Resource database
Verified, primary-source resources for the four audiences this crisis touches: people who use 7-OH, the families around them, the clinicians who will treat them, and the institutions that have to plan for them. Every link below resolves to an authoritative source. Nothing here is sponsored.
If this is urgent
For suspected overdose, unresponsiveness, difficulty breathing, or seizure: call 911. Administer naloxone if available — 7-OH is an opioid and naloxone may be effective, though higher or repeated dosing can be required.
Poison Control
Free, confidential, 24/7 expert advice on ingestion and toxicity.
988 Suicide & Crisis Lifeline
Call or text 988. Withdrawal-associated dysphoria and suicidality are real and treatable.
SAMHSA National Helpline
Free, confidential, 24/7 treatment referral and information service.
Patients & families
The single most important message on this page: withdrawal from 7-OH is treatable, usually as an outpatient, and usually without anyone finding out about it who does not need to. Stopping abruptly and alone is the option with the worst outcomes.
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SAMHSA's official locator for substance use treatment, including outpatient buprenorphine providers. Filter for “buprenorphine” and “outpatient” rather than accepting the default residential results.
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24/7 confidential treatment referral in English and Spanish. No insurance required to call.
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Mail-based naloxone distribution in most states. Anyone dependent on an opioid — including 7-OH — and anyone who lives with them should have naloxone on hand, especially through a supply disruption.
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Practical overdose-prevention material and local programme directories. Relevant because the principal mortality risk in this transition is substitution into the illicit supply, where counterfeit pills may contain fentanyl or other potent opioids in unpredictable amounts.
A plain-language guide written for people who use 7-OH and the families around them — what to expect, how to get naloxone today, why substituting street opioids is the thing that kills people, when to be seen, and what treatment actually looks like. Read the patient and family guide →
Finding a buprenorphine prescriber
Since the removal of the federal X-waiver requirement, any clinician with a DEA registration to prescribe controlled substances may prescribe buprenorphine for opioid use disorder. In practice, availability still varies enormously by geography, so it is worth searching more than one directory.
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Broadest coverage. Search by ZIP code and filter to medication-assisted treatment.
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Professional society; member directory, national practice guideline for opioid use disorder, and clinician education.
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State chapter; regional referral and the venue at which this author presented on the neurobiology of addiction and emerging compounds of concern in 2025.
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Several national telehealth services provide buprenorphine induction and maintenance. Listed as a category, not an endorsement — verify licensure in your state and confirm the prescriber will manage 7-OH specifically.
Clinician references
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The core reference for buprenorphine, methadone, and naltrexone use. 7-OH is not addressed by name; the guideline nonetheless governs the underlying management.
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Free, comprehensive treatment improvement protocol covering induction, dosing, special populations, and programme design.
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NIDDK's clinical and research database on drug-induced liver injury. The kratom monograph is the best single source on the hepatotoxicity pattern.
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Compound-by-compound working reference: alkaloids, active metabolites, semisynthetic analogues, metabolic pathways, elimination, and human detection status. Prints as a standalone document.
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Fifty-seven graded records with key findings and stated limitations, filterable by domain. Every inline citation across the site resolves here.
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National Institute on Drug Abuse overview and links to funded research.
Every page on this site carries a print stylesheet. Printing to PDF hides the navigation and status bar, expands all collapsed sections automatically, prints link destinations in full, and avoids breaking sections across pages — so the treatment module or the chemistry reference becomes a grand-rounds or ED handout with no extra work.
clinician-downloads
If you want purpose-built one-pagers beyond the print view — a bedside withdrawal card, an
induction decision tree, a patient handout, a grand-rounds deck — they would be linked here
as PDFs. Not required for launch.
Laboratory testing
Standard opiate immunoassays do not reliably detect kratom alkaloids. Confirmatory liquid chromatography–tandem mass spectrometry is required, and the panel must be requested specifically. Ordering guidance is in module 02.
Reference-laboratory test menus change without notice, and listing a laboratory that cannot actually run a validated mitragynine / 7-OH panel would be worse than listing none. Take the analyte list and specimen requirements from the testing section to your own laboratory and ask what they can run or where they send it.
Regulatory & policy documents
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The primary document. Docket DEA-1570, 91 FR 40917, published 6 July 2026. Contains the threshold definition, the legal authority, and the agency's findings.
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Companion notice covering the three related compounds at any concentration. Docket DEA-1644, 91 FR 40909.
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The separate solicitation for scientific comment on the concentration threshold. Docket HHS-OASH-2026-0232. Comment period closed 31 July 2026.
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The agency's own framing, including the statement that the action does not apply to botanical kratom below the threshold.
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The originating recommendation, explicitly distinguishing concentrated 7-OH from natural kratom leaf.
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The clearest neutral legal summary of the mechanism, scope, duration, and the END 7-OH Act. Recommended reading for administrators and journalists.
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Historical context: the DEA's first attempt to schedule mitragynine and 7-OH, withdrawn after public comment. Docket DEA-442W.
Literature
The peer-reviewed base is uneven — solid preclinical receptor and pharmacokinetic work, a growing case-report literature on hepatotoxicity and seizure, and very little controlled human data on withdrawal or its treatment. The full citation list for this site, including everything cited in the clinical modules, is maintained separately.
| Domain | Source | Why it matters |
|---|---|---|
| Product chemistry | E09 Brown et al. | Elevated 7-OH in products misbranded as kratom — the analytical basis for the whole distinction. |
| Product chemistry | E10 Avula et al. | Quantitative 7-OH in commercial products and its stability. Explains why labels cannot be trusted. |
| Market | E11 Hill et al. | Characterises the semisynthetic retail category as de facto opioids. |
| Receptor pharmacology | E12 Hemby et al. | Multifaceted modulation of human opioid receptors by kratom alkaloids. The core pharmacodynamic paper. |
| Receptor pharmacology | E15 Chakraborty et al. | Kratom alkaloids as probes of opioid receptor function — why efficacy labels are assay-dependent. |
| Non-opioid targets | E14 Chen et al. | Mitragynine at α-adrenoceptors. Part of why this withdrawal is not textbook. |
| Metabolism | E16 Kruegel et al. | Establishes 7-OH as an active metabolite of mitragynine and a key mediator of its effect. |
| Metabolism | E18 Kamble et al. | Plasma metabolism of a kratom alkaloid metabolite increases its opioid potency — the pseudoindoxyl problem. |
| Kinetics | E20 Tanna et al. | Clinical pharmacokinetic assessment in healthy adults. The best controlled human data available. |
| Interactions | E35 Tanna et al. | Clinical assessment of kratom drug-interaction potential. |
| Toxicity | E24 Pullman et al. | Cardiopulmonary arrest revived with naloxone after reported 7-OH use. The human respiratory signal. |
| Hepatotoxicity | E31 Ahmad et al. | DILIN series on liver injury associated with kratom. |
| Withdrawal | E25 Lybik et al. | Acute withdrawal after high-dose chronic 7-OH use — the case where COWS was 5 at 48 hours. |
| Treatment | E26 Fenske et al. | Buprenorphine for 7-OH use, retrospective case series of nine. The single most useful treatment paper to date. |
| Emerging analogues | E39 Gour et al. | From kratom to semisynthetic opioids: the rise and risks of MGM-15. |
For institutions
Health systems, emergency departments, rehabilitation centres, universities, correctional health services, and employers are all going to encounter this population, most of them without warning. Education, protocol review, and a named point of contact are cheap; an unprepared first case is not.
Grand rounds, staff education, and protocol review — offered directly
Presentations for rehabilitation centres, hospital systems, universities, and employers, plus case consultation for clinicians and briefings for press.
This resource list is educational and does not constitute medical advice, and inclusion of a link is not an endorsement of any organisation, product, or service. No physician–patient relationship is created by use of this site. Anyone experiencing withdrawal from or toxicity due to kratom or 7-OH products should be evaluated by an addiction medicine professional — start with the buprenorphine prescriber finder.