Kratom, 7-OH, Mitragynine Pseudoindoxyl, and the Next Wave of Opioid-Like Compounds

Using 7-OH or worried about DEA changes? Talk with a DevotedDOc physician.

What Patients Need to Know About 7-Hydroxymitragynine, MGM-15, MGM-16, Withdrawal, DEA Scheduling, and Treatment

This article provides general education and is not a substitute for an individualized medical evaluation. Do not start, stop, or combine medications based solely on this information. Call 911 for suspected overdose, severe breathing difficulty, seizure, loss of consciousness, chest pain, or immediate danger. For suicidal thoughts or an inability to stay safe, call or text 988 in the United States, or go to the nearest emergency department.

A New Kind of Product on the Shelf

Over the past few years, a new class of products has appeared in gas stations, smoke shops, convenience stores, supplement stores, and online. You may have seen them sold as kratom extract, enhanced kratom, 7-OH, 7-hydroxymitragynine, “Hydroxie” or similar brand names, pressed 7-OH tablets, kratom shots, mitragynine pseudoindoxyl, pseudoindoxyl, MGM-15, or MGM-16.

Many people buy these believing they are ordinary herbal kratom—something mild and natural, safe because it is sold openly. That belief is understandable, and it is also where the danger begins. Concentrated 7-OH and related compounds can act much more like short-acting opioids than like traditional leaf, and the FDA has described 7-OH as an emerging opioid threat rather than a gentle herbal supplement. ^[1,2,3]

If you or someone you love is using one of these products and feeling trapped—taking more than intended, waking up sick, or frightened by the new laws—please know two things. First, physical dependence is not a moral failure; it is a predictable response of the body to a substance that acts on opioid receptors. Second, this is treatable, and help exists. This article explains, in plain language, what these products are, why they cause dependence and withdrawal, what treatment looks like, and what the July 2026 DEA action does and does not mean for you.

The Basics: Kratom, Mitragynine, and 7-OH

What is traditional kratom?

Kratom is made from the leaves of a Southeast Asian tree called Mitragyna speciosa. People have used the leaf and teas for generations. It contains dozens of natural compounds called alkaloids, and its effects are complex—mild stimulation at low amounts and more sedating, opioid-like effects at higher amounts. Importantly, traditional kratom leaf is not proven safe: it can cause dependence, withdrawal, and other harms. But it is chemically different from the concentrated products now on shelves. ^[7,8]

What is mitragynine?

Mitragynine is usually the most abundant alkaloid in traditional kratom leaf. It has some activity at opioid receptors, but relatively weak activity compared with the compound below. ^[7,10]

What is 7-hydroxymitragynine (7-OH)?

7-hydroxymitragynine—almost always shortened to 7-OH—is a much more potent alkaloid. In natural leaf it is usually present only in trace or low amounts. It can also form in the body when the liver processes mitragynine, and it can be created or increased through processing. The problem is that many commercial products now contain 7-OH that has been enhanced, concentrated, oxidized, or separately manufactured to levels far above anything found in ordinary leaf. ^[2,3,10]

7-OH has clinically important activity at the mu-opioid receptor—the same receptor targeted by morphine, oxycodone, and fentanyl. That is what explains its pain relief, euphoria, and sedation, and also its potential for tolerance, physical dependence, and opioid-like withdrawal. ^[3,10]

What is mitragynine pseudoindoxyl?

Mitragynine pseudoindoxyl (sometimes just called pseudoindoxyl or MP) is a specific, distinct compound—a semi-synthetic derivative related to kratom’s alkaloids. It is a potent mu-opioid receptor agonist and is increasingly sold online and over the counter, often mislabeled as “kratom” or “7-OH.” Case reports describe rapid-onset, full-spectrum opioid-like withdrawal in people using it. ^[11,13,17]

What are MGM-15 and MGM-16?

MGM-15 and MGM-16 are two more separately named compounds related to 7-OH. In the DEA’s July 2026 documents, MGM-15 is identified as dihydro-7-hydroxymitragynine and MGM-16 as 9-fluoro-7-hydroxymitragynine—note that MGM-16 is fluorinated, a chemical change that does not occur in a natural plant. ^[4,9]

A crucial point about names and numbers: “MGM-15” is the name of a chemical. It does NOT mean “mitragynine pseudoindoxyl 15 mg,” and it does NOT mean “a 15-milligram dose.” Mitragynine pseudoindoxyl, MGM-15, and MGM-16 are three different substances. Separately, products are often sold as tablets labeled “7-OH 10 mg,” “15 mg,” “20 mg,” or higher—but a label is not a lab test. Product labels may not reliably reflect the true identity, purity, or potency of what is inside.

Why “Natural” and “Legal” Do Not Mean “Safe”

It is worth saying plainly: “plant-derived,” “natural,” “legal,” or “sold as a supplement” does not automatically mean nonaddictive or medically safe. Many powerful drugs come from plants. What matters is how a compound behaves in the body, not where it started. ^[2,3]

It is also worth being precise about potency, because the internet is full of dramatic claims. Laboratory studies have found 7-OH and mitragynine pseudoindoxyl to be more potent opioid-receptor agonists than mitragynine, and some early experiments described them as more potent than morphine in specific test systems. But exact “X times stronger than morphine” figures depend heavily on the laboratory model, the receptor assay, the route, metabolism, the formulation, and the endpoint being measured—so any single multiplier should be treated with caution. The honest summary is that these are genuinely opioid-active compounds capable of causing opioid-like effects and dependence. ^[10,19]

Finally: no kratom-derived product, 7-OH product, mitragynine pseudoindoxyl product, MGM-15 product, or MGM-16 product is FDA-approved to treat pain, anxiety, depression, opioid withdrawal, or opioid use disorder. Some are marketed as if they were treatments. They are not approved as such.

Is 7-OH the Same as Traditional Kratom?

No—they should not automatically be treated as identical, even though they come from the same plant family. Think of a spectrum, from the whole leaf on one end to laboratory-modified compounds on the other. As you move along it, the products behave less like an herbal tea and more like a short-acting opioid.

Product	What it is	How it tends to behave
Traditional leaf/tea	Whole or crushed Mitragyna speciosa leaf; mostly mitragynine, trace 7-OH	Complex, milder effects; can still cause dependence and withdrawal
Powder & capsules	Ground leaf in bulk or capsules	Similar to leaf; dose and potency vary by batch
Concentrated extracts	Leaf processed to raise alkaloid content	Stronger, more opioid-like; higher dependence risk
Enhanced 7-OH products	7-OH added/increased above natural levels	Behaves like a short-acting opioid
Pressed 7-OH tablets	Tablets sold as “7-OH 10/15/20 mg”	Fast, potent opioid-like effects; label may not match contents
Mitragynine pseudoindoxyl (MP)	A distinct semi-synthetic derivative	Potent mu-opioid agonist; rapid, severe withdrawal reported
MGM-15 (dihydro-7-OH)	A separate named 7-OH-related substance	Opioid-active; covered by DEA July 2026 action
MGM-16 (9-fluoro-7-OH)	A separate, fluorinated derivative	Opioid-active; not naturally occurring; covered by DEA action

Two things can be true at once. Traditional kratom is not harmless—it can cause dependence and adverse effects, and no one should read this article as an endorsement of ordinary leaf. At the same time, it is not accurate to lump all botanical kratom together with concentrated 7-OH and semi-synthetic derivatives when the science and the DEA’s own thresholds treat them differently. ^[7,8,3]

Why Dependence Can Develop Quickly

When a substance acts on opioid receptors and leaves the body quickly, the brain adapts fast. With repeated use of a short-acting, opioid-like product, a familiar pattern can take hold—often faster than people expect with something bought at a convenience store. ^[3,13]

• Needing more to get the same effect (tolerance)
• Taking doses more often, sometimes every few hours
• Waking during the night in early withdrawal and dosing to get back to sleep
• Using mainly to avoid feeling sick, rather than to feel good
• Trying to cut down or stop and not being able to
• Cravings and preoccupation—thinking about the next dose
• Spending more and more money
• Hiding use from family
• Slipping at work, in relationships, in sleep, or in mental health
• Returning to use because withdrawal became intolerable

If you recognize yourself here, you are describing a medical condition with a known biology and known treatments—not a character flaw. People recover from this every day.

What Does Kratom or 7-OH Withdrawal Feel Like?

Withdrawal is different for everyone. How it feels depends on the specific product, the dose, how often and how long it was used, whether other substances are involved, and individual physiology. Withdrawal from concentrated 7-OH or mitragynine pseudoindoxyl may resemble withdrawal from other short-acting opioids, and case reports describe it as intense. ^[13,16,18]

Common symptoms are grouped below to make them easier to recognize. Not everyone gets all of them.

Category	Symptoms that may occur
Physical/musculoskeletal	Muscle aches, bone or joint discomfort, tremor, restless legs, fatigue after the acute phase
Gastrointestinal	Nausea, vomiting, abdominal cramping, diarrhea
Autonomic	Sweating, chills or gooseflesh, runny nose, watery eyes, yawning, dilated pupils, rapid heart rate, elevated blood pressure
Sleep-related	Insomnia, disrupted sleep, restlessness at night
Psychological	Anxiety, irritability, intense cravings, depression, dysphoria or inability to feel pleasure, panic, difficulty concentrating

On timing, honesty matters more than false precision. For some short-acting products, symptoms may begin within hours of the last dose and build over the following days; sleep problems, fatigue, low mood, anxiety, and cravings can linger longer. But there is no single universal onset or duration that fits every product and every person, so be wary of anyone who promises an exact timeline. ^[13,18]

Seek urgent medical evaluation if withdrawal includes severe or repeated vomiting, signs of dehydration, confusion, hallucinations, chest pain, fainting, or seizure—or if there are suicidal thoughts, pregnancy-related concerns, or use together with fentanyl, alcohol, benzodiazepines, or other sedatives. These situations can be dangerous and should not be managed alone.

Can 7-OH or Pseudoindoxyl Cause an Overdose?

Yes—concentrated, opioid-active products can cause profound sedation and may contribute to slowed or stopped breathing (respiratory depression), especially at high doses or in combination with other substances. The risk rises sharply when these products are mixed with: ^[3,9]

• Fentanyl or other opioids
• Benzodiazepines (for example, alprazolam, clonazepam)
• Alcohol
• Gabapentinoids (gabapentin, pregabalin)
• Sleep medications
• Sedating antihistamines
• Muscle relaxants
• Other central nervous system depressants

Because these products act on opioid receptors, naloxone (Narcan) should be given when an opioid overdose is suspected. Call 911, give naloxone, provide rescue breathing if you are trained, and repeat naloxone according to the emergency instructions. Naloxone is available without a prescription, and everyone using these products should have it on hand and make sure someone nearby knows how to use it.

Two cautions: naloxone is not guaranteed to reverse every toxicity, particularly when sedatives like alcohol or benzodiazepines are also involved. And a person who wakes up after naloxone is not necessarily safe to stay home—naloxone can wear off before the opioid does. Emergency evaluation is still needed.

How Medical Treatment Can Help

There is no one-size-fits-all protocol. Good treatment is individualized and usually has several parts. Below is what to expect—not a do-it-yourself plan.

1. A careful clinical assessment

A clinician will want a detailed picture, which is why it helps to bring or photograph your products. Useful information includes:

• Exact product names and photos of the packaging
• Tablet strength or labeled milligrams
• How many tablets, shots, or servings per day
• The time of your last dose
• How long you have been using
• Any prior opioid exposure, and any fentanyl or other opioid use
• Alcohol, benzodiazepine, stimulant, or sedative use
• Pregnancy status
• Medical and psychiatric history, and any prior withdrawal complications
• A suicide-risk check, and review of prescription-monitoring and toxicology information when appropriate

One practical point: routine drug screens may not reliably detect all kratom alkaloids or these newer derivatives, so a normal urine test does not rule out dependence. Your history is often more informative than the screen. ^[3,14]

2. Symptom-directed withdrawal care

For milder situations, clinicians may treat specific symptoms with non-opioid medicines—for example, for nausea, diarrhea, sweating and other autonomic symptoms, anxiety, aches, and insomnia. This is done under supervision. Please do not assemble your own combination of sedating medications at home; mixing sedatives without guidance can be dangerous. ^[18]

3. Buprenorphine-based treatment

Buprenorphine/naloxone, commonly known by the brand name Suboxone, is FDA-approved for opioid use disorder. It is not specifically FDA-approved for “kratom use disorder” or “7-OH use disorder,” but because these products act on opioid receptors, clinicians may use it when a person meets criteria for opioid use disorder. ^[3]

The current evidence for buprenorphine in kratom, 7-OH, and pseudoindoxyl dependence comes mainly from published case reports, small case series, clinical reviews, and conference reports—not from large randomized trials. Several of these describe patients with severe dependence who improved on buprenorphine-based treatment. This is encouraging but preliminary, and a case report is not a universal guideline. ^{[11,12,13,15]}

A few things every patient should understand:

• There is not yet one standardized, trial-proven protocol; decisions must be individualized.
• Starting buprenorphine at the wrong time can trigger or worsen withdrawal (“precipitated withdrawal”).
• For that reason, patients should not attempt a self-directed induction based only on instructions found online.
• Depending on the product, the timing of last use, withdrawal status, and any other opioid exposure, a qualified clinician may consider a standard induction or a low-dose (“micro-induction”) approach.
• The goals are relief of withdrawal and cravings, less uncontrolled use, more stability, lower overdose risk, and engagement in ongoing care.

This article intentionally does not give specific buprenorphine doses or a home induction recipe. Dosing must be decided by a clinician who knows your situation. Published protocols vary, and what is right for one person can be unsafe for another.

4. Ongoing recovery care

Medication is a start, not the whole plan. Sustained recovery usually includes:

• Follow-up visits and medication adjustment over time
• Behavioral-health treatment, and care for co-occurring anxiety, depression, trauma, pain, and insomnia
• Naloxone access and harm-reduction education
• Peer or family support and relapse-prevention planning
• A transition to longer-term maintenance, or a carefully supervised taper when that is clinically appropriate

Not everyone who uses kratom needs buprenorphine. Someone with mild use or limited physical dependence may need a very different plan than someone who meets criteria for a moderate or severe opioid use disorder. The right answer comes from an evaluation, not from a headline. ^[3]

What Did the DEA Announce in July 2026?

On July 1, 2026, the DEA announced its intent to temporarily place several kratom-derived compounds into Schedule I of the Controlled Substances Act. The related notices were published in the Federal Register on July 6, 2026. The action covers four things: (1) 7-hydroxymitragynine above a defined concentration threshold; (2) mitragynine pseudoindoxyl; (3) MGM-15; and (4) MGM-16. ^[4,5,6]

The DEA used its temporary scheduling authority (under 21 U.S.C. 811(h)), which lets the agency act quickly to address what it calls an imminent hazard to public safety. The stated aim was to target concentrated, enhanced, synthetic, and semi-synthetic high-potency products—not to categorically ban ordinary botanical kratom leaf that contains only trace natural 7-OH below the threshold. ^[4,5,9]

Is it illegal to possess these products right now? 

This is the most important—and most misunderstood—part. As of July 17, 2026, the DEA has issued Notices of Intent to temporarily schedule certain 7-OH substances, but it has not published an effective temporary scheduling order. A Notice of Intent formally announces that the DEA plans to schedule a substance; it does not, by itself, place that substance in Schedule I.

According to the Federal Register Notice of Intent for 7-OH, the temporary scheduling order cannot be issued before August 5, 2026. If the DEA publishes the order on or after that date, it will take effect on the date of publication in the Federal Register. Until an applicable temporary scheduling order is published and becomes effective, the federal Schedule I controls and penalties do not arise solely from the Notice of Intent. State laws may already prohibit or restrict these products and may be stricter than federal law. ^[5,7]

So, it is essential to distinguish among these very different things:

• A DEA press announcement — a public explanation of the agency’s intended action.
• A notice of intent (NOI) — formal notice that scheduling is planned (this is where things stand at publication).
• A temporary scheduling order — the actual legal action that places a substance in Schedule I.
• The effective date — the day the order’s controls and penalties begin.
• Any later permanent scheduling process — a separate, longer rulemaking.
• State-specific kratom laws — which already vary widely and may be stricter than federal law.

The DEA announcement on enhanced 7-OH products explains that the planned action applies to 7-OH above the specified threshold and to mitragynine pseudoindoxyl, MGM-15, and MGM-16. The HHS and FDA announcement on the temporary scheduling process also clarifies that the action is not intended to regulate natural kratom leaf that does not contain enhanced levels of 7-OH. ^[20]

Once an applicable temporary scheduling order takes effect, the manufacture, distribution, dispensing, sale, or possession of the covered substances becomes subject to the Controlled Substances Act and its criminal, civil, and administrative provisions. Until then, do not assume that the Notice of Intent alone made possession a federal crime. However, consumers should also not assume these products are lawful under every state law or safe to use. ^[5]

What exactly is the 7-OH threshold?

The DEA action was written to separate high-potency 7-OH products from low-7-OH botanical material. In patient-friendly terms, the specified threshold covers:

• Botanical material from the kratom plant (Mitragyna speciosa) that contains more than 0.050% 7-OH by dry weight; and
• Non-botanical or altered material—for example, synthetic 7-OH, or extracts, concentrates, edibles, or pressed pills processed in ways that raise 7-OH—containing more than 0.050% 7-OH (by weight or volume) or more than 1.00 milligram of 7-OH in the article.

In plain language: the concern is concentrated 7-OH, not the trace amount in ordinary leaf. The DEA framed the action to distinguish covered high-potency products from botanical material below the threshold, and it does not, on its face, categorically schedule all kratom leaf. The precise regulatory wording is in the Federal Register documents linked in the references, which should be read directly for legal certainty. ^[5,6]

This is a rapidly changing legal area. Patients should not rely on old packaging, retailer statements, social-media posts, or this article alone to determine whether a product is legal. Confirm current federal status in the Federal Register and check your state’s laws, which may differ.

I Use 7-OH or Pseudoindoxyl Every Day. What Should I Do Now?

What to do today ✓  Do not panic. A scheduling change is not an emergency you must solve tonight by quitting cold turkey. ✓  Do not stockpile products in anticipation of a ban. ✓  Do not switch to fentanyl, heroin, counterfeit pills, tianeptine, loperamide misuse, or unknown online opioids—these are far more dangerous. ✓  Do not abruptly stop on your own if severe withdrawal, pregnancy, unstable medical illness, or use of other substances could make sudden cessation unsafe. ✓  Contact an addiction medicine clinician promptly to make a plan. ✓  Bring or photograph the package, label, ingredients, lot number, tablet strength, and the website you bought from. ✓  Be honest about how much you use and when your last dose was—clinicians are not there to judge you. ✓  Ask about withdrawal management, buprenorphine treatment, naloxone, and behavioral-health support. ✓  Confirm current federal and state law using official government sources. ✓  Seek emergency care for overdose symptoms, severe dehydration, confusion, seizure, chest pain, suicidal thoughts, or any time you cannot stay safe.

How DevotedDOc Can Help

DevotedDOc provides confidential, physician-led telemedicine evaluation for people experiencing dependence on kratom, concentrated extracts, 7-OH, mitragynine pseudoindoxyl, and other opioid-like compounds, where it is legally and clinically appropriate. Care is nonjudgmental and built around you.

An evaluation can include addiction medicine assessment, an individualized treatment plan, consideration of buprenorphine/naloxone when clinically appropriate, withdrawal-support planning, naloxone education, behavioral-health referrals, and longitudinal follow-up—with multi-state telemedicine access where available. If recommended as part of your treatment plan, you can learn more about how buprenorphine works and why it is commonly used to treat opioid use disorder.

To be transparent: scheduling an appointment does not guarantee a particular medication, and buprenorphine is not right for everyone. We also cannot promise same-day prescribing in every case. What we can promise is a careful, respectful evaluation and a plan that fits your situation.

A Compassionate Word Before You Go

If you are using one of these products, you are not weak, and you are not alone. These compounds were engineered—sometimes literally—to be potent and habit-forming, and they were sold to you as something harmless. Recognizing the problem is the hardest step, and you may have already taken it just by reading this far.

Please reach out for physician-led help before withdrawal, a change in the law, or an ever-more-potent next product pushes you toward something more dangerous. The safest path off these substances runs through a clinician who can treat withdrawal, protect against overdose, and walk with you into recovery. If you’re ready to take the next step, start treatment with DevotedDOc today.

With respect and hope—

— The DevotedDOc

Founder | Emergency Physician | Advocate for Patients and Clinician-Led Virtual Care

Frequently Asked Questions

References

Regulatory status was current as of July 16, 2026. Because DEA temporary scheduling is time-sensitive, verify whether a temporary order has taken effect before relying on the legal statements above. Case reports and conference abstracts are lower-level (preliminary) evidence, not treatment guidelines.

1. FDA. Products Containing 7-OH Can Cause Serious Harm (Consumer Update). https://www.fda.gov/consumers/consumer-updates/products-containing-7-oh-can-cause-serious-harm

2. FDA. Hiding in Plain Sight: 7-OH Products (Public Health Focus). https://www.fda.gov/news-events/public-health-focus/hiding-plain-sight-7-oh-products

3. FDA. 7-Hydroxymitragynine (7-OH): An Assessment of the Scientific Data and Toxicological Concerns Around an Emerging Opioid Threat (PDF). https://www.fda.gov/files/drugs/published/7-hydroxymitragynin_7-oh_an_assessment_of_the_scientific_data_and_toxicological_concerns_around_an_emerging_opioid_threat.pdf

4. DEA. DEA to Temporarily Schedule 7-OH and Related Substances to Protect Public Safety (Press Release, July 1, 2026). https://www.dea.gov/press-releases/2026/07/01/dea-temporarily-schedule-7-oh-and-related-substances-protect-public

5. Federal Register. Schedules of Controlled Substance: Temporary Placement of 7-Hydroxymitragynine Above a Specified Threshold in Schedule I (Notice of Intent; Doc. 2026-13580, July 6, 2026). https://www.federalregister.gov/documents/2026/07/06/2026-13580/schedules-of-controlled-substance-temporary-placement-of-7-hydroxymitragynine-above-a-specified

6. Federal Register. Temporary Placement of 7-Hydroxymitragynine Above a Specified Threshold in Schedule I; Request for Information (HHS/OASH; Doc. 2026-13608, July 6, 2026; comments due July 31, 2026). https://www.federalregister.gov/documents/2026/07/06/2026-13608/temporary-placement-of-7-hydroxymitragynine-above-a-specified-threshold-in-schedule-i-request-for

7. Federal Register. Schedules of Controlled Substances: Temporary Placement of Mitragynine Pseudoindoxyl, MGM-15, and MGM-16 in Schedule I (Notice of Intent; Doc. 2026-13581, July 6, 2026). https://www.federalregister.gov/documents/2026/07/06/2026-13581/schedules-of-controlled-substances-temporary-placement-of-mitragynine-pseudoindoxyl-mgm-15-and

8. DEA. Kratom (Drug Fact Sheet). https://www.dea.gov/factsheets/kratom

9. ASAM Practice Pearls. Kratom and 7-OH: What Clinicians Need to Know. https://elearning.asam.org/products/asam-practice-pearls-kratom-and-7-oh-what-clinicians-need-to-know

10. De facto opioids: Characterization of novel 7-hydroxymitragynine and mitragynine pseudoindoxyl products (peer-reviewed study). https://www.sciencedirect.com/science/article/pii/S0376871625001541

11. 7-Hydroxymitragynine: Clinical Implications of a Potent Kratom Alkaloid (clinical review). https://link.springer.com/article/10.1007/s40429-026-00755-x

12. A Case of 7-Hydroxymitragynine Use Disorder Treated With Buprenorphine (case report). https://www.researchgate.net/publication/403111438_A_Case_of_7-Hydroxymitragynine_Use_Disorder_Treated_With_Buprenorphine

13. Mitragynine Pseudoindoxyl Withdrawal Treated with Macro-Dosed Buprenorphine Induction: A Case Report and Review (preliminary; MDPI). https://www.mdpi.com/2813-1851/5/1/7

14. ASAM. Kratom and 7-OH (Practice Pearls podcast page). https://asampracticepearls.podbean.com/e/kratom%E2%80%AFand-7-oh-what-clinicians-need-to-know/

15. ASAM 2026 Annual Conference. Low-dose buprenorphine initiation for severe 7-OH-related opioid use disorder (poster/case report; preliminary evidence). https://annualconference.asam.org/fsPopup.asp?PosterID=776788&mode=posterInfo

16. Severe Early-Onset Withdrawal Following Intentional Use of Mitragynine Pseudoindoxyl: A Case Report (PMC). https://pmc.ncbi.nlm.nih.gov/articles/PMC13075513/

17. Management of acute withdrawal from 7-hydroxymitragynine after abrupt cessation (case report; PubMed). https://pubmed.ncbi.nlm.nih.gov/41690384/

18. Management of acute withdrawal from 7-hydroxymitragynine after high-dose chronic use: A case report (ScienceDirect). https://www.sciencedirect.com/science/article/pii/S1544319126000324

19. Historical pharmacology of mitragynine oxidative derivatives at opioid receptors (context for potency claims; see review in ref. 11). https://link.springer.com/article/10.1007/s40429-026-00755-x

20. HHS. HHS, FDA Commend DEA Action Against Dangerous Enhanced 7-OH Products. July 1, 2026. https://www.hhs.gov/press-room/hhs-fda-support-dea-7-oh-scheduling.html