforcement event does not estimate national market size, exposure prevalence, or clinical incidence.
  47. E47 A FDA scheduling recommendation 2025

    FDA Takes Steps to Restrict 7-OH Opioid Products Threatening American Consumers. Open source

    Evidence typeOfficial federal announcement
    Key findingDescribes FDA action and recommendation concerning concentrated 7-OH.
    LimitationsPolicy announcement, not a clinical trial.
  48. E48 D Practice-based evidence 2024-2026

    Harris B. EusomniaMD practice-based 7-OH/kratom clinical experience and consultation series.

    Evidence typeUnpublished clinical experience
    Key findingDirect treatment of a case series in the teens plus informal consultation on dozens of additional 7-OH withdrawal cases across diverse demographic and professional groups.
    LimitationsAuthor-reported, unpublished, not IRB-reviewed, not systematically adjudicated, and not an incidence or efficacy study.
  49. E49 B Withdrawal/treatment 2025

    Wightman RS, Hu D. A Case of 7-OH Mitragynine Use Requiring Inpatient Medically Managed Withdrawal. J Addict Med. Open source

    Evidence typeInpatient human case report
    Key findingCOWS peaked at 14; symptom-guided sublingual buprenorphine 2-8 mg/day was used as a short inpatient taper before residential care.
    LimitationsSingle patient with prior OUD; does not establish a universal timeline, taper, or preferred induction.
  50. E50 B Treatment 2026

    Sherrick RC. Treatment of Kratom Use Disorder With Methadone in an Opioid Treatment Program. J Addict Med. Open source

    Evidence typeFourteen-patient retrospective OTP case series
    Key finding64% used both kratom and 7-OH; 13/14 remained in treatment at last follow-up; no adverse events reported.
    LimitationsMixed kratom/7-OH population, retrospective, no comparator or systematic isolated-7-OH confirmation.
  51. E51 A General OUD treatment 2020

    ASAM National Practice Guideline for the Treatment of Opioid Use Disorder: 2020 Focused Update. Open source

    Evidence typeNational clinical-practice guideline
    Key findingSupports evidence-based use of buprenorphine and methadone and individualized ongoing OUD treatment.
    LimitationsNot 7-OH-specific and does not establish an induction interval or dose conversion.
  52. E52 A Overdose response 2024-current

    Centers for Disease Control and Prevention. What to Do If You Think Someone Is Overdosing. Open source

    Evidence typeAuthoritative public-health guidance
    Key findingGive naloxone, call 911, support breathing, position to reduce aspiration risk, and remain with the person.
    LimitationsGeneral opioid guidance; coingestants may not respond to naloxone.
  53. E53 B Antagonist-precipitated withdrawal 2026

    Williams JB, et al. A Case of Precipitated Withdrawal From Naltrexone Treated With Buprenorphine in a Patient With Kratom Use Disorder. Open source

    Evidence typeHuman case report
    Key findingNaltrexone precipitated severe withdrawal in a kratom-dependent patient; buprenorphine was used in management.
    LimitationsSingle kratom case; direct purified-7-OH opioid-free interval unknown.
  54. E54 A MOUD safety policy 2017-current

    U.S. Food and Drug Administration. Buprenorphine and methadone should not be withheld solely because a patient uses benzodiazepines or other CNS depressants. Open source

    Evidence typeOfficial federal medication-safety guidance
    Key findingCareful medication management is preferred to categorical denial of MOUD despite additive CNS-depressant risk.
    LimitationsDoes not make combinations safe or remove monitoring and benzodiazepine-withdrawal concerns.
  55. E55 A State regulation 2026

    Ohio Administrative Code Rule 4729:9-1-01.1, Mitragynine-Related Compounds. Open source

    Evidence typeBinding state administrative rule
    Key findingEffective May 19, 2026, classifies 7-OH, MP, dihydro-7-OH, and 7-acetoxy as Schedule I while excluding natural leaf and ground natural leaf.
    LimitationsDoes not provide case-specific legal advice or full penalty analysis.
  56. E56 B Related-compound withdrawal 2026

    Stanciu CN. Severe Early-Onset Withdrawal Following Intentional Use of Mitragynine Pseudoindoxyl. Open source

    Evidence typeHuman case report
    Key findingNine 20-mg MP doses/day with nocturnal use; COWS 31, hypertension and tachycardia; supportive treatment over 72-96 hours.
    LimitationsSingle case; cannot define comparative potency, universal time course, or treatment protocol.
  57. E57 B Product adulteration 2026

    Marshall S, et al. Unlabeled kratom alkaloids detected in products marketed as kava. Open source

    Evidence typeFive-product analytical cluster report
    Key findingKava-labeled products associated with opioid-like withdrawal contained kratom alkaloids; MP predominated in quantitative testing.
    LimitationsSmall cluster; market prevalence and dose-response unknown.
Update and corrections policy

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