For Patients & Families

Seek urgent or emergency care for a seizure; chest pain, fainting, or severe palpitations; severe confusion, hallucinations, or psychosis; repeated vomiting or inability to keep fluids down; severe agitation or inability to stay safe; possible alcohol or benzodiazepine withdrawal; or suicidal intent. A published case report documents cardiopulmonary arrest after reported 7-OH use with naloxone-associated revival; it cannot establish the risk for every product or person.^E24

Naloxone reverses opioid overdose. Keep it where you sleep or spend time. Tell someone close to you where it is and how to use it; a person who has overdosed cannot give it to themselves.

Ask a pharmacy, local health department, or harm-reduction programme about getting naloxone. You do not need to wait until you are ready to stop using 7-OH. Naloxone should be available before a crisis, not after one.

Concentrated 7-OH is an opioid-active product. It can be sold in an ordinary shop or online, but the retail setting does not make it low-risk. People can become physically dependent after using products sold as 7-OH, 7-hydroxy, kratom extract, pseudoindoxyl, MGM-15, or MGM-16.

Dependence means your body has adapted to the drug. It is not a character flaw. If you feel anxious, restless, sweaty, chilled, nauseated, achy, or sick when a dose is late, your body may be dependent.

Also avoid mixing 7-OH with alcohol, benzodiazepines, other opioids, gabapentinoids, or other sedating medicines without medical guidance. Combining drugs that slow breathing can be dangerous. A clinician can help you make a safer plan.

Arrange a medical appointment soon if any of these apply:

• You dose every few hours, wake at night to dose, or feel withdrawal between doses.
• You have tried to stop more than once and could not tolerate the withdrawal.
• You are taking more than intended, using mainly to feel normal, or spending increasing time or money getting the product.
• You also drink heavily, take benzodiazepines, use other opioids, or are thinking about finding another drug to stop withdrawal.
• You are pregnant or think you might be; do not stop abruptly on your own—talk to a clinician promptly.
• You have a seizure disorder, serious heart, liver, kidney, or lung disease, sleep apnoea, or a major mental-health concern.

You do not need to wait until the situation is catastrophic. Write down the product name, the amount on the label, how often you take it, how many units you actually use, and when you last used it.

1. A straightforward conversation. A clinician asks what you take, how often, for how long, what happens when a dose is late, and what else you use. Bring the package or clear photos of it if possible.
2. A plan matched to you. Many people can be treated as outpatients. Some need urgent, emergency, residential, or inpatient care because of medical, mental-health, or other substance-use risks.
3. Medication treatment when appropriate. Buprenorphine can reduce withdrawal, craving, and the need to keep redosing. Methadone is another established medication for opioid use disorder in an appropriate clinical setting.
4. Help with symptoms and follow-up. Clinicians may also treat nausea, diarrhoea, cramping, aches, sleep problems, anxiety, or low mood and check in early during the transition.

In a small retrospective series of nine people using purified 7-OH, six had low-dose and three had standard clinician-directed buprenorphine initiation; eight initiated and stabilised, and no precipitated withdrawal or other adverse events were reported. This small uncontrolled study is encouraging, but it is not a self-treatment protocol.^E26

Do not be put off if you do not identify with the words “opioid use.” Tell the clinician exactly what the package says and what happens if you miss a dose. A routine opioid urine screen may not test for 7-OH, so a negative screen does not settle the question.

The person you are worried about may not think of themselves as using opioids. They may have bought the product from a shop and been told little about what it was. Start with what happens when the dose is late, not with an argument about labels.

A useful family member can:

• learn the product name, label, dosing pattern, and other substances without shaming the person;
• keep naloxone accessible and learn how to use it;
• help arrange an appointment before supply changes or the situation worsens;
• help with transport, childcare, work logistics, food, fluids, and a calm place to recover;
• watch for breathing problems, dehydration, confusion, severe distress, and suicidal thoughts; and
• call 911 for an emergency rather than trying to manage it alone.

The goal is safety and treatment engagement. You do not have to win an argument to be useful.